AC-2024-LON-001145 - [2025] EWHC 2075 (Admin)

Turning to the facts, the first appellant has been registered with the GMC since May 2002. She joined the Practice as a GP Trainee in August 2005, becoming a GP partner in 2008. She is of Ghanaian heritage.

The second appellant has been registered with the GMC since February 1995. He too was a partner in the Practice. He is of Bangladeshi heritage.

The Practice was founded in 2004. On 1 April 2013, it was registered with the Care Quality Commission (“CQC”) to undertake regulated activities under the Health and Social Care Act 2008. Dr Strommer was the Registered Manager of the Practice. In December 2015, it was made a condition of the CQC registration that the membership of the Practice should comprise Dr Agoe, Dr Ali, Dr Strommer and a fourth GP.

In 2016 and 2017, the Practice faced disruption owing to the migration of patient data to a new IT system. In July and August 2017, the CQC carried out an inspection. The resulting report, in October 2017, rated the Practice as “inadequate” overall with specific concerns raised about patient safety and a number of other matters. As a consequence, the Practice was placed under special measures with effect from 19 October 2017.

On 18 April 2018, NHSE served a remedial notice on all four partners, alleging breach of their obligations under their General Medical Services Contract (“GMS Contract”) with the NHS. In taking this action, NHSE relied on the CQC report.

Following further inspections, the CQC on 8 May 2018 suspended the Practice’s registration. The four partners were prohibited from providing regulated activities. NHSE appointed the Forest Road Group Practice to act as a so-called “caretaker.” The Forest Road Group Practice took over the provision of GP services at the Medical Centre. The appellants, Dr Strommer and the fourth partner were permitted to work there on a locum basis. By the end of July 2018, both Dr Strommer and the fourth partner had resigned from the partnership.

A further CQC report dated 13 August 2018 again rated the Practice as “inadequate” overall. As regards specific concerns, the report noted (among other things) that:

On 19 October 2018, the CQC extended the suspension of the partnership to March 2019. Meanwhile, Forest Road Group Practice had informed NHSE that it did not wish to act as a caretaker beyond 31 October 2018. As a result, NHSE appointed Federated4Health as a new caretaker to start work at the Medical Centre on 1 November 2018. The list of patients for that day shows that (among other GPs) both the appellants and Dr Strommer were due to work there. The appellants held consultations with patients. The evidence before me does not show whether Dr Strommer did so. I shall assume (without finding) that he worked in the Medical Centre on 1 November 2018 in accordance with the patient list.

It has at all material times been the GMC’s case that Federated4Health staff were initially not permitted to enter the building, to the extent that they were left outside in the rain. They were then permitted to enter but were confined to one part of the building. As a result, the handover from one caretaker to another could not take place. It is the GMC case that, from 1 to 6 November 2018, the Federated4Health staff and officials from NHSE waited for the handover to take place.

On 5 November 2018, the appellants issued a claim in the High Court seeking a declaration as to whether a dissolved partnership survives for the purposes of the CQC registration regime. An urgent application for an interim injunction to restrain the CQC from taking action pending the determination of the claim was refused. I have taken this information from one of the first appellant’s witness statements as I have not been provided with documents relating to the claim or the injunction.

On 6 November 2018, the CQC applied to the Magistrates’ Court for an order cancelling the Practice’s registration on the basis that the appellants were in breach of the terms of their CQC suspension by providing regulated activities from 1 November to 6 November 2018. The Magistrates made the order, such that the Practice’s registration was cancelled (“the cancellation order”).

The Practice appealed to the FTT against the cancellation order. The appeal was heard over three days in January 2019. The Practice was represented by Dr Ogunsanya, a solicitor advocate in the same firm as Mr Ojo. Dr Ogunsanya confirmed to the FTT that he was instructed by the appellants and not by the other partners in the Practice. The first appellant filed a witness statement and gave oral evidence. The second appellant provided a witness statement that adopted the first appellant’s statement. He declined to give oral evidence.

In a careful and detailed judgment, promulgated on 4 February 2019, the FTT (Tribunal Judge Siobhan Goodrich, Specialist Member Caroline Joffe and Specialist Member Wendy Stafford) dismissed the appeal: Staunton Group Practice v Care Quality Commission [2019] UKFTT 0070 (HESC). In doing so, the FTT made the following findings (among others):

The FTT went on to conclude:

“65.

In our view the findings of the inspection in May 2018 were very serious: the practice was inadequate in all domains. The range of inadequacies covered basic areas in the safe delivery of clinical care where timely and efficient care is needed to protect the life, health and well-being of patients ….

…

67.

… We find that the reality is that Dr Agoe and Dr Ali should either have closed the practice on 1 November or allowed the new caretaker in to take on the role of clinical governance moving forward. The effect of the decision made by Drs Agoe and Ali was to ignore the suspension, and not to allow the new caretaker practice to provide the clinical governance that was so very obviously required in the interests of patient safety. In our view it is obvious that the threshold test that 'there will be a serious risk to a person's life, health or well-being' was met.

…

81.

We have balanced the impact of the decision upon the Appellants’ interests as against the public interest. We consider that the facets of the public interest engaged far outweigh the interests of Dr Agoe and Ali and any other person affected. In our view the decision to cancel registration was (and remains) reasonable, necessary and proportionate.”

In reaching these strong conclusions against the appellants, the FTT criticised the first appellant’s evidence as follows:

“52.

We noted that Dr Agoe said in her oral evidence that she was unaware that there was to be a handover to Federation4Health [sic] until 1 November. This assertion only emerged in the course of cross examination. In our view this is inconsistent with her witness statement which makes clear that she knew that the [Forest Road Group Practice] contract was coming to an end and the intention of… NHSE was that Federation4Health (the Haringey Federation) would take over as caretaker…

59.

Dr Agoe told us that she was not even aware that an application to cancel registration was to be made to the Magistrates’ Court on 6 November. This is odd given that she was aware that an application was made on her behalf in the High Court to seek an injunction against the CQC restraining any enforcement action. It appears from the Statement of Case provided to the Magistrate that notice had been given. Further, Mr Ojo appeared on her behalf at the hearing at the Magistrates Court (where he also cross-examined [a witness]). If what Dr Agoe is saying is reliable he did so without her knowledge or instructions. This seems very improbable.

…

61.

We are… unable to accept that most aspects of the factual account that Dr Agoe gave in her oral evidence are reliable. In so far as there is any conflict in the facts, we prefer the evidence of Dr Jowett and Mr Smart.”

The FTT commented on the first appellant’s conduct as follow (at para 55):

“It is surprising that a professional person would act in this manner. It suggests a very poor understanding of the importance of compliance with regulation. Dr Agoe's explanation to Mr Smart on 6 November 2018 was that she believed that she was able to continue to work because she was covered by the [Forest Road Group Practice] caretaker arrangements. Her case is that she understood this had been confirmed by Dr Ogunsanya over the telephone. We do not, however, accept that Dr Jowett told Dr Ogunsanya that Dr Agoe was able to continue to work under the Forest Group caretaker arrangement. That contract had ended and had ended at the wish of the [Forest Road Group Practice].”