Dr Abhishek Singh v General Dental Council

Mr Justice MacDonald: INTRODUCTION

1. This is an appeal pursuant to s.29(3) Dentists Act 1984 (hereafter ‘ the 1984 Act ’) by Dr Abhishek Singh (hereafter ‘Dr Singh’ or the ‘appellant’), a dentist registered under s.15(1) of the 1984 Act . Dr. Singh appeals against the decision of the Professional Conduct Committee (hereafter the ‘PCC’) of the General Dental Council (hereafter the ‘GDC’) to order his immediate suspension and impose the sanction of erasure, such that he is no longer able to practice dentistry in the United Kingdom. Dr Singh is represented by Mr Simon Butler of counsel. The GDC is represented by Mr Sam Thomas of counsel, who appeared before the PCC.

2. The allegations faced by Dr Singh concerned the care provided to Patient A, between 4 April 2019 and 8 January 2021, and his lack of co-operation with the GDC during their investigation into the complaint raised by Patient A, between 5 November 2021 and 25 October 2023. Dr. Singh attended a remote hearing before the PCC listed between 25 and 29 November 2024 where he represented himself. He has not attended this hearing.

3. In summary, the PCC found that Dr Singh’s fitness to practice was impaired by reason of misconduct in that he failed to provide Patient A with an adequate standard of care, failed to adequately assess the risks to Patient A’s safety, treating Patient A without adequate support, did not obtain proper consent from Patient A before extracting a wisdom tooth, failed to co-operate with the investigation of the GDC, failed to maintain with the GDC an up to date address and acted in a misleading and dishonest manner with regard to the GDC’s investigation in between 2021 and 2023.

4. Dr Singh relies on the following grounds of appeal, two of which relate to the findings of fact made by the PCC and two of which relate to the sanction imposed by the PCC: i) Ground 1: The PCC were wrong to conclude that Dr. Singh had been dishonest in sending an email to the GDC stating that he had worked at a practice called Orasculpt (hereafter the ‘practice’) part-time between 2013 and 2017 and that the practice had an NHS inspection but closed due to the COVID pandemic. ii) Ground 2: The PCC were wrong to conclude that the content of a voicemail message sent to the GDC on 25 October 2023 was misleading. iii) Ground 3: The PCC were wrong to conclude that a period of suspended registration would not be sufficient to protect the public or the wider public interest. iv) Ground 4: The PCC were wrong to conclude that the only appropriate and proportionate sanction to impose is that of erasure.

5. Pursuant to CPR 52.21(3), the court will allow the appeal if the decision was wrong or unjust because of a serious procedural or other irregularity in the proceedings below. In determining the appeal, I have had the benefit of Skeleton Arguments from each counsel, an appeal bundle, a supplementary bundle and an authorities bundle. I reserved judgment and now set out my decision and reasons for it. BACKGROUND

6. Dr Singh first registered with the GDC in 2006, after passing his MFDS with the Royal College of Surgeons in Glasgow in 2005. Dr Singh practiced predominantly as a dentist at various clinics in Scotland, both privately and with the NHS. Within that context, he owned a practice based in Glasgow named ‘Orasculpt’ between 2013 and 2017. During his closing submissions to the PCC, Dr Singh asserted that the GDC was aware he was the owner of the practice from an exchange of correspondence that took place in 2014, although Dr Singh was not able to produce that correspondence to the PCC. Orasculpt closed in December 2017, although the subsequent treatment by Dr Singh of Patient A took place at the Orasculpt premises.

7. Prior to these proceedings, Dr Singh has twice before come to the attention of the regulator. In 2014, Dr Singh was the subject of an unpublished warning following allegations being received concerning the standard of care provided by him, his record keeping and his probity. In March 2019, Dr Singh appeared before the PCC in relation to concerns regarding his treatment of a previous patient. The charges at that time centred on the standard of care provided to that patient, Dr Singh’s record-keeping and his failure to record the complaint made by that patient. Those charges were found proved. In addition, the PCC found that Dr Singh had acted in a misleading and dishonest manner lacking in integrity. That finding was grounded in the appellant having presented notes that were not contemporaneous without indicating that they were not contemporaneous. The PCC concluded that the appellant’s fitness to practice was impaired by reason of misconduct and he was made the subject of a conditional registration for a period of 2 years. In March 2021, the appellant’s conditional registration was reviewed and it was determined that his fitness to practice was no longer impaired. In consequence, the conditions on his registration were revoked.

8. As I have noted, the charges before the PCC with which this appeal is concerned involved dental treatment given by the appellant to a family friend, Patient A, between 4 April 2019 and 8 January 2021 (and therefore within the period during which the appellant was subject to conditional registration). Much of the background to the charges brought before the PCC is not disputed by Dr Singh. The relevant facts that are not the subject of dispute can be summarised as follows.

9. Patient A was referred to Dr. Singh as a ‘family friend’ with social connections to Dr Singh’s family. Within this context, over the course of the treatment that followed, Dr. Singh made little financial gain when providing Patient A with dental services (charging £250 for two root canal treatments and £25 for an extraction). This was considered by the PCC to be a mitigating factor.

10. Patient A sent a message to Dr Singh on 3 April 2019 stating that her filling had come out and was causing a sensation. Patient A initially attended for treatment on 4 April 2019 at the Orasculpt premises. As I have noted, the Orasculpt practice was closed in December 2017 and no staff were present at the time Patient A was being treated. On that occasion, the appellant replaced a filling that had come loose on Patient A’s lower left back molar (LL8). Throughout April 2019, Patient A continued to experience pain and reported this to Dr. Singh. On 29 April 2019, Patient A was given a further filling. Dr Singh provided further treatment to Patient A on 30 April 2019 in the form of root canal therapy to the same tooth. Following the treatment provided by Dr Singh on 30 April 2019, Patient A developed increased pain, which she reported to him and stated that she may have suffered a nerve injury. Thereafter, Patient A continued to experience pain, which she again reported to Dr Singh.

11. Patient A had a series of further appointments with Dr Singh in May 2019. On 1 May 2019, Dr Singh provided root canal therapy to Patient A on the tooth adjacent to LL8, namely LL7. On 4 May 2019, Patient A attended Dr Singh for pain relief. On 6 May 2019, Dr Singh recleaned Patient A’s LL7 and applied a temporary filling. On 12 May 2019, Dr Singh administered local anaesthetic for pain relief. On 16 May 2019, Dr Singh filed down LL8 and, on 20 and 23 May 2019, filed down both Patient A’s LL7 and LL8 as part of his continued effort to relieve her pain. On 27 May 2019, Dr Singh again filed down the LL8. On 29 May 2019, Dr Singh re-cleaned the temporary root canal therapy on Patient A’s LL8 and applied a temporary filling to that tooth. At that appointment, Patient A asked Dr Singh to refer her for a neurological assessment, having previously asked him for a referral to another dental clinic or to a dental hospital. On 1 June 2019, the appellant extracted Patient A’s LL8 in a further effort to relieve the pain that Patient A continued to report to the appellant. Following removal by the appellant of her LL8, on 6 June 2019, Patient A was examined by a Maxillofacial Consultant at a local dental hospital arranged by Dr Singh and was subsequently diagnosed with trigeminal neuralgia on 7 June 2019.

12. Patient A continued to attend appointments with Dr. Singh. On 10 and 17 August 2019, Patient A attended Dr Singh due to a filling coming loose. On 8 January 2021, Patient A requested an x-ray of her tooth, which was performed by Dr Singh, who confirmed that there was no infection.

13. On 26 July 2021, a complaint was made by Patient A to the GDC regarding the treatment provided by Dr Singh between 2019 and 2021. The complaint was that Dr Singh had injured a nerve during treatment, causing Patient A pain and which led to Patient A taking early retirement. On 20 July 2021, the GDC commenced an investigation into Dr. Singh.

14. On 28 June 2022, the Interim Orders Committee imposed an interim suspension order. It is not the role of the Interim Orders Committee to make findings of fact. However, for reasons that will become apparent, certain statements made by Dr Singh at the interim hearing on 28 June 2022 are, I am satisfied, relevant to the determination of this appeal. I have had the benefit of the transcript before me of the interim hearing on 28 June 2022. The transcripts were not available to the PCC at the substantive hearing in November 2024, but no objection has been taken by the respondent to Dr Singh relying on the transcripts in this appeal and they have, as I have stated, been included in the appeal bundle.

15. The transcript of the hearing before the Interim Orders Committee on 28 June 2022 makes clear that: i) Having failed to respond to emails sent on 21 October 2021 and 8 February 2022, a telephone call on 19 May 2022 and a registered letter of the same date, requesting Dr Singh’s employment details, indemnity and patient records, at the hearing before the Interim Orders Committee, Dr Singh provided: a) Details of his then current working arrangements. b) Proof of indemnity from 2009 to the date of the hearing before the Committee on 28 June 2022. Notwithstanding this, and for reasons that are not clear, Dr Singh conceded before the PCC that between the 5 November 2021 and 25 November 2023 he had failed to provide the GDC with proof of his indemnity for the period of 4 April 2018 and 22 September 2020. c) A letter dated 11 January 2020 referring Patient A to a dental hospital for treatment. ii) Dr Singh made clear in his oral submissions to the Interim Orders Committee that he had treated Patient A and provided an account of that treatment, informing the Interim Orders Committee that: a) He had treated Patient A and treated her as an extended family member rather than “a patient only”. b) He was stressed and ashamed that he was under GDC supervision and did not want people to know that. c) At the time he agreed to treat Patient A, she was not aware that he had conditions imposed on him and that that was the reason he was working on his own when treating her. d) When he realised Patient A was having problems he endeavoured to help her during the Covid-19 pandemic by telephone, by giving her antibiotics in person and attending her property when she was in pain. e) He did not charge Patient A for the treatment he gave her. f) He wrote to a consultant at the dental hospital “explaining my limitation” and requesting that she be seen at the hospital. He included in the letter that Patient A was prescribed bisphosphonates which made extraction difficult. g) He had “profusely” apologised to Patient A. h) He had not been “as good with my care for [Patient A]” at the relevant time but it was a difficult period due to his being under restrictions between 2019 and 2021. iii) Dr Singh is recorded as giving no credible explanation for his continued failure to provide the records held for Patient A.

16. Within the foregoing context, on 28 June 2022, the Interim Orders Committee determined that an interim order was not necessary for the protection of the public in respect of Dr Singh’s indemnity and practising status. The Interim Orders Committee did, however, impose an interim order having regard to Dr Singh’s failure to engage and cooperate with the investigation. An order for interim conditional registration was made. Following a review hearing on 12 September 2024, at which Dr Singh did not attend, the Interim Order Committee replaced the interim conditional registration with an order for interim suspension.

17. On 24 May 2023, the GDC contacted Dr Singh noting that he had not provided a completed GDC Working Arrangements Form and requested that he do so. That request was repeated by email on 1 June 2023, to which Dr Singh responded on 5 June 2023, stating he was “gathering the information”, and again on 19 June 2023, asking for confirmation that the GDC had received the form he had sent. On 26 June 2023, the GDC notified Dr Singh that the posted form had not been received and requested confirmation that the form had been sent. The request was repeated on 28 June 2023.

18. The GDC Working Arrangements Form sent to Dr Singh is headed with the words “Working Arrangements and Indemnity Insurance – please complete this form and return it to us.” The form asks five questions as follows: i) Please provide all the practice name(s), address(es) and dates of where you were working from [date] (the person responding is required to provide in tabular form their principal or employer name including GDC number, principal direct / secure email address, dental practice name and address, dates and employment status). ii) Please provide all the practice name(s), address(es) and dates where you currently work (again, the person responding is required to provide in tabular form their principal or employer name including GDC number, principal direct / secure email address, dental practice name and address, dates and employment status). iii) If you have an NHS / Health Board contract or provide NHS treatment, or have previously done so, please provide details below: (the person responding is required to provide in tabular form their NHS regional team, dental practice, dates and NHS Performers List number / contract number). iv) Are you currently indemnified? (the person responding is required to provide a copy of their indemnity certificate if currently indemnified provide reasons why they are not indemnified). v) Previous indemnity arrangements (the person responding is required to provide indemnity certificates covering a defined period, any indemnity certificates providing retrospective cover and, if not indemnified, the reasons for that). On the GDC Working Arrangements Form there is no question regarding, or space for dealing with, the nature and details of the complaint in response to which the form is sent to the person who is the subject of the complaint.

19. On 30 June 2023, and after the interim hearing on 28 June 2022 at which he had made the admissions set out above, Dr Singh emailed the GDC to state that he worked at the practice part-time between 2013-2017 and that the practice had an NHS inspection but closed down to the Covid pandemic. The complete terms of Dr Singh’s email of 30 June 2023 set out the information requested in the Working Arrangements Form as follows: “ Abhishek Singh GDC: 105433 2014 – current places of work Manor Crescent Dental Care, Tullibody August 2012 – August 2014 Ayr Dental Spa, Ayr August 2014 – 2017 (Part time) Genix Healthcare, Edinburgh August 2014 – 2017 (Part time) La Belle court dental practice, Edinburgh 2015 – 2019 (Part time) Q court dental practice, Edinburgh 2015 – 2019 (Part time) Glasgow Emergency Dental Services (GEDS-NHS emergency shift work sessions) 2008 – 2018 Orasculpt Dental practice, Glasgow 2013 – 2017 (Part time) Practice had an NHS inspection but closed down due to Covid pandemic. Kilmarnock Smile Studio, Kilmarnock July 2019 – present National Dental Implant Centre Dorchester 2019 - present”

20. On 15 October 2024, Dr Singh sent an additional email to the GDC, providing further details as follows: “1. I was the practice owner and dentist at Orasculpt during 2013-2017. I worked part time. Practice closed in December 2017.

2. The records were paper based records and digital x rays. After practice closure, there was an interest from a medical practice group taking over the premises so the paper records were physically boxed and kept away in storage. There was a water leak/damage to all the stored boxes as well as other stored items. This occurred over several weeks and all of the contents had to be disposed and were not salvageable.

3. The takeover of premises fell through unfortunately and I attempted to get an NHS inspection done at the practice for re- opening as a new dental practice in 2018-2019.

4. The Covid pandemic completely prevented any chance of this opening of the practice as lockdown rules came into force. There was also no support for the practice financially with the NHS support for only for existing practices. Any patients who needed help / advice were redirected as best as possible. I was working in Kilmarnock, Scotland and did see some patients if they were willing to travel. During the difficult pandemic period, emergency care and advice was very constrained and remote prescribing and virtual emergency advice was in use. I felt guilty and responsible to help patients who contacted me between 2019/2021 and had hoped that the practice would be open with other dentists. Pertaining to (allegation 7b), I did not do active treatments but did meet / reassure any previous patients without divulging the difficulties of my circumstances in anticipation of my colleagues being able to see them.”

21. On 25 October 2023, Dr Singh left a voicemail message for the GDC. In that voicemail, Dr Singh stated that the practice was closed and that there was “no access to any kind of records remaining, otherwise I would have sent them months ago”.

22. Within the foregoing context, the totality of the charges levelled at Dr Singh before the PCC were that being a registered dentist: i) Between 4 April 2019 and 8 January 2021 he failed to provide Patient A with an adequate standard of care, in that at one or more appointments he treated Patient A without the support of an appropriately qualified member of the dental team, who was required to be present at all times when he was treating Patient A in a dental setting. ii) He failed adequately to assess the risks to Patient A’s safety, treating Patient A without adequate support as alleged, in that there was an increased risk of: a) Choking; b) Hypochlorite acceding during root canal treatment; c) Complications during extraction; d) Inefficient response to medical emergencies such as cardiac arrest. iii) On 7 June 2019 he extracted the lower left wisdom tooth (LL8) without obtaining informed consent in that he failed to discuss with Patient A: a) The general risks of wisdom tooth extraction; b) The heightened risk of inferior alveolar nerve damage; c) The risk of osteonecrosis of the jaw; and d) The option of referral to a specialist. iv) He failed to cooperate with an investigation conducted by the GDC in that: a) Between 5 November 2021 and 25 October 2023 he failed to provide the GDC with proof of his indemnity for the period of 4 April 2018 and 22 September 2020; b) He did not provide the GDC with patient records for his treatment of Patient A between 5 November 2021 and 11 October 2023. v) He failed to maintain with the GDC a correct and up to date registered address. vi) On 30 June 2023 he emailed the GDC to state that he worked at the practice part time between 2013 and 2017 and the practice had an NHS inspection but closed down due to the Covid pandemic. vii) His actions in doing so were: a) Misleading; b) Dishonest, as he treated Patient A between 2019 and 2021. viii) On 25 October 2023 he left a voicemail message for the GDC stating that the practice was closed and that there was “no access to any kind of records remaining, otherwise I would have sent them months ago”. ix) His actions in so doing were: a) Misleading; b) Dishonest in that he knew he was the owner of the practice and could access Patient A’s records.

23. The substantive hearing before the PCC took place between 25 and 29 November 2024. Dr Singh did not give evidence before the committee and so was not cross-examined. Instead, written submissions were provided by Dr Singh during the hearing, dated 26 and 27 November 2024, he was permitted to write questions for each of the witnesses and he made oral submissions. On behalf of the respondent, Mr Thomas submits that the PCC went out of its way to accommodate Dr Singh and treat him fairly.

24. Oral evidence was given by Patient A and the expert witness. The PCC considered documentary evidence that included the witness statements, together with exhibits, the statements of a case worker from the GDC’s Fitness to Practise Team, the statements of a paralegal from the GDC’s in house legal team, the report of an expert witness instructed by the GDC and documents in the form of photographs and email exchanges from Dr Singh. The PCC also had access to incomplete dental records for Patient A, which included those provided to the GDC by Patient A and her subsequent treating dentist. The only dental records provided by Dr Singh by the time of the PCC hearing comprised an incomplete set of digital radiographs.

25. In reaching its decision the PCC took account of the GDC’s Guidance for the Practice Committees, including Indicative Sanctions Guidance (October 2016, updated December 2020). The PCC was also provided with legal advice and reminded itself that the burden of proof was on the GDC and the standard of proof was the balance of probabilities. The PCC noted that the appellant was of good character and cautioned itself to consider each head of charge separately.

26. Within the foregoing context, the following charges were admitted by Dr Singh and found proved on the basis of his admissions: i) Between 4 April 2019 and 8 January 2021 he failed to provide Patient A with an adequate standard of care, in that at one or more appointments he treated Patient A without the support of an appropriately qualified member of the dental team, who was required to be present at all times when he was treating Patient A in a dental setting. ii) He failed adequately to assess the risks to Patient A’s safety, treating Patient A without adequate support as alleged, in that there was an increased risk of (a) choking and (b) complications during extraction. iii) On 7 June 2019 he extracted the lower left wisdom tooth (LL8) without obtaining informed consent in that he failed to discuss with Patient A (d) the option of referral to a specialist. iv) He failed to cooperate with an investigation conducted by the GDC in that (a) between 5 November 2021 and 25 October 2023 he failed to provide the GDC with proof of his indemnity for the period of 4 April 2018 and 22 September 2020; and (b) he did not provide the GDC with patient records for his treatment of Patient A between 5 November 2021 and 11 October 2023. As noted, notwithstanding that Dr Singh provided to the Interim Orders Committee proof of indemnity from 2009 to the date of the hearing before that Committee on 28 June 2022, he appears nonetheless to have accepted before the PCC that he failed to provide proof of his indemnity for the period 4 April 2018 and 22 September 2020. v) He failed to maintain with the GDC a correct and up to date registered address. vi) On 30 June 2023 he emailed the GDC to state that he worked at the practice part time between 2013 and 2017 and the practice had an NHS inspection but closed down due to the Covid pandemic. vii) His actions in sending the email of 30 June 2023 were (a) misleading.

27. In addition, the following charges were found proved by the PCC on the basis of the evidence before it: i) Dr Singh failed adequately to assess the risks to Patient A’s safety, treating Patient A without adequate support as alleged, in that there was an increased risk of (d) inefficient response to medical emergencies such as cardiac arrest. ii) On 1 June 2019 he extracted the lower left wisdom tooth (LL8) without obtaining informed consent in that he failed to discuss with Patient A (b) the heightened risk of inferior alveolar nerve damage. iii) His actions in emailing the GDC on 30 June 2023 to state that he worked at the practice part time between 2013 and 2017 and the practice had an NHS inspection but closed down due to the Covid pandemic were (b) dishonest, as he treated Patient A between 2019 and 2021. iv) His action on 25 October 2023 of leaving a voicemail message for the GDC stating that the practice was closed and that there was “no access to any kind of records remaining, otherwise I would have sent them months ago” was (a) misleading.

28. Having regard to Dr Singh’s grounds of appeal, it is necessary to examine in more detail two of the charges that were not admitted by Dr Singh but that the PCC found proved and against which he now appeals. The first is the finding that Dr Singh’s actions in emailing the GDC on 30 June 2023 to state that he worked at the practice part time between 2013 and 2017 and the practice had an NHS inspection but closed down due to the Covid pandemic were dishonest because he treated Patient A between 2019 and 2021.

29. From the transcript of the hearing before the PCC it is clear that the case put by the GDC in opening was that Dr Singh’s email of 30 June 2023 was dishonest because he stated in the email that he had worked at Orasculpt part time between 2013 and 2017, but failed to acknowledge in any way that (a) he had treated Patient A at Orasculpt in 2019 and (b) he was the owner of the Orasculpt practice, meaning he would have had access to Patient A’s records notwithstanding his statement to the contrary in his voicemail of 25 October 2023. In closing, the GDC contended that Dr Singh’s actions were dishonest because he had intentionally left out of his email of 30 June 2023 the fact that he was treating Patient A at the Orasculpt practice between 2019 and 2020 and that he was the practice owner, Mr Thomas submitting: “We say that that information has been intentionally left off. We say that it has intentionally been removed or omitted that he was treating Patient A at that practice in the period of 2019 to 2020 potentially going into 2021, but we say until 2020 certainly. It is a lie.”

30. As I have noted, the PCC did not have before it the transcript of the hearing on 28 June 2022 before the Interim Orders Committee at which Dr Singh made clear in his oral submissions to the Interim Orders Committee that he had treated Patient A and provided an account of that treatment. Dr Singh did not refer to the account given to the Interim Orders Committee in June 2022 when he was before the PCC in November 2024.

31. In its written reasons the PCC states that, in approaching this head of charge, it applied the test set out in Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67 . Namely, the PCC was required to decide, subjectively, the actual state of Dr Singh’s knowledge or belief as to the facts before applying the objective standards of ordinary and decent people to determine whether his conduct was dishonest by those standards. The PCC recounted Dr Singh’s submissions, noting in particular the explanations he had given in support of his contention that he did not intend to mislead and denied acting a dishonest manner: “You stated that you were the owner of, and worked part time as the sole practitioner at, your practice from 2013 until its closure in 2017. You stated that the practice was closed with the intention of it reopening as an NHS practice. You stated that you subsequently attempted to rearrange an NHS inspection of the practice so that it could be reopened as a new dental practice, but that the COVID-19 pandemic and its associated lockdown restrictions prevented such a re-opening. In your previous response to the allegations dated 15 October 2024 you stated that you ‘felt guilty and responsible to help patients who contacted me between 2019/2021’, and that you ‘did not do active treatments but did meet / reassure any previous patients’. In your written submissions of 27 November 2024 you stated that you saw Patient A ‘to ease her dental emergency as a genuine helping gesture but this doesn’t equate to working regularly / doing clinical sessions’.”

32. Having recalled the submission of the GDC that Dr Singh’s statement was dishonest in that he treated, and knew that he had treated, Patient A at the practice premises between 2019 and 2021, the PCC set out their finding and the reasons for it as follows: “In accordance with the legal test set out above, the Committee first considered the actual state of your knowledge or belief as to the facts when emailing the GDC on 30 June 2023. The Committee finds that your actual knowledge and belief at that time was that you knew you had treated Patient A at the practice on a number of occasions between 2019 and 2021. The Committee considers that, by stating to the GDC that you had most recently worked at the practice in 2017, you misrepresented the situation concerning your treatment of Patient A. The Committee considers that you could not have been in any doubt that you had cared for and treated Patient A at your practice on a considerable number of occasions. Having determined your actual knowledge at the relevant time, the Committee when on to determine whether your conduct was dishonest by reference to the standards of ordinary and decent people. The Committee considers that your conduct was dishonest by reference to those objective standards. The Committee considers that ordinary and decent people would consider your statement to have been deliberately misleading, and intended to obfuscate the GDC’s understanding of the circumstances of your practice, in particular in relation to Patient A. For these reasons, the Committee finds the facts alleged at head of charge 7(b) proved.”

33. The second charge requiring more detailed consideration is the finding that Dr Singh’s conduct on 25 October 2023 in leaving a voicemail message for the GDC stating that the practice was closed and that there was “no access to any kind of records remaining, otherwise I would have sent them months ago” was misleading.

34. In opening the case to the PCC, the GDC used the voicemail of 25 October 2023 as supporting evidence for its case that Dr Singh’s email of 30 June 2023 was misleading and dishonest. In circumstances where Dr Singh was the practice owner, the GDC contended in opening that the voicemail was misleading and dishonest in its claim that Dr Singh could not access the records of Patient A because the practice was closed. In closing, the GDC contended that the voicemail was misleading in that it suggested the reason Dr Singh could not access Patient A’s records was because the practice had closed. This being misleading in circumstances where Dr Singh could, as the practice owner, access the relevant records, was responsible for the care of those records and where the treatment of Patient A did not start until 2019, two years after the records were placed in storage and allegedly damaged. Within this context, in closing Mr Thomas submitted on behalf of the GDC that the most likely explanation for Dr Singh failing to produce Patient A’s records is that he did not make any.

35. In its written reasons, the Committee again referred to the test set out by the Supreme Court in Ivey v Genting Casinos (UK) Ltd t/a Crockfords and recounted the submissions of Dr Singh as follows: “In your written submissions of 26 November 2024 you denied that you acted in a dishonest manner, and that you did not intend to mislead. You stated that you were the owner of, and worked part-time as the sole practitioner at, your practice from 2013 until its closure in December 2017. You stated that patients’ clinical records consisted of both paper-based records and digital radiographs. You stated that you boxed and stored the paper-based records in a separate storage garage, and that a water leak over a number of weeks caused damage to those stored and boxed records, with the damage being so serious that the contents were not salvageable and had to be disposed of. You stated that you attempted to arrange an NHS inspection of the practice so that it could be re-opened as a new dental practice, but that the COVID-19 pandemic and its associated lockdown restrictions prevented such a reopening. In your previous response to the allegations dated 15 October 2024 you stated that you ‘felt guilty and responsible to help patients who contacted me between 2019/2021’, and that you ‘did not do active treatments but did meet / reassure any previous patients’. In your written submissions of 27 November 2024 you stated that you did not have access to patient records which were stored in the garage, and that you to ask family and friends to gain access to the garage. You also stated that in your voicemail message of 25 October 2023 you did not elaborate on the reasons for not being able to provide Patient A’s records, that you accept you should have done so, but deny that you intended to mislead. You further stated in those written submissions of 27 November 2024 that you accept that you have a duty as a practice owner, including the owner of a closed practice, to keep patient records safe, and that the damage was beyond your control. You stated that you are not able to evidence your paper records for Patient A, and that there is no reason for you lie about that matter. You stated that the digital records that you did have at the relevant time were shared with Patient A, and were later shared by her with the GDC.”

36. Having recalled the submission of the GDC that Dr Singh’s statement was misleading, and was also dishonest, in that he was, and knew he was, the owner of the practice and that he could access and provide Patient A’s records, the PCC set out its finding and the reasons for it as follows: “The Committee accepts as plausible your account that paper-based records were destroyed as a result of water damage. Although you do not say so explicitly, the Committee infers from your representations of 27 November 2024 that this destruction included Patient A’s records, as you that the water damage affected ‘all of the stored boxes’ and that ‘all of the contents had to be disposed [of] and were not salvageable’. The Committee was not entirely clear as to when the water damage happened, although it understands from the information you have provided that it occurred subsequent to the closure of the practice, in December 2017. In relation to head of charge 9(a), the Committee considers that actions in making the statement in question were misleading, in that you did not elaborate on why you could not access provide any records, for instance because of water damage that you stated rendered the paper records unsalvageable. The Committee considers that your statement deprived the GDC of a proper understanding of the true situation pertaining to Patient A's records. Accordingly, the Committee finds that your actions in making this statement were misleading. The committee therefore finds the facts alleged at head of charge 9(a) proved.”

37. The remainder of the charges were found not proved, including the charge that Dr Singh’s action on 25 October 2023 of leaving a voicemail message for the GDC stating that the practice was closed and that there was “no access to any kind of records remaining, otherwise I would have sent them months ago” was dishonest. In explaining its reasons for not finding this charge of dishonesty proved, the PCC stated as follows: “Having determined that your actions in making the statement [in the voicemail message of 25 October 2023] were misleading, the Committee then turned to the question of whether it was also dishonest. The Committee reminded itself of the legal test set out above, namely that must decide subjectively the actual state of an individual’s knowledge or belief as to the facts, and must then apply the objective standards of ordinary and decent people to determine whether your conduct was dishonest by those standards. The Committee notes that the allegation of dishonesty is predicated on the contention that you could access Patient A’s records. Therefore, before considering your actual state of knowledge and belief as to the facts, the Committee first considered whether you could indeed access Patient A’s records. The Committee finds that the GDC has not demonstrated to the required standard that there were records in existence at that time that you were capable of accessing and providing. In oral submission Mr Thomas suggested that the position of the GDC is that it is more likely than not that there were no records made of your care of Patient A. The Committee notes that in your written submissions and earlier responses you have consistently stated that patient records, which as set out above the Committee infers included Patient A’s records, had been destroyed as a result of water damage. As the Committee is not satisfied that you did have access to Patient A’s records when you left the voicemail records, the issue of dishonesty falls away. It therefore finds the facts alleged at head of charge 9(b) not proved.”

38. Within the context of the findings the PCC did find proved, and having considered Dr Singh’s fitness to practice history in the context summarised above, the PCC determined that the facts proved amounted to misconduct and that Dr Singh’s fitness to practice was impaired by reason of that misconduct. In these circumstances, and having considered the ‘Indicative Sanctions Guidance’, the mitigating factors (Dr Singh had apologised to Patient A and to the GDC, time had elapsed since the clinical aspects of this case and Dr Singh’s conduct had not brought about any, or any significant, financial gain) and the aggravating factors (Dr Singh’s actions placed Patient A at risk of harm, that findings of dishonest conduct had been made, that Dr Singh lacked insight into his conduct, that Dr Singh’s failure to co-operate with the GDC represented a ‘blatant and wilful disregard of the GDC’ and that he had been subject to previous regulatory findings, including dishonest conduct), the PCC decided that erasure was the only appropriate and proportionate sanction: “60. Your misconduct represents a serious departure from professional standards and is highly damaging to your fitness to practise. Your dishonest conduct is in the Committee’s judgement particularly serious, in that it related to your dealings with the GDC, whose statutory remit is to protect the public. You have demonstrated a persistent lack of insight into your conduct, and the consequences that it had for Patient A and the wider public. You pose an ongoing risk of significant harm to the public.

61. The Committee considers that its findings, and in particular its identification of persistent and repeated obfuscation, including dishonesty, connote a fundamental disregard and disdain for the regulatory process. This is such to suggest a deep-seated professional attitudinal problem. The Committee considers that, particularly because of the previous findings made against you, you ought to have been in no doubt whatsoever as to the importance of being honest and open, and of the importance of engaging with the GDC. The Committee considers that a direction of suspended registration would not be likely to serve any useful purpose as, in light of previous findings, especially of dishonesty, the Committee does not consider that a period of suspension will bring about the necessary rectification of your conduct and behaviour. The Committee considers that a period of suspended registration would not be sufficient to protect the public or the wider public interest.

62. The Committee has therefore determined that the only appropriate and proportionate sanction to impose in the particular circumstances of this case is that of erasure. The Committee hereby directs that your name be erased from the register.” SUBMISSIONS Ground 1

39. Dr Singh contends that the PCC was wrong to conclude that he had been dishonest in sending an email to the GDC stating that he worked at Orasculpt Dental Practice in Glasgow between 2013-2017 part time and that the practice had an NHS inspection but closed down due to Covid pandemic.

40. On Dr Singh’s behalf, Mr Butler reminds the court of the wording of the relevant charges, namely: “6. On 30 June 2023, you emailed the GDC to state that you worked at the Practice part-time between 2013 – 2017 and that the Practice had an NHS inspection but closed down to the Covid pandemic.

7. Your actions at charge 6 were: a. Misleading b. Dishonest, as you treated Patient A between 2019 to 2021.”

41. Within this context, Mr Butler submits that the statements made by Dr Singh in the email were factually correct in that (a) Dr Singh had worked at the practice as a part time dental practitioner from 2013 until its closure in 2017; (b) he had intended to reopen the practice following an NHS inspection but this did not happen; and (c) the practice remained closed after December 2017 due to the Covid-19 pandemic and there was no prospect of the practice re-opening under any circumstances.

42. Mr Butler further points to the fact that the GDC contended before the PCC that Dr Singh’s email of 30 June 2023 was dishonest because Dr Singh had intentionally left out of the email the fact that he was treating Patient A at the Orasculpt practice between 2019 and 2020 and that he was the practice owner. In this context, Mr Butler submits that, in applying the objective standards of ordinary and decent people to determine whether the email of 30 June 2023 was dishonest by those standards, it was necessary for the PCC to look at the Work Arrangements Form sent to Dr Singh by the GDC that resulted in his email, in order to ascertain the nature of the information he was asked to provide by way of his response, and to satisfy itself of the information the appellant had already provided prior to the that request.

43. In this context, Mr Butler points to the fact that Dr Singh had already conceded to the GDC’s Interim Order’s panel on 28 June 2022 that he had treated Patient A at the Orasculpt practice between 2019 and 2020. Mr Butler further relies on the fact that the GDC Working Arrangements Form that elicited the response set out in the email of 30 June 2023 did not ask for details of patients treated. In these circumstances, Mr Butler submits that whilst Dr Singh concedes the email was misleading, where Dr Singh had already made clear to the GDC at an earlier hearing that he had treated Patient A, and where Dr Singh was not asked in the Work Arrangements Form to provide details of who he had treated, not mentioning in the email his treatment of Patient A cannot be equated with dishonesty on the part of Dr Singh. As such, Mr Butler submits the PCC was wrong to reach a conclusion of dishonesty with respect to email of 30 June 2023.

44. In response, Mr Thomas submits that, in addition to the matters admitted and found proved, the PCC was entitled to conclude on the evidence that appellant’s actions in stating that he worked at the practice part time between 2013 and 2017 and the practice had an NHS inspection but closed down due to the Covid pandemic were dishonest as well as misleading, and gave reasoning for that decision.

45. Mr Thomas submits that the evidence of the dishonesty on the part of Dr Singh was clear to the PCC and he had intentionally sought to obfuscate the position in relation to his treatment of the Patient A, particularly having regard to the contents of the further email from Dr Singh dated 15 October 2024. Further, Mr Thomas submits that the fact that the PCC were not satisfied that Dr Singh’s voicemail message on 25 October 2023 was not dishonest as well as misleading does not undermine the conclusion of dishonesty overall. During his oral submissions, Mr Thomas further submitted that even had the PCC had before it the transcript of the hearing before the Interim Orders Committee, that transcript would not have made a difference to the finding adopted by the PCC having regard to the plain terms of the email of 30 June 2023 and its omitting any mention of the treatment of Patient A. Ground 2

46. Dr Singh submits through Mr Butler that the PCC were wrong to find that he had engaged in misleading conduct by leaving a voicemail message for the GDC on 25 October 2023 stating that the practice was closed and that there was “no access to any kind of records remaining, otherwise I would have sent them months ago”.

47. Once again, on behalf of Dr Singh, Mr Butler reminds the court of the wording of the relevant charge: “8. On 25 October 2023 he left a voicemail message for the GDC stating that the Practice was closed and that there was “no access to any kind of records remaining, otherwise I would have sent them months ago”.

9. Your actions in so doing were: 9.(a) Misleading”

48. On behalf of Dr Singh, Mr Butler submits that the conclusion of the PCC that the voicemail message left for the GDC on 25 October 2023 stating that “the practice was closed and that there was no access to any kind of records remaining” was misleading was fundamentally contradicted by the finding made by the PCC, immediately thereafter and when considering whether the voicemail was also dishonest, that Dr Singh did not have access to Patient A’s records when he left the voicemail. As such, Mr Butler submits that the PCC found in respect of the records that underpinned both the charge of misleading and the charge of dishonesty that those records were not accessible by Dr Singh, fatally undermining, as a matter of logic, the PCC’s finding that appellant misled the GDC by stating there was no access to any kind of records remaining.

49. Mr Butler further submits that the finding made by the PCC that Dr Singh engaged in conduct that was misleading did not reflect the terms of the relevant head of charge laid against Dr Singh. With respect to the voicemail of 25 October 2023, the PCC concluded it was misleading in that Dr Singh “did not elaborate on why you could not access provide any records” (emphasis added). However, the head of charge was not that Dr Singh had mislead the GDC by failing sufficiently to explain why he could not access the records but rather because he stated in terms in the voicemail he could not access the records.

50. By way of response, Mr Thomas submits that the PCC did not conclude that Dr Singh’s contention that he did not have access to the records was true, but rather that the GDC had failed to prove the records were in existence at the time Dr Singh left the voicemail on 25 October 2024. Within this context, Mr Thomas submits that the statement in Dr Singh’s voicemail that “no access to any kind of records remaining, otherwise I would have sent them months ago” was misleading as it did not provide sufficient information relating to Dr Singh and his practice. Accordingly, Mr Thomas submits that it was open to the PCC to find that the statement was misleading in circumstances where the PCC was satisfied that Dr Singh did not explain adequately why he could not access those records. Grounds 3 and 4

51. In light of my conclusions in respect of Grounds 1 and 2 and the consequential need to remit the matter for reconsideration of sanction, as set out below, it is not necessary to summarise the submissions made by the Dr Singh and the GDC with respect to Grounds 3 and 4 concerning the sanction of erasure imposed by the PCC. RELEVANT LAW

52. With respect to the relevant law, s.1 of the Dentists Act 1984 provides as follows with respect to the duties of the GDC: “ 1 Constitution and general duties of the Council (1) There shall continue to be a body corporate known as the General Dental Council (in this Act referred to as “the Council”) (1ZA) The over-arching objective of the Council in exercising their functions under this Act is the protection of the public. (1ZB) The pursuit by the Council of their over-arching objective involves the pursuit of the following objectives— (a) to protect, promote and maintain the health, safety and well-being of the public; (b) to promote and maintain public confidence in the professions regulated under this Act ; and (c) to promote and maintain proper professional standards and conduct for members of those professions. (1A) When exercising their functions under this Act , the Council shall have proper regard for— (a) the interests of persons using or needing the services of registered dentists or registered dental care professionals in the United Kingdom; and (b) any differing interests of different categories of registered dentists or registered dental care professionals.”

53. Section 27 of the 1984 Act deals with allegations regarding impairment of a registered dentist’s fitness to practice as follows: “ 7 Allegations (1) This section applies where an allegation is made to the Council against a registered dentist that his fitness to practise as a dentist is impaired. (2) A person’s fitness to practise as a dentist shall be regarded as “impaired” for the purposes of this Act by reason only of— (a) misconduct; (b) deficient professional performance; (c) adverse physical or mental health; (d) a conviction or caution in the United Kingdom for a criminal offence, or a conviction elsewhere for an offence which, if committed in England and Wales, would constitute a criminal offence; (e) the person having— (i) accepted a conditional offer under section 302 of the Criminal Procedure (Scotland) Act 1995 (fixed penalty: conditional offer by procurator fiscal), or (ii) agreed to pay a penalty under section 115 A of the Social Security Administration Act 1992 (penalty as alternative to prosecution); (f) the person, in proceedings in Scotland for an offence, having been the subject of an order under section 246(2) or (3) of the Criminal Procedure (Scotland) Act 1995 discharging him absolutely; or (g) a determination by a body in the United Kingdom responsible under any enactment for the regulation of a health or social care profession to the effect that the person’s fitness to practise as a member of that profession is impaired, or a determination by a regulatory body elsewhere to the same effect. (3) It does not matter whether the allegation is based on a matter alleged to have occurred— (a) outside the United Kingdom; or (b) at a time when the person was not registered in the register.”

54. Where, pursuant to s.27(5) of the 1984 Act , the Registrar refers an allegation to the Investigating Committee, and the Interim Orders Committee if appropriate, and the Investigating Committee determines following investigation that, pursuant to s.27 A(1), the matter ought to be considered by a Practice Committee, then pursuant to s.27 B(1) the PCC must investigate the allegations referred to it by the Investigating Committee and determined whether the person’s fitness to practice as a dentist is impaired. Pursuant to s.27 B(6) of the 1984 Act , if the PCC determines that a person’s fitness to practice as a dentist is impaired, they may, if they consider it appropriate, direct: i) That the person’s name shall be erased from the register; ii) That his registration in the register shall be suspended during such period not exceeding twelve months as may be specified in the direction; iii) That his registration in the register shall be conditional on his compliance, during such period not exceeding three years as may be specified in the direction, with such conditions specified in the direction as the Practice Committee think fit to impose for the protection of the public or in his interests; or iv) That he shall be reprimanded in connection with any conduct or action of his which was the subject of the allegation.

55. Erasure is a particularly severe sanction. In the GDC’s Practice Guidance at paragraph 6.30 onwards states as follows with respect to the sanction of Erasure: “6.30 The ability to erase exists because certain behaviours are so damaging to a registrant’s fitness to practise and to public confidence in the dental profession that removal of their professional status is the only appropriate outcome. Erasure is the most severe sanction that can be applied by the PCC and should be used only where there is no other means of protecting the public and/or maintaining confidence in the profession. Erasure from the register is not intended to last for a particular or specified term of time. However, a registrant may apply for restoration only after the expiry of five years from the date of erasure. …/ 6.32 The PCC is obliged to consider sanctions in increasing order of severity. Therefore, before considering erasure the PCC must have considered all the preceding sanctions before determining that the decision to erase the Registrant is proportionate. …/ 6.34 Erasure will be appropriate when the behaviour is fundamentally incompatible with being a dental professional: any of the following factors, or a combination of them, may point to such a conclusion: • serious departure(s) from the relevant professional standards; • where serious harm to patients or other persons has occurred, either deliberately or through incompetence; • where a continuing risk of serious harm to patients or other persons is identified; • the abuse of a position of trust or violation of the rights of patients, particularly if involving vulnerable persons; • convictions or findings of a sexual nature, including involvement in any form of child pornography; • serious dishonesty, particularly where persistent or covered up; • a persistent lack of insight into the seriousness of actions or their consequences.”

56. The approach to dishonesty set out in Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67 , [2018] AC 391 applies in regulatory proceedings (see Photay v General Dental Council [2023] EWHC 661 (Admin) at [44]. In Ivey v Genting Casinos at [74], Lord Hughes explained the legal test for dishonesty as follows: “[74]...Where dishonesty is in question the fact-finding tribunal must first ascertain (subjectively) the actual state of the individual's knowledge or belief as to the facts. The reasonableness or otherwise of his belief is a matter of evidence (often in practice determinative) going to whether he held the belief, but it is not an additional requirement that his belief must be reasonable; the question is whether it is genuinely held. When once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact-finder by applying the (objective) standards of ordinary decent people. There is no requirement that the defendant must appreciate that what he has done is, by those standards, dishonest.” In the circumstances, the state of mind of the registered dentist is a critical issue for the PCC to resolve in determining whether the conduct in question meets the threshold of dishonesty (see GDC v Williams [2023] EWCA Civ 481 ).

57. Pursuant to s.29(1) of the 1984 Act , there is a right to appeal the decision of the PCC. Section 29(1) (b) of the 1984 Act allows for an appeal against a decision by the committee to erase a person from the register. Within this context, pursuant to s.29 (1B) of the 1984 Act , a person may, before the end of the period of 28 days beginning with the date on which notification of the decision of the Professional Conduct Committee was served, appeal against the decision to the relevant court. There is no permission stage. The appeal is by way of a rehearing (see Professional Standards Authority for Health and Social Care v General Dental Council [2024] EWHC 2610 (Admin) at [19], CPR 52.21(1)(a) and PD 52D paragraph 19). However, in Manoria Balachandra v General Dental Council [2024] EWHC 18 (Admin) Ritchie J stated at [8] that the word “rehearing” is misleading and that: “...the appellate Court does not re-hear or re-see any live witnesses. Instead, what the appellate Court does do is re-analyse the transcript of the evidence and the bundles of evidence put before the PCC. So, it is actually an appeal by way of a reanalysis, not a full rehearing.”

58. In undertaking this exercise, the Court considers whether the PCC findings or decision regarding the sanction is wrong or unjust due to serious procedural or other irregularity. In dealing with an appeal pursuant to s.29(3) of the 1984 Act the Court will give appropriate weight to the fact that the Panel is a specialist tribunal, whose understanding of what the medical profession expects of its members in matters of medical practice deserves respect ( Wasu v GDC [2013] EWHC 3782 (Admin) at [17]).

59. In this case, Grounds 1 and 2 seek to appeal findings of fact made against Dr Singh by the PCC. The proper approach to an appeal pursuant to s.29(3) of the 1984 Act with respect to matters of fact can be summarised as follows: i) The Court will have regard to the fact that the tribunal has had the advantage of hearing the evidence from live witnesses and the Court should accordingly be slow to interfere with decisions on matters of fact taken by the first instance body. However, the degree of deference to be accorded to the findings of the first instance body will depend upon the circumstances ( Sastry v General Medical Council [2021] EWCA Civ 623 , [2021] 1 WLR 5029 ) and on the nature of the issue below, namely primary fact, secondary fact or evaluative judgment ( Byrne v General Medical Council [2021] EWHC 2237 (Admin) ). ii) Findings of primary fact of the first instance body (as opposed to findings of secondary fact or evaluative judgment), particularly if founded upon an assessment of the credibility of witnesses, have been described as being unassailable, and must be shown with reasonable certainty to be wrong if they are to be departed from ( Wasu v GDC at [17]). In addition to the formulation adopted in Wasu v GDC , as noted by Morris J in Byrne v General Medical Council , the circumstances in which the appeal court will interfere in primary findings of fact have been formulated in a number of different ways, including where “any advantage enjoyed by the trial judge by reason of having seen and heard the witnesses could not be sufficient to explain or justify the trial judge's conclusion” ( Thomas v Thomas [1947] AC 484 as approved in Gupta v General Medical Council [2001] UKPC 61 , [2002] 1 WLR 1691 ), findings “sufficiently out of tune with the evidence to indicate with reasonable certainty that the evidence had been misread” ( Libman v General Medical Council [1972] AC 217 ), findings “plainly wrong or so out of tune with the evidence properly read as to be unreasonable” ( Casey v General Medical Council [2011] NIQB 95 and R (Dutta) v General Medical Council [2020] EWHC 1974 (Admin) ) and where there is “no evidence to support a...finding of fact or the trial judge's finding was one which no reasonable judge could have reached” ( Perry v Raleys Solicitors [2019] UKSC 5 ). iii) Where what is concerned is a matter of judgement and evaluation of evidence which relates to areas outside the immediate focus of interest and professional experience of the body, the Court will moderate the degree of deference it will be prepared to accord, and will be more willing to conclude that an error has, or may have been, made, such that a conclusion to which the Panel has come is or may be 'wrong' or procedurally unfair ( Wasu v GDC at [17]).

60. As to sanction, in Ghafoor Manan v General Dental Council [2023] EWHC 2604 (Admin) Fordham J held, having regard to the decision in Sastry v General Medical Council [2021] EWCA Civ 623 [2021] 1 WLR 5029 at [102], that the essential question to ask is whether the erasure sanction imposed by the committee was appropriate and necessary in the public interest or whether it was excessive and disproportionate. Once again, in light of my conclusions in respect of Grounds 1 and 2 and the consequential need to remit the matter for reconsideration of sanction, as set out below, it is not necessary to descend into detail in this judgment with respect to the legal principles concerning sanction.

61. Finally, with respect to the remedies available on appeal, the power of the court to set aside the PCC's rulings and findings is set out in CPR r.52.21(3). Pursuant to s.29(3) of the 1984 Act the court has the following powers on an appeal brought pursuant to s.29(1) of the 1984 Act : “(3) On an appeal under this section, the court may— (a) dismiss the appeal, (b) allow the appeal and quash the decision appealed against, (c) substitute for the decision appealed against any other decision which could have been made by the Professional Conduct Committee, the Professional Performance Committee or (as the case may be) the Health Committee, or (d) remit the case to the Professional Conduct Committee, the Professional Performance Committee or (as the case may be) the Health Committee to dispose of the case under section 24, 27B, 27C or 28 in accordance with the directions of the court. and may make such order as to costs (or, in Scotland, expenses) as it thinks fit.” DISCUSSION

62. Having considered carefully the written and oral submissions in this matter, I am satisfied that the appeal must be allowed in respect of Grounds 1 and 2, the findings dealt with by those grounds quashed and the matter remitted to the PCC for re-consideration of sanction having regard to the revised factual foundation that results from the successful appeal. My reasons for so deciding are as follows. Ground 1

63. As properly conceded by Mr Thomas during the hearing, the drafting of the charge of dishonesty in relation to the 30 June 2023 email left a good deal to be desired.

64. With respect to the charge of dishonesty relating to the email of 30 June 2023, charges 6 and 7(b) are drafted to be read together. The charge at paragraph 6 contends that “On 30 June 2023 [Dr Singh] emailed the GDC to state that he worked at the Practice part time between 2013 and 2017 and the Practice had an NHS inspection but closed down due to the Covid pandemic”. Within this context, the addition of the words “as he treated Patient A between 2019 and 2021” to Charge 7(b) suggest that GDC sought to demonstrate before the PCC that, in the context of his assertion that he “worked at the Practice part time between 2013 and 2017 and the Practice had an NHS inspection but closed down due to the Covid pandemic”, it was the omission of any mention in the email of 30 June 2023 of his having treated Patient A that comprised Dr Singh’s dishonest conduct. This impression is further reinforced when looking at the manner in which the case was opened by the GDC. As set out above, in opening the case to the PCC Mr Thomas submitted in terms that the fact that Dr Singh was treating Patient A at that practice in the period of 2019 to 2021 was intentionally removed or omitted by Dr Singh from the email of 30 June 2023. At the appeal hearing, Mr Thomas’s submissions seeking to uphold the finding of dishonesty were likewise predicated on the assertion that Dr Singh had intentionally sought, by his email of 30 June 2023, to obfuscate the position in relation to his treatment of Patient A and did not indicate that he was the owner and operator of the practice.

65. In the foregoing circumstances, and Dr Singh having conceded that the email of 30 June 2023 was misleading , there are in my judgment two key difficulties with the finding of dishonesty made by the PCC with respect to that email. First, Dr Singh had already admitted to the GDC’s Interim Orders Committee on 28 June 2022 that he had treated Patient A between 2019 and 2021. Second, the Working Arrangements Form that led to the email of 30 June 2023 did not require Dr Singh to provide details of individual patients or their treatment.

66. The PCC found that Dr Singh’s actual knowledge and belief at the time he sent the email on 30 June 2023 was that he knew he had treated Patient A at the practice on a number of occasions between 2019 and 2021 and, by stating to the GDC that he had most recently worked at the practice in 2017, he dishonestly misrepresented his actual knowledge by reference to the objective standards of ordinary decent people. However, as is clear from the transcript of the Interim Orders hearing on 28 June 2022, Dr Singh had, over a year earlier, already admitted to the GDC that had cared for and treated Patient A at his practice on a considerable number of occasions, providing details of the nature and extent of the treatment and the reasons for it and going so far as to provide the GDC with a referral letter dated 11 January 2020. It is correct that, having stated that he worked at the practice part time between 2013 and 2017, Dr Singh did not repeat in his email of 30 June 2024 the admission made to the Interim Orders Committee a year earlier on 28 June 2022 that he had treated Patient A between 2019 and 2021. He was not, however, asked to. As I have noted, nowhere on the GDC Working Arrangements Form was it indicated that the details required included details of the treatment given to individual patients.

67. I acknowledge that Ground 1 of the appeal deals with a matter of fact and that the PCC had the advantage of hearing the evidence from live witnesses (although not from Dr Singh) and that this court should accordingly be slow to interfere with decisions on matters of fact. However, the degree of deference to be accorded to the findings of the first instance body will depend upon the circumstances. Further where, as here, the court is concerned with a matter of judgement, the court will moderate the degree of deference it is prepared to accord, and will be more willing to conclude that an error has, or may have been, made, such that a conclusion to which the Panel has come to is or may be wrong.

68. The state of mind of the registered dentist is a critical issue for the PCC to resolve in determining whether the conduct in question meets the threshold of dishonesty (see GDC v Williams ). Whilst the email of 30 June 2023 was misleading, as conceded by Dr Singh, insofar as the PCC concluded that Dr Singh’s statement that he worked at the practice part time between 2013 and 2017 sought dishonestly to disguise the fact that he treated Patient A at the Orasculpt premises between 2019 and 2021, that conclusion is in my judgment unsustainable having regard to the totality of Dr Singh’s actual knowledge.

69. In addition to Dr Singh having actual knowledge of the fact he had treated Patient A between 2019 and 2021, Dr Singh also had actual knowledge of the fact he had already admitted that fact to the regulator on 28 June 2022 and in relatively detailed terms. Further, and as set out above, the Work Arrangements Form that had elicited from Dr Singh the email of 30 June 2023 did not ask or require him to set out details of individual patient treatments, whether in respect of the matters under investigation or otherwise. There was nothing in the Work Arrangements Form that required him to address the charges against him. Whilst Mr Thomas submits that it was open to Dr Singh to make these points before the PCC and he did not, I bear in mind that Dr Singh was a litigant in person, that as far as he was concerned he had already made admissions in the process and that it was to the GDC’s Interim Orders Committee that Dr Singh made those admissions, on the record. It was not incumbent on Dr Singh to point out information the GDC already had.

70. Having regard to the totality of Dr Singh’s actual knowledge, I am satisfied that the PCC fell into error in concluding that in omitting to state in his email of 30 June 2023 that he had treated Patient A between 2019 and 2021, Dr Singh engaged in conduct that was not only misleading but also dishonest. In my judgment, had the attention of the PCC been drawn to Dr Singh’s admission to the GDC Interim Orders Committee in June 2022 that he had treated Patient A during the relevant period, enabling the PCC to have regard to the entirety of Dr Singh’s actual knowledge, the PCC would have reached a different conclusion. Namely, that an ordinary decent person asked whether someone who had already admitted a fact, and was responding by email to a request that did not invite the repetition of that fact, was acting dishonestly in not again mentioning that previously admitted fact in the email, the ordinary decent person would respond in the negative.

71. Finally, I acknowledge that Dr Singh did not state in the email of 30 June 2023 that he was the owner of the Orasculpt practice during the period 2013 to 2017 or thereafter. However, that omission was not relied on, or referred to, as an incident of or evidence of dishonesty in Charge 6, to which the charge dishonesty in Charge 7(b) referred.

72. I likewise acknowledge that in his response to the allegations dated 15 October 2024, Dr Singh stated that he ‘felt guilty and responsible to help patients who contacted me between 2019/2021’, and that he ‘did not do active treatments but did meet / reassure any previous patients’. However, and once again, this statement was not relied on, or referred to, as an incident of or evidence of dishonesty in Charge 6, to which the charge dishonesty in Charge 7(b) referred, being relied on by the PCC only as corroborating evidence for its finding that the charge of dishonesty in relation to the email of 30 June 2023 was made out as pleaded, the problems with which conclusion I have articulated above.

73. None of the above is to fail to recognise the seriousness of the actions taken by Dr Singh in treating Patient A in the manner and in the circumstances in which he did, described by Mr Thomas as a species of “backstreet dentistry”. However, the matters set out above do, in my judgment, undermine the finding of dishonesty made against Dr Singh by the PCC to the extent that I am satisfied that, notwithstanding the respect that falls to be accorded by this court to the findings of fact made by the PCC, that finding must be quashed. Ground 2

74. I am satisfied that, in circumstances where the PCC found that it could not be satisfied that Dr Singh had access to Patient A’s medical records at the time he left the voicemail with the GDC on 25 October 2023, the PCC’s finding that the statement contained in the voicemail was misleading and its finding that the voicemail was not dishonest were contradictory in circumstances where both charges were predicated on Dr Singh having access to Patient A’s medical records.

75. The allegation that Dr Singh misled the PCC by his voicemail of 25 October 2023, and the allegation that he was dishonest in that regard, both arise from the same statement by Dr Singh, namely that he had “no access to any kind of records remaining”. Having regard to statement relied on in the charge, access by Dr Singh to the records was a precondition for making out both the charge of dishonesty and the charge of misleading. However, in relation to the charge of dishonesty as it pertained to the voicemail of 25 October 2023, the PCC concluded as follows: “The Committee finds that the GDC has not demonstrated to the required standard that there were records in existence at that time that you were capable of accessing and providing.”

76. If, having found it could not be satisfied that Dr Singh had access to Patient A’s medical records at the time he left the voicemail with the GDC on 25 October 2024 for the purposes of the charge of dishonesty, it follows that the PCC could also not be satisfied for the that Dr Singh had access to Patient A’s medical records at the relevant time purposes of determining the charge of being misleading. As such, where the PCC concluded that in circumstances where it could not be satisfied that Dr Singh had access to Patient A’s medical records he could not be held to be dishonest in stating that he had “no access to any kind of records remaining”, it must also follow as a matter of logic that where the PCC could not be satisfied that Dr Singh had access to Patient A’s medical records, Dr Singh could likewise not be held to be have misled the GDC in stating that he had “no access to any kind of records remaining”. Having concluded that it could not be satisfied that Dr Singh had access to Patient A’s records, the PCC considered the allegation of dishonesty fell away. But in the foregoing context, and as a matter of logic, so did the allegation that Dr Singh misled the GDC by stating he had no access to Patient A’s records.

77. It is correct that Dr Singh did not explain why he had no access to the records and that the PCC found that Dr Singh had misled the GDC because he “did not elaborate on why you could not access provide any records” (emphasis added). However, the head of charge was not that Dr Singh had mislead the GDC by failing sufficiently to explain why he could not access the records, but rather because he stated in terms in the voicemail that he could not access the records. In the circumstances, the stated basis of the finding made by the PCC that Dr Singh engaged in conduct that was misleading did not reflect the relevant head of charge laid against Dr Singh.

78. Once again, I acknowledge that Ground 2 of the appeal deals with a matter of fact and that this court should accordingly be slow to interfere with decisions on matters of fact. However, and once again, the degree of deference to be accorded to the findings of the first instance body will depend upon the circumstances. The court is again here concerned with a matter of judgement, moderating the degree of deference to be accorded to the finding made by the PCC. For the reasons I have given, the finding that Dr Singh misled the GDC by his voicemail of 25 October 2025 is fatally undermined by its finding that the records that underpinned the charge of misleading were not accessible by Dr Singh. Grounds 3 and 4

79. In circumstances where I am satisfied that Dr Singh succeeds on Grounds 1 and 2, I am satisfied that it is necessary for the question of sanction to be reconsidered where it is clear that the findings which this court has quashed formed a central element of the rationale for the sanction of erasure imposed by the PCC: “61.The Committee considers that its findings, and in particular its identification of persistent and repeated obfuscation, including dishonesty, connote a fundamental disregard and disdain for the regulatory process. This is such to suggest a deep-seated professional attitudinal problem. The Committee considers that, particularly because of the previous findings made against you, you ought to have been in no doubt whatsoever as to the importance of being honest and open, and of the importance of engaging with the GDC. The Committee considers that a direction of suspended registration would not be likely to serve any useful purpose as, in light of previous findings, especially of dishonesty, the Committee does not consider that a period of suspension will bring about the necessary rectification of your conduct and behaviour. The Committee considers that a period of suspended registration would not be sufficient to protect the public or the wider public interest.”

80. Having regard to the expertise of the PCC in such matters, I am satisfied that it is appropriate for this court to remit the case to the PCC for reconsideration of sanction on the basis of the revised factual matrix arising out of Dr Singh’s successful appeal. In doing so, I express no view as to what the appropriate sanction may be, that being a matter for the PCC.

81. In the circumstances, I am satisfied that it is not necessary for the court to deal with the substantive submissions as to Grounds 3 and 4 of the appeal in circumstances where the PCC will be required to reconsider the question of sanction having regard to the outcome of Grounds 1 and 2. Within that context, the question of whether a period of suspended registration would be sufficient to protect the public or the wider public interest and the question of whether the only appropriate and proportionate sanction to impose is that of erasure will be, inter alia, questions for the PCC. Once again, I express no view on these matters, they being questions for the PCC having regard to the revised factual foundation that results from this successful appeal. CONCLUSION

82. In conclusion, I allow Dr Singh’s appeal on Grounds 1 and 2, and quash the findings with respect to Charge 7(b) and the findings with respect to Charge 9(a). Having allowed the appeal in these terms, I remit the question of sanction for reconsideration by the Professional Conduct Committee in accordance with the directions of the court, namely to reconsider whether erasure is the necessary and appropriate sanction having regard to the revised factual matrix that results from this successful appeal. I will invite counsel to draft an order accordingly.