PUBLIC RECORD Dates: 16/10/2017 18/10/2017 Medical Practitioner s name: Dr Johannes Christiaan Hermanus BASSON GMC reference number: 4056885 Primary medical qualification: Type of case New - Misconduct MB ChB 1987 University of Pretoria Outcome on impairment Impaired Summary of outcome Suspension, 1 month. Tribunal: Legally Qualified Chair Lay Tribunal Member: Medical Tribunal Member: Mr Stephen Povey Ms Sharon Gimson Dr Karen Slade Tribunal Clerk: Ms Esther Morton Attendance and Representation: Medical Practitioner: Medical Practitioner s Representative: GMC Representative: Present and represented Mr Andrew Colman, Counsel, instructed by RadcliffesLeBrasseur Ms Chloe Fordham, Counsel Attendance of Press / Public The hearing was all heard in public. 1
DETERMINATION ON THE FACTS - 17/10/2017 Background 1. Dr Basson qualified in 1987 and prior to the events which are the subject of the hearing trained as a surgeon before transferring to General Practice. He finished his General Practitioner ( GP ) training in 2001, and subsequently worked as a GP in Namibia and London. At the time of the events in question Dr Basson was practising as a GP at the Keats Surgery ( the Surgery ) in Edmonton, London - a post he still holds. 2. On 25 July 2016 Patient A attended a consultation with Dr Basson at the Surgery. During this consultation, it is alleged that Dr Basson inappropriately touched Patient A s leg and commented on the length of her skirt. It is alleged that his comments and actions were sexually motivated. 3. Patient A referred these concerns to the GMC on 25 July 2016. Patient A also referred her concerns to the Metropolitan Police; on 15 August 2016 the Metropolitan Police closed their investigation with no further action. The Outcome of Applications Made during the Hearing 4. The Tribunal refused Mr Colman s application, made of behalf of Dr Basson, to remove paragraph 2 of the allegation. Mr Colman submitted that the Tribunal did not have jurisdiction to consider paragraph 2 of the allegation, on the basis that it had not been considered by a Case Examiner. The Tribunal s full decision on the application is included at Annex A. The Allegation and the Doctor s Response 5. The Allegation made against Dr Basson is as follows: Paragraph One On or around 25 July 2016, during a consultation with Patient A, you: a. inappropriately touched Patient A s right leg when there was no clinical reason to do so; Admitted and found proved b. on learning that Patient A was on her way to work, commented, that is the reason for the short skirt then or words to that effect. Admitted and found proved Paragraph Two 2
Your actions/comment at paragraph 1 above were sexually motivated. To be determined The Admitted Facts 6. At the outset of these proceedings, Dr Basson, through his Counsel, made admissions to some paragraphs and sub-paragraphs of the Allegation, as set out above, in accordance with Rule 17(2)(d) of the General Medical Council (GMC) (Fitness to Practise) Rules 2004, as amended ( the Rules ). In accordance with Rule 17(2)(e) of the Rules, the Tribunal announced these paragraphs and sub-paragraphs of the Allegation as admitted and found proved. The Facts to be Determined 7. In light of Dr Basson s response to the Allegation made against him, the Tribunal is required to determine whether Dr Basson s actions/comment towards Patient A on 25 July 2016 were sexually motivated. Factual Witness Evidence 8. The Tribunal received written and oral evidence on behalf of the GMC from Patient A. 9. The Tribunal also received evidence on behalf of the GMC in the form of witness statements from the following witnesses who were not called to give oral evidence: Ms B, Retail and HR Director; Mr C, Buying and Marketing Director; Ms D, Assistant Sales Manager. 10. Dr Basson provided his own witness statement dated 3 October 2017 and also gave oral evidence at the hearing. Documentary Evidence 11. The Tribunal had regard to the documentary evidence provided by the parties. 12. On behalf of the GMC this evidence included, but was not limited to, a transcript of Dr Basson s 12 August 2016 interview with the Metropolitan Police, correspondence between the Metropolitan Police and the GMC, correspondence between Dr Basson and the GMC, as well as Patient A s medical records. 3
13. On behalf of Dr Basson this evidence included, but was not limited to, photographs of his consultation room at the Surgery, a certificate of attendance at a Maintaining Professional Boundaries course, an undated reflective note, as well as colleague testimonials and professional references. The Tribunal s Approach 14. In reaching its decision on facts, the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation. Dr Basson does not need to prove anything. The standard of proof is that applicable to civil proceedings, namely the balance of probabilities, i.e. whether it is more likely than not that the events occurred. The Tribunal s Analysis of the Evidence and Findings 15. The Tribunal has considered each outstanding paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts. Paragraph Two 16. In relation to the outstanding paragraph of the Allegation, the Tribunal first had regard to the credibility of Patient A and Dr Basson. 17. The Tribunal was satisfied that Patient A was an honest and credible witness who did not exaggerate or embellish events, and did her best to assist this hearing. Patient A described Dr Basson s actions as sleazy, and the Tribunal had no reason to doubt her evidence, nor her version of events. The Tribunal accepted that, following her consultation with Dr Basson, Patient A felt that Dr Basson had acted towards her in a sexually motivated way. Following this consultation Patient A was left visibly upset a fact that is corroborated by the witness statements of her three colleagues. 18. The Tribunal also found that Dr Basson gave open and honest answers and did his best to assist the Tribunal. Dr Basson informed the Tribunal that he could not remember the consultation in question - a position he has maintained since his initial interview with the Metropolitan Police in August 2016. From his evidence, the Tribunal accepted that Dr Basson did not remember the consultation, and it was satisfied that he was not attempting to mislead the hearing in any way, or to cover up his actions. 19. It was not in dispute that Dr Basson has an otherwise unblemished professional career. 20. In this case, the Tribunal was charged with considering Dr Basson s state of mind during the consultation with Patient A on 25 July 2016. Dr Basson cannot 4
remember the consultation and can only speculate as to his state of mind. Patient A was only able to describe what she perceived Dr Basson s motivation to have been. The Tribunal therefore had to consider all the evidence and form a view on Dr Basson s likely motivation at the aforesaid consultation. 21. Despite not recalling the incident, Dr Basson accepted Patient A s account that he touched her leg and commented on the length of her skirt. He also accepted that his behaviour in so doing was inappropriate. In his reflective statement he described his actions as wrong and totally unwarranted, but denied any sexual motivation. Dr Basson suggested that, as with all of his patients, he was attempting to put Patient A at ease by being chatty and by engaging in small talk. The Tribunal had regard to the colleague and professional testimonials provided on Dr Basson s behalf, which describe him as a man of integrity and good character, who is a very competent clinician. 22. Dr Basson accepted that there was no clinical reason for his touching of Patient A s leg, or for his comment regarding her skirt length. He described his behaviour as boisterous and in his reflective statement wrote that: The Police officer described it [his behaviour towards Patient A] as a laddish act and that is probably an apt description 23. Dr Basson accepted that his behaviour was a laddish act. In the Tribunal s view - in respect of the kind of behaviour towards a young woman as accepted in this case - the word laddish connotes a sexual element. Dr Basson did not touch Patient A on the hand or the arm, but on the bare skin of her leg; this touching was accompanied by a comment about the length of her skirt. The Tribunal considered the impact of Dr Basson s behaviour on Patient A. It concluded that such behaviour, in the absence of an alternative explanation, was likely to be sexually motivated. In that regard, Dr Basson s suggestion that he had been attempting to put Patient A at ease failed to credibly explain his actions. 24. For those reasons, the Tribunal has found that Dr Basson s actions and comment at Paragraph 1 of the Allegation were sexually motivated. The Tribunal has therefore found Paragraph 2 of the Allegation proved. The Tribunal s Overall Determination on the Facts 25. The Tribunal has determined the facts as follows: Paragraph One On or around 25 July 2016, during a consultation with Patient A, you: 5
a. inappropriately touched Patient A s right leg when there was no clinical reason to do so; Admitted and found proved b. on learning that Patient A was on her way to work, commented, that is the reason for the short skirt then or words to that effect. Admitted and found proved Paragraph Two Your actions/comment at paragraph 1 above were sexually motivated. Disputed and found proved DETERMINATION ON IMPAIRMENT - 18/10/2017 1. The Tribunal now has to decide in accordance with Rule 17(2)(k) of the Rules whether, on the basis of the facts which it has found proved as set out before, Dr Basson s fitness to practise is impaired by reason of misconduct. The Evidence 2. The Tribunal has taken into account all the evidence received during the facts stage of the hearing, both oral and documentary. The Tribunal did not receive any additional evidence on behalf of the GMC at the impairment stage. 3. On behalf of Dr Basson, the Tribunal received a log detailing incidents of nonclinical touch and informal or non-clinical language and/or small talk spanning a oneweek period ( the log ). Dr Basson did not give further oral evidence at the impairment stage. Submissions 4. Ms Fordham, on behalf of the GMC, submitted that Dr Basson s actions amounted to misconduct not just by virtue of the upset they caused to Patient A, but also by virtue of the sexual motivation behind them. Turning to impairment, Ms Fordham submitted that the correspondence between Dr Basson and the GMC indicates a persistent lack of insight until very recently. She submitted that the enduring nature of this lack of insight may suggest deep-seated attitudinal issues, and that the remediation undertaken by Dr Basson was minimal and may not negate these issues. She therefore submitted that there is a risk of repetition of similar behaviour in the future, and invited the Tribunal to find that Dr Basson s fitness to practise is currently impaired by reason of his misconduct. 5. In the light of the findings of fact made by the Tribunal at stage 1, Mr Colman - on behalf of Dr Basson - did not submit that Dr Basson s fitness to practise was not currently impaired. He reminded the Tribunal of the need to consider current (rather 6
than past) impairment, and submitted that this hearing had been a salutary experience for Dr Basson. The Relevant Legal Principles 6. The Tribunal reminded itself that at this stage of proceedings, there is no burden or standard of proof and the decision of impairment is a matter for the Tribunal s judgment alone. 7. In approaching its decision, the Tribunal was mindful of the two stage process to be adopted: first whether the facts as found proved amounted to misconduct, and that the misconduct was serious; second, whether the finding of that misconduct which was serious could lead to a finding of impairment. 8. The Tribunal must determine whether Dr Basson s fitness to practise is impaired today, taking into account Dr Basson s conduct at the time of the events and any relevant factors since then such as whether the matters are remediable, have been remedied and any likelihood of repetition. The Tribunal s Determination on Impairment Misconduct 9. In determining misconduct, the Tribunal bore in mind that its primary responsibility is to its statutory overarching objective, which is as follows: To protect, promote, and maintain the health, safety, and well-being of the public; To promote and maintain public confidence in the medical profession; To promote and maintain proper professional standards and conduct for members of that profession. 10. The Tribunal determined that Dr Basson s actions towards Patient A breached a number of key principles set out in Good Medical Practice ( GMP ). It had regard to paragraphs 46 and 47 of GMP, which state: You must be polite and considerate You must treat patients as individuals and respect their dignity and privacy The Tribunal determined that by acting in a laddish way towards Patient A Dr Basson did not treat her with dignity, and was not considerate towards her as an individual. 7
11. The Tribunal further had regard to paragraph 65 of GMP, which states: You must make sure that your conduct justifies your patients trust in you and the public s trust in the profession Patient A was shocked and upset by Dr Basson s behaviour, and his conduct towards her in the consultation on 25 July 2016 did not justify her trust in him. Further, given that the Tribunal has found Dr Basson s actions to have been sexually motivated, the Tribunal determined that his conduct towards Patient A could seriously undermine public confidence in the medical profession. 12. Bearing the above in mind, the Tribunal has concluded that Dr Basson s conduct fell so far short of the standards of conduct reasonably to be expected of a doctor so as to amount to misconduct. Impairment 13. Having found misconduct, the Tribunal went on to consider whether, as a result of that misconduct, Dr Basson s fitness to practise is currently impaired. 14. In determining impairment, the Tribunal bore in mind that Dr Basson has consistently accepted the facts of the case, despite being unable to remember the consultation in question. It found him to be an open and believable witness, and notes that he has taken full responsibility for this incident. The Tribunal had regard to the remediation he has undertaken, which includes attendance at a Maintaining Professional Boundaries Course, a reflective statement, and apologies to Patient A. The Tribunal further had regard to the log kept by Dr Basson, which indicates that he has put his remediation into practice and is taking steps to change his behaviour during consultations. The Tribunal accepted that this entire experience has been a salutary lesson for Dr Basson, and one that he will continue to reflect on. As such, the Tribunal was satisfied that there is a low risk of repetition, and that Dr Basson does not pose any real and current risk to members of the public. 15. However, whilst it was satisfied that there are no concerns regarding patient safety, the Tribunal bore in mind that its overarching objective requires it to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of that profession. Mr Colman referred it to the case of CHRE v NMC and Grant 2011 EWHC 927 (Admin), where Mrs Justice Cox set out at [74] that: In determining whether a practitioner's fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be 8
undermined if a finding of impairment were not made in the particular circumstances. The Tribunal determined that a reasonable and well-informed member of the public would be concerned to learn that a finding of sexual motivation did not result in a finding of impairment, and it considered that a finding of no impairment would not send the proper message to members of the medical profession. Accordingly - given its finding that Dr Basson s conduct towards Patient A was sexually motivated - the Tribunal determined that a finding of impairment is necessary in order to maintain public confidence in the medical profession and in order to maintain proper professional standards and conduct for members of that profession. 16. The Tribunal has therefore determined that Dr Basson s fitness to practice is currently impaired by reason of misconduct. DETERMINATION ON SANCTION - 18/10/2017 1. Having determined that Dr Basson s fitness to practise is impaired by reason of misconduct, the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction, if any, to impose. The Evidence 2. The Tribunal has taken into account evidence received during the earlier stages of the hearing where relevant to reaching a decision on sanction. The Tribunal did not receive any further evidence from either the GMC or Dr Basson at the sanction stage. Submissions 3. Ms Fordham, on behalf of the GMC, submitted that the appropriate and proportionate sanction in this case is one of suspension. She submitted that Dr Basson s sexual misconduct took place in a clinical setting, and that his actions towards Patient A were an abuse of the position of trust he occupies as a doctor. Ms Fordham reminded the Tribunal that the reputation of the profession as a whole is more important that the interests of any individual practitioner, and she submitted that a sanction lesser than suspension would neither protect the public nor maintain public confidence in the medical profession. Ms Fordham did not address the Tribunal in respect of length of any order, but invited the Tribunal to direct a review hearing. 4. Mr Colman, on behalf of Dr Basson, submitted that an order of suspension would be more punitive than protective, and that given the Tribunal s finding that Dr Basson did not pose any real or current risk to the public suspension was not necessary in order to protect the public. Mr Colman further informed the Tribunal that, under Regulation 28 of The National Health Service (Performers Lists) 9
(England) Regulations 2013, any suspension of Dr Basson s registration would require automatic removal of his name from the GP Performers List. Mr Colman submitted that Dr Basson would need to reapply to join the Performers List after any period of suspension, and described this as a time-consuming and cumbersome process that would effectively elongate any period of suspension. Mr Colman submitted that this would be disproportionate and would negatively impact on Dr Basson s patients. He therefore invited the Tribunal to impose an order of conditions on Dr Basson s registration, submitting that conditions would be sufficient to protect the wider public interest. He suggested that a condition requiring Dr Basson to develop a Personal Development Plan that included further reflection could be appropriate, and made no submission regarding length of order, or the necessity of any review hearing. The Tribunal s Determination on Sanction 5. The decision as to the appropriate sanction to impose, if any, is a matter for this Tribunal exercising its own judgement. In reaching its decision, the Tribunal has taken account of the Sanctions Guidance ( SG ), and has borne in mind that the purpose of a sanction is not to be punitive, although a sanction may have a punitive effect. The Tribunal has applied the principle of proportionality, weighing Dr Basson s interests with the wider public interest. No action 6. The Tribunal first considered whether to conclude Dr Basson s case by taking no action. It determined that there were no exceptional circumstances in this case that would warrant it taking no action, and considered that doing so would be wholly disproportionate given its findings at the impairment stage. Conditions 7. The Tribunal next considered whether it would be sufficient to impose an order of conditions on Dr Basson s registration. It has borne in mind that any conditions imposed would need to be appropriate, proportionate, workable, and measureable. 8. The Tribunal bore in mind that the purpose of any sanction is to address impairment; the impairment found in Dr Basson s case was on the basis that his misconduct could have a detrimental impact on public confidence in the medical profession, and fell well below the standards expected of the profession. 9. The Tribunal had regard to paragraphs 81 and 82 of the SG, which set out that: 10
Conditions are likely to be appropriate in cases where there is evidence of shortcomings in a specific area of the doctor s practice; Conditions are likely to be workable where a period of retraining and/or supervision is likely to be the most appropriate way of addressing any findings. The Tribunal considered that there are no specific areas of Dr Basson s practice that could be addressed by a period of supervision or retraining; it has not identified any specific areas of clinical concern, and it has found that Dr Basson does not pose a real or current threat to members of the public. The Tribunal bore in mind that its finding of impairment was on the basis of upholding public confidence in the medical profession, and it was not satisfied that any conditions could be formulated which would satisfactorily address this. On this basis, the Tribunal determined that conditions were neither workable nor appropriate. Suspension 10. The Tribunal next considered whether a period of suspension would be appropriate in Dr Basson s case. In so doing, it had regard to paragraph 91 of the SG, which sets out that: Suspension has a deterrent effect and can be used to send out a signal to the doctor, the profession and public about what is regarded as behaviour unbefitting a registered doctor 11. The Tribunal further had regard to paragraph 93 of the SG, which sets out that: Suspension may be appropriate where there may have been acknowledgment of fault and where the Tribunal is satisfied that the behaviour or incident is unlikely to be repeated 12. Bearing these points in mind, the Tribunal determined that suspension would be appropriate and proportionate in order to uphold the wider public interest, which includes maintaining public confidence in the medical profession, as well as sending a message to the public and the profession about what is behaviour unbefitting of a registered medical practitioner. In reaching this decision, the Tribunal also had regard to paragraph 97 of the SG, which sets out a list of factors that indicate suspension may be appropriate; a number of these factors are present in Dr Basson s case, including Dr Basson s insight, and the lack of any evidence of repetition. 13. The Tribunal bore in mind Mr Colman s submission regarding removal from the Performers List, and it appreciates the impact this decision will have on Dr Basson and his registration, as well as on his patients. However, it considered that 11
these concerns are secondary to overall public confidence in the medical profession, and it determined that given the nature of Dr Basson s misconduct a period of suspension was necessary in order to indicate to the public, the profession, and to Dr Basson that his misconduct was not appropriate, and will not be accepted. 14. In determining the length of the order of suspension, the Tribunal considered the mitigating factors in Dr Basson s case, which include but are not limited to his acceptance of the facts, the steps he has already taken to address his behaviour, his reflection and remediation, his apology to Patient A, and the testimonials received from professional colleagues and patients. It has balanced these factors against the fact that Dr Basson abused his professional position in a clinical context, albeit on a single occasion. The Tribunal determined that whilst Dr Basson s misconduct is serious it is at the lower end of the scale of sexual misconduct, and it has already found that risk of repetition is low. Bearing these factors in mind, the Tribunal determined that a period of one month s suspension would be appropriate and proportionate. Review 15. In determining whether it was necessary to direct a review hearing, the Tribunal had regard to paragraph 164 of the SG, which sets out that: In some misconduct cases it may be self-evident that, following a short suspension, there will be no value in a review hearing 16. The Tribunal has found that Dr Basson does not pose any real and current risk to patients, and has imposed the period of suspension solely to mark the seriousness of Dr Basson s misconduct, and in order to send a message to the public and the profession about behaviour unbefitting of a medical practitioner. In light of Dr Basson s remediation and insight to date, and changes he has made to his practice, the Tribunal considered that risk of repetition is low. There are no clinical concerns in Dr Basson s case and - given his period of suspension is for one month - de-skilling is unlikely. The Tribunal determined that a review would be of no value, and was not necessary in the public interest. The Tribunal therefore determined not to direct a review hearing. DETERMINATION ON IMMEDIATE ORDER - 18/10/2017 1. Having determined that Dr Basson s registration is to be suspended for a period of one month, the Tribunal has considered, in accordance with Rule 17(2)(o) of the Rules, whether Dr Basson s registration should be subject to an immediate order. Submissions 2. Neither Ms Fordham nor Mr Colman submitted that it was necessary to impose an immediate order in this case. 12
The Tribunal s Determination 3. Given there are no patient safety concerns in Dr Basson s case, and given that the order of suspension was imposed solely on the grounds of the public interest, the Tribunal determined that it was not necessary to impose an immediate order of suspension on Dr Basson s registration. The Tribunal was satisfied that the substantive order for suspension as already announced is sufficient to protect the public interest, and that allowing Dr Basson to remain in unrestricted practice until the substantive suspension comes into effect will not adversely impact patient safety. 4. This means that Dr Basson s registration will be suspended 28 days from today, unless he lodges an appeal. If Dr Basson does lodge an appeal he will remain free to practise unrestricted until the outcome of any appeal is known. 5. There is no interim order to revoke. 6. That concludes Dr Basson s case. Confirmed Date 18 October 2017 Mr Stephen Povey, Chair 13
Annex A 16 October 2017 [Application to remove Paragraph 2 of the allegation] 1. Prior to the case formally opening, Mr Colman applied to remove paragraph 2 of the allegation. This matter was previously raised with the MPTS at a pre-hearing meeting on 15 June 2017. Paragraph 2 reads as follows: Your actions/comment at paragraph 1 above were sexually motivated 2. In summary, Mr Colman submitted that paragraph 2 had not been properly referred to the Tribunal in accordance with Sections 35C and 35D of the Medical Act 1983, as amended ( the Act ), and in accordance with Rules 4, 7, and 8 of the General Medical Council (Fitness to Practise) Rules Order of Council 2004 ( the Rules ). 3. Mr Colman submitted that, by not referring the issue of sexual motivation to the Case Examiners, the GMC has not properly complied with its own processes, and has deprived Dr Basson of the procedural protection offered by the Case Examiner screening process. Mr Colman submitted that the Tribunal cannot adjudicate on an allegation that has not been properly referred in accordance with the Rules, and he therefore invited the Tribunal to remove paragraph 2 of the allegation. 4. In response, Ms Fordham accepted that the GMC had initially omitted to charge sexual motivation, although she invited the Tribunal to consider that Dr Basson appeared to have understood the nature of the allegation from as early as 22 January 2017 onwards, as shown by his correspondence with the GMC. She invited the Tribunal to have regard to Rule 17(1) of the Rules, which sets out that: A shall consider any allegations referred to it in accordance with these Rules 5. Ms Fordham submitted that the term allegation is deliberately broad, and that whilst the particulars of the allegation have changed the allegation before the Tribunal is materially the same as that considered by the Case Examiners. Ms Fordham therefore submitted that the Tribunal does have the jurisdiction to hear paragraph 2 of the allegation, in accordance with the Rules. 6. In reaching its decision, the Tribunal first considered whether paragraph 2 of the allegation fell within its jurisdiction. In so doing, it adopted the definition of allegation as set out in the interpretation section of the Rules, as follows: allegation means an allegation that the fitness to practise of a practitioner is impaired 14
The Tribunal noted that this definition does not include any reference to the particulars upon which the allegation is based. It considered that this definition reflects the reality of how an allegation may be refined and developed throughout the investigation process, and it noted that as well as adding particulars the GMC has removed particulars too. It was satisfied that the allegation before it today is the same as that charged by the GMC in its Rule 7 letter of 3 January 2017, and the Rule 8 letter of 2 March 2017, albeit with different particulars. It was therefore satisfied that paragraph 2 of the allegation was referred to this Tribunal in accordance with the Rules, and does fall within its jurisdiction. 7. Having reached this decision, the Tribunal next considered whether it should remove paragraph 2 of the allegation in accordance with Rule 17(6), which allows the Tribunal to amend the allegation where it is satisfied that any amendment can be made without injustice. 8. In considering whether or not any amendment would be unjust, the Tribunal balanced Dr Basson s interests with the interests of the GMC, as well as with the wider public interest in accordance with its statutory overarching objective. 9. The Tribunal considered that the allegation of sexual misconduct is serious, and the GMC accepts that it omitted to deal with the issue of sexual motivation in its initial referral. Given this, Dr Basson has not had the benefit of specifically addressing the sexual motivation aspect of the allegation from the outset, and has not been afforded the procedural protection of the sexual motivation element being considered by a Case Examiner. 10. The Tribunal balanced this with the fact that the initial complaint raised the issue of sexual misconduct, and it is satisfied that Dr Basson was aware of this complaint from the outset. Although not explicitly charged by the GMC at that stage, Dr Basson denied any sexual motivation in a response to the GMC on 22 January 2017, writing: I have not assaulted her, and I have not sexually assaulted her In addition, Dr Basson was informed of the sexual motivation aspect of the allegation on 23 March 2017, amending the Rule 8 letter of 2 March 2017. Dr Basson has been on notice of the allegation of sexual misconduct for almost 9 months, and specifically of alleged sexual motivation since 23 March 2017. Dr Basson was given the opportunity to provide additional comments at that stage in respect of the allegation of sexual motivation. 11. Having regard to all these factors, the Tribunal determined not to amend the allegation in accordance with Rule 17(6). 15