The Remedy judicial review being heard on 11 May could drive a coach and horses through the meaning of misconduct, and the meaning of unfitness to practice.

Doctors who are involved in management will be anxiously awaiting the verdict, since they may find themselves personally liable for their managerial decisions in future. And appeal lawyers across the country will be looking to the judgement to see whether the GMC has opened the floodgates for them.

Doctors are always happy to whinge about their managers, but serious action against doctors in management is rare. The GMC has only taken action in a handful of cases. One such case was that of Dr Roylance - the chief executive caught up in the Bristol babies cardiac surgery storm.

The MTAS recruitment process was a unique disaster. Some of the superlatives used at the time still stand out; it was described as the “biggest disaster” in a generation, and the anger it generated has still not subsided. So when Remedy wrote to the GMC asking for the senior doctors responsible for it to be referred to a fitness to practice committee then they hoped that the case would be duly investigated.

But the GMC politely declined the opportunity to hold such an inquiry. At this point Remedy reached for their lawyers, and challenged the GMC to defend themselves in court.

The case raises significant issues well beyond the events of 2007. At the heart of it lies the prickly and complex issue of what constitutes unfitness to practice. What sort of actions outside the clinical arena will render a doctor unfit to practice as a medical practitioner? The GMC have defended themselves on the grounds that: 

Whatever the conduct of [The Proposed Defendants] with regard to MTAS, I do not consider that it can sensibly be said to impinge on their fitness to practise as medical practitioners.

Yet this seems to be at odds with many previous rulings. There are many doctors who have been removed from the medical register for what has been referred to as “bringing the profession into disrepute” and for “conduct unbecoming of a doctor”. And if, for example, the doctors under investigation had knowingly breached the laws affecting international medical graduates then would the GMC still be arguing that this had no effect on their ability to work as doctors?

There has never been a case of deficient professional performance brought against a doctor for managerial issues. If Remedy is successful then this verdict will send a cold chill down the spines of medical directors and doctors working for health authorities - especially in an era of financial uncertainty.

The case is being heard in the High Court on 11 May - five days after the general election. Remedy has created a Facebook group for supporters of their case. If you agree with us, please attend court or, failing that, express your support.

This verdict is going to be studied by medico-legal bodies for many years to come.

Last year, Remedy called for the architects of MTAS to be referred to the GMC Fitness to Practice Committee. The GMC had refused and Remedy had sought a judicial review of this decision. On 27 July, the first part of the case was heard.

It was an exciting feeling to walk into the high court. The building has a timeless and hallowed air to it. The outer facade, familiar from many TV appearances, seems almost familiar, and unmistakeably British. The hall inside is filled with lawyers and their clients clustered in huddles, while others rush up and down urgently carrying piles of papers.

Today was the culmination of many months of work. The decision to embark on this action had not been easy. There had been many long and emotional meetings of Remedy’s committee where we had discussed the pros and cons. The argument had been won, at least for me, on two counts. Firstly there was our reading of the law, which seemed to indicate that we were clearly in the right. And, secondly, there had been the views of our members - canvassed repeatedly - who had put their hands in their wallets in order to fund this action. We all hoped that we would not let them down.

Court 5 in this multiplex is up a flight of stone stairs. I had arrived a little early, hoping that some of our supporters would be there to give us some moral encouragement. We were not disappointed; Remedy supporters from as far away as Edinburgh had arrived. My 83-year-old father had made the journey to support the team. Our lawyers - two barristers, a solicitor and three pupils - arrived, donned their wigs and led us into court.

This is where Remedy had lost their fight two years previously to stop MTAS, the disastrous online recruitment system. Memories came flooding back.

Today was the first stage of a judicial review: a permission hearing. Our task was to convince the judge that our case had merit and was arguable. If we were successful then the second stage would be a full hearing, hopefully later this year. The other point at stake was the question of costs. We wanted a cap placed on the costs that we would have to pay were we to lose. We could not run the risk of bankrupting Remedy.

The Hon Mr Justice Hickinbottom entered and our barrister - Tom de la Mare - started to speak. He had only got to his second sentence when the judge asked him to stop. He did not have the case notes in front of him. It seemed like a surreal scene - the notes had gone missing - and there was a short pause while they were found.

The heart of the case hinged around whether or not the GMC had jurisdiction in a case like this. Our barrister presented our case and outlined the case law which supported our position.

Then it was time for the GMC’s team to speak. Their barrister spoke in slow measured tones, and presented his case. As he spoke, the judge interrupted him and picked him up on some key issues. Was there a link between the management of MTAS and medicine? Was there a duty of care?

In the middle of this a group of 20 Italian schoolchildren filed into court. They sat looking bored, then started to talk to each other, until finally they were expelled from the room.

The judge looked through his papers, drank a glass of water, then delivered his verdict. We had won the day. More than that, it was a quadruple whammy. We won on both our grounds. We had won on cost-capping. And we were awarded costs for the day’s hearing.

It was a perfect outcome. We made our way across The Strand to the Edgar Wallace pub, still in a daze. We still had to fight the next part of the case. There was still work to be done. But we were winning. The judge had accepted our submission, had accepted that there was a public interest in the case, and had reaffirmed my faith in the independent judiciary.

On Monday 27 July, Remedy will be going to the High Court. The court will hear the next stage of the judicial review into the decision by the GMC not to refer the architects of MTAS to the Fitness to Practice Committee.

MTAS tore families apart, precipitated the march of 12,000 angry protesters through London and Glasgow and was heavily criticised by the profession. The Douglas report concluded that MTAS had sparked the biggest crisis within the medical profession in a generation.

Justice Goldring recognised that there had been “disastrous consequences” from it, and even health secretary Patricia Hewitt had the decency to apologise to those affected by it.

A Health Select Committee report was highly critical, and contemporary evidence documented the knock-on effects on patient care resulting from the stress junior doctors were under.

Many of those responsible for the 2007 recruitment process were doctors.

Last year a letter signed by 1,600 supporters asked the GMC to investigate whether the conduct of those responsible for MTAS had been sufficiently bad as to constitute serious professional misconduct or deficient professional performance. They asked for the case to be properly investigated.

But the GMC declined this request, reasoning that the alleged misconduct, even if proved, could not sensibly be said to impinge on their fitness to practice medicine.

The GMC has always seen one of its key roles as being the preservation of the reputation of the medicine. It seems surprising that they would take such a hands-off approach to a fiasco of this magnitude, especially since they had taken action before in non-clinical matters that attracted public attention. The cases of Roylance and Meadows are the best known precedents.

There are some who argue that a lot of water has passed under the bridge since 2007, that lessons have been learned and that it is time to move on.

We disagree. There is an important point of principle at stake around the issue of professional accountability. Remedy believes that this case is important not only because of the events in question but also because it acts as a benchmark for future practice and conduct. We consider this action an essential step in maintaining the reputation of the profession in the eyes of other doctors and the general public, and in protecting the public (and the public purse) against future equivalent mismanagement.

See you in court.