Dentist removed from NHS lists for exploiting Covid payment system refused appeal against unsuitability finding

About this case:

• Citation:
  [2026] CSIH 11
• Judgment:
  External link
• Court:
  Court of Session Inner House
• Judge:
  Lord Beckett

Sanjit Nandhra challenged a decision and associated order of an NHS tribunal dated 12 May 2025, contending that the tribunal applied the wrong legal test in determining his unsuitability, and invited the court to make a new determination or have his case remitted to be redetermined. The Lothian, Fife, and Lanarkshire Health Boards appeared as interested parties, as the appellant was included in the dental lists maintained by them until it was determined that he was unsuitable for continued inclusion, and made submissions in the absence of a respondent to the appeal.

The appeal was heard by the Lord Justice Clerk, Lord Beckett, with Lord Malcolm and Lord Armstrong, with McGregor KC appearing for the appellant and Clair, advocate, for the interested parties.

Slow down on patients

On 26 October 2020, the chief dental officer wrote to practices to advise them that from 1 November 2020 they would be able to provide the full range of NHS services to patients again, following a period of closure save for emergency treatments, on a system of tiered financial support. The introduction of this support was delayed by three months after new restrictions were imposed in December 2020, with the highest tier of support requiring a practice to achieve a throughput of NHS patients of at least 20 per cent of pre-pandemic levels.

On 18 January 2021, the appellant emailed his colleagues in Sayegh Orthodontics Ltd, which he owned, noting that the grant was now guaranteed with no submissions required until June. He said that after that week “we should slow down on the number of patients we see daily” because the practice would still receive the grant “whether we see 10 or 100 patients”. It was alleged that this email and a follow-up the next day were profit-motivated instructions to exploit the support system by reducing the number of NHS patients seen. The appellant’s position was that the policy was proposed to give his overworked staff a break, and there was no evidence that SOL had treated more or less NHS patients than it was required to.

The tribunal found that the appellant had undermined the purpose of the NHS by drawing funds without providing the expected level of patient care and increasing the systemic burden of waiting times. While there was no fraud, the appellant being entitled to the payment, he had maximised his return from the scheme in a manner compliant with its letter but not its spirit, rendering him unsuitable to be included on the dental lists.

Senior counsel for the appellant submitted that there could be no wrongful conduct in circumstances where the appellant had been lawfully entitled to the sums which he claimed. He had an unblemished 40-year career as a dentist, which was a powerful mitigating factor. At worst, it could be said there was a “grey area”, and in such circumstances a finding of lack of integrity was not appropriate.

Counsel for the interested parties submitted that sanction was an area in which the views of professional tribunals were to be given the utmost respect. No explanation had been offered as to why the appellant acted as he did. Disqualification was the only suitable response to conduct it had found to be deliberate and damaging to the NHS at a time of national need.

Amply justified conclusions

Delivering the opinion of the court, Lord Beckett began by noting a particular passage of the tribunal’s decision, which said: “The top up payment of 85 per cent was intended to act as a safety net to ensure preservation of practices and continuity of income. It was not intended to act as a lavish gift or an invitation to be unethically abused for financial advantage. The clear intention behind remobilisation was to encourage practices to speed up seeing and caring for patients, in order to begin to tackle the backlog of patients awaiting care and to meet ever-increasing patient needs.”

Considering this observation, he added: “The tribunal found that the appellant took steps to the disadvantage of his patients for financial advantage at a time of crisis in society generally, and in dentistry specifically. Given its findings, we infer that the tribunal considered that the appellant acted with a lack of integrity. In any event the tribunal was entitled to conclude, given the appellant’s conduct, that the professional requirements of a person carrying out skilled dental procedures at the expense of the public purse - for which the trust of individual patients, patients generally and health boards is essential - could not be met by the appellant.”

On whether the tribunal had properly assessed the appellant’s conduct, Lord Beckett said: “The tribunal properly assessed the appellant’s conduct and did not set unrealistically high standards or judge him against the standards of a paragon of virtue. The finding that the appellant had exploited the system and sought to sustain a level of payment under a scheme intended to mobilise dental services after their pandemic-enforced disruption, whilst reducing the numbers of patients he treated for financial benefit, and no therapeutic reasons so far as his patients were concerned, demonstrated a serious lack of integrity even if the tribunal did not use that term.”

He concluded: “The appellant broke the trust patients must place in their dentist by acting against their interests. Even allowing for the appellant’s long and otherwise unblemished career, appreciation of the whole circumstances amply justified the conclusions the tribunal reached on the evidence and submissions before it. We would add that if the appellant had not been disqualified from the health board lists but his patients knew what he had done and why, we consider that they would have been unlikely to continue to seek his services.”

The appeal was therefore refused on all grounds.