Grzelczak v General Dental Council

B e f o r e :

HIS HONOUR JUDGE SIDDIQUE (SITTING AS A DEPUTY HIGH COURT JUDGE) ____________________

____________________

Simon Butler and Atanas Angelov (instructed by BSG Solicitors LLP) for the Appellant Alexis Hearnden (instructed by General Dental Council) for the Respondent Hearing dates: 25 March 2026 ____________________

HTML VERSION OF APPROVED JUDGMENT ____________________

Crown Copyright ©

His Honour Judge Siddique (Sitting as a Deputy High Court Judge):

Introduction

Ms Hanna Grzelczak qualified as a dentist in 2003. Having trained and practised in Poland for seven years, she moved to the United Kingdom in 2009, obtaining further qualifications and registration with the General Dental Council (the "GDC"), the statutory body for regulating dental professionals in the UK.

On 24 September 2025, following a three day hearing, the GDC's Professional Conduct Committee (the "Tribunal") imposed on Ms Grzelczak a sanction of erasure with immediate suspension, following findings of misconduct and current impairment. Erasure is the most serious sanction available to the Tribunal under the Dentists Act 1984. It removes a registrant's name from the GDC's register and thereby deprives them of the legal right to practise dentistry in the UK. As GDC sanctions are published publicly, they also carry significant reputational and professional consequences.

Ms Grzelczak, represented by Mr Simon Butler, appeals against the Tribunal's decision on sanction under s.29(1)(a)(i) of the Dentists Act 1984. She submits that the Tribunal was wrong to impose a sanction of erasure, which was excessive and disproportionate. The GDC opposes the appeal. Ms Alexis Hearnden, for the GDC, submits that the sanction imposed was appropriate and necessary in the public interest.

Relevant Factual Background

Ms Grzelczak began working for Damira Dental Studios from January 2022, initially in a locum position and then permanently as an Associate Dentist at their Fareham practice, in Hampshire, from May 2022. Eleven months later, on 28 March 2023, Ms Grzelczak gave notice of her resignation, effective 30 June 2023.

From late July 2023, Ms Grzelczak wrote to Damira Dental Studios asking for her name to be removed from their website and online materials. In four emails she made remarks relating to "Indian" dentistry. Three emails were sent on 25 August, 26 August and 21 September 2023 to "Person A", an administrative member of staff described as having "an obviously Indian name." The 25 August 2023 email read:

The 26 August 2023 email read:

The 21 September 2023 email read:

"I am buying private practice.

I noticed my name Hanna Grzelczak dentist

In Google is connected with Damira practices.

On 22 September 2023, Ms Grzelczak wrote an email to Person B. Person B was also an administrative member of staff and is similarly described as having "an obviously Indian name." The email stated:

The Misconduct

Following a complaint and a subsequent investigation, four charges were brought, each relating to one of the four emails. It was alleged that the communications were:

a. unprofessional; and/or

b. inappropriate; and/or

c. racially motivated,

and that Ms Grzelczak's fitness to practise was impaired due to misconduct.

At the start of the Tribunal hearing on 22 September 2025, Ms Grzelczak formally admitted all the allegations.

The Legal Framework

By s.29(3) of the Dentists Act 1984, following an appeal against the Tribunal's decision, the High 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."

CPR 52.21(1) provides:

"(1) Every appeal will be limited to a review of the decision of the lower court unless—

(2) Unless it orders otherwise, the appeal court will not receive—

(3) The appeal court will allow an appeal where the decision of the lower court was—

(4) The appeal court may draw any inference of fact which it considers justified on the evidence."

CPR 52D, para 19.1 provides:

"(1) This paragraph applies to an appeal to the High Court under … (c) section 29 or section 44 of the Dentists Act 1984; …

(2) Every appeal to which this paragraph applies must be supported by written evidence and, if the court so orders, oral evidence and will be by way of re-hearing."

The approach to be taken by the court in an equivalent appeal under section 40 of the Medical Act 1983 was set out by the Court of Appeal in Sastry v General Medical Council [2021] EWCA Civ 623 , [2021] 1 WLR 5029 . Nicola Davies LJ, giving the judgment of the court, identified the following points as to the nature and extent of the appeal and the approach of the appellate court at [102]:

"(i) an unqualified statutory right of appeal by medical practitioners pursuant to section 40 of the 1983 Act;

(ii) the jurisdiction of the court is appellate, not supervisory;

(iii) the appeal is by way of a rehearing in which the court is fully entitled to substitute its own decision for that of the tribunal;

(iv) the appellate court will not defer to the judgment of the tribunal more than is warranted by the circumstances;

(v) the appellate court must decide whether the sanction imposed was appropriate and necessary in the public interest or was excessive and disproportionate;

(vi) in the latter event, the appellate court should substitute some other penalty or remit the case to the tribunal for reconsideration."

Measure of respect for the decision of a professional tribunal

When considering the measure of respect to be afforded to the decision of a professional tribunal, it was held in Sastry at [113]:

The central question, therefore, is whether the sanction of erasure was appropriate and necessary in the public interest, or whether it was excessive and disproportionate. Under s.29 of the Dentists Act 1984, the High Court's jurisdiction is by way of a rehearing, not a review. That distinction is critical. A rehearing requires the court to undertake its own evaluative assessment of the relevant facts and circumstances, and, where appropriate, to substitute its own judgment for that of the Tribunal. At the same time, the court must give a proper, though not undue, measure of respect to the Tribunal's expertise and findings. This balance was clearly articulated by Nicola Davies LJ in Sastry at [112]:

Thus, the approach in the present appeal stands in contrast to appeals by way of review, for example those under s.40A of the Medical Act 1983. In General Medical Council v Bawa-Garba [2018] EWCA Civ 1879 , a case concerning s.40A, the Court of Appeal explained at [61-67] that in an appeal by way of review, considerable respect is ordinarily to be afforded to the evaluative and multifactorial judgments of a specialist tribunal. The appellate function is consequently narrower. By contrast, an appeal under s.29 of the Dentists Act 1984 requires this court to undertake its own evaluative assessment of sanction, while ensuring that any deference accorded to the Tribunal's findings is no more than the circumstances warrant.

This approach is consistent with the wider line of authority. In General Medical Council v Jagjivan and another [2017] EWHC 1247 (Admin) ; [2017] 1 WLR 4438 , the Divisional Court held at [40]:

"(iv) When the question is what inferences are to be drawn from specific facts, an appellate court is under less of a disadvantage. The court may draw any inferences of fact which it considers are justified on the evidence: see CPR Part 52.11(4).

(v) In regulatory proceedings the appellate court will not have the professional expertise of the Tribunal of fact. As a consequence, the appellate court will approach Tribunal determinations about whether conduct is serious misconduct or impairs a person's fitness to practise, and what is necessary to maintain public confidence and proper standards in the profession and sanctions, with diffidence: see Raschid's case at para 16; and Khan v General Pharmaceutical Council [2017] 1 WLR 169 , para 36.

(vi) However there may be matters, such as dishonesty or sexual misconduct, where the court "is likely to feel that it can assess what is needed to protect the public or maintain the reputation of the profession more easily for itself and thus attach less weight to the expertise of the Tribunal …": see Council for the Regulation of Healthcare Professionals v General Medical Council and Southall [2005] EWHC 579 (Admin) at [11], and Khan's case at para 36. As Lord Millett observed in Ghosh v General Medical Council [2001] 1 WLR 1915 , para 34, the appellate court "will accord an appropriate measure of respect to the judgment of the committee … But the [appellate court] will not defer to the committee's judgment more than is warranted by the circumstances".

(vii) Matters of mitigation are likely to be of considerably less significance in regulatory proceedings than to a court imposing retributive justice, because the overarching concern of the professional regulator is the protection of the public.

(viii) A failure to provide adequate reasons may constitute a serious procedural irregularity which renders the Tribunal's decision unjust."

More recently, in Gilbert v General Medical Council [2026] EWCA Civ 53 , the Court of Appeal held at [57]:

The purpose of fitness to practise proceedings

Section 1(1ZA) of the Dentists Act 1984 makes clear that the "over-arching objective" of the GDC in exercising its functions under the Act "is the protection of the public." It is similarly well established in case law that the purpose of fitness to practise proceedings is not to punish a practitioner but to protect the public: see Ghosh v General Medical Council [2001] UKPC 29 ; [2001] 1 WLR 1915 , PC, at [35] and [39]; and Meadow v General Medical Council [2006] EWCA Civ 1390 ; [2007] QB 462 at [30] and [32]. In Meadow , Sir Anthony Clarke MR, giving judgment of the court held at [32]:

This is reiterated in the GDC's "Guidance for the Practice Committees including Indicative Sanctions Guidance" (effective 1st October 2016, revised December 2020). Para 1.6 provides:

Para 5.14 provides:

Para 6.1 provides:

Grounds of Appeal

There are five grounds of appeal. They concern the assessment of the risk of harm, the likelihood of repetition, whether Ms Grzelczak demonstrated a deep-seated and harmful attitudinal or personality issue, and whether a sanction of erasure was disproportionate. They are as follows:

a. Ground 1: The Tribunal was wrong to conclude that Ms Grzelczak posed a risk of harm to the public or individuals who might receive racially motivated communications in the future.

b. Ground 2: The Tribunal erred in determining that Ms Grzelczak was likely to repeat the conduct, and that that repetition could pose a risk of harm to future potential recipients.

c. Ground 3: The Tribunal was wrong to conclude that Ms Grzelczak's emails posed a risk of harm given that the witness statements of the recipients did not suggest they were harmed.

d. Ground 4: The Tribunal was wrong to infer that Ms Grzelczak's emails indicated a deep-seated and harmful personality or professional attitudinal issue.

e. Ground 5: Erasure was disproportionate and the Tribunal was wrong to conclude that a lesser sanction would not suffice.

Guidance for the Practice Committees including Indicative Sanctions Guidance (the "Sanctions Guidance")

Para 6.32 of the Sanctions Guidance provides:

There is no dispute between the parties that Ms Grzelczak's fitness to practise was impaired due to misconduct. On her behalf, it was also conceded that a sanction of suspension was appropriate and necessary in the public interest.

Suspension factors

In respect of the appropriateness of a sanction of suspension, para 6.28 of the Sanctions Guidance provides:

Erasure factors

In respect of the appropriateness of a sanction of erasure, para 6.30 of the Sanctions Guidance provides:

Para 6.34 continues:

The Tribunal's Determination and Reasons

Before turning to sanction, the Tribunal set out the mitigating and aggravating factors at paras 37 and 38 of its determination. In mitigation, it noted that Ms Grzelczak had expressed some remorse, made full admissions to the charges, accepted that her actions amounted to misconduct and that her fitness to practise was impaired, and demonstrated some, albeit limited, insight. It also took account of the time that had elapsed since the emails were sent, during which no further concerns had arisen, and the fact that Ms Grzelczak's conduct was not financially motivated. As to aggravating factors, the Tribunal noted Ms Grzelczak's relevant fitness to practise history relating to unprofessional communications (when she received a reprimand), the repeated nature of the misconduct over approximately four weeks, the risk of harm associated with the communications, the element of premeditation arising from the act of typing and sending four emails, and Ms Grzelczak's lack of full insight.

Suspension

The Tribunal set out its determination on sanction at paras 41 to 43. In addressing whether a period of suspension would be sufficient, it stated as follows:

Serious departure from the relevant professional standards

The Tribunal found Ms Grzelczak's misconduct represented "a serious departure from the professional standards expected of a registered dentist."

As this is one of the erasure factors in the Sanctions Guidance, it reasoned that suspension "would not be sufficient to meet the risks to the public and the wider public interest in the particular, and particularly serious, circumstances of this case."

I accept that Ms Grzelczak's misconduct represented a serious departure from the professional standards expected of a registered dentist, particularly the duties to treat colleagues with respect, to avoid discriminatory behaviour, and not to bring the profession into disrepute. Although the Sanctions Guidance treats such departures as a potential indicator for erasure, the factor is not determinative. Erasure is reserved for behaviour fundamentally incompatible with continued registration, such as an attitudinal concern that is entrenched or irremediable. In reasoning that suspension would not meet the risks to the public and the wider public interest, the Tribunal relied upon the following (at para 41):

a. the fact that there were "four separate emails over a period of approximately four weeks";

b. Ms Grzelczak "breached a fundamental tenet of the profession, namely the need to treat others with respect and not bring the profession into disrepute"; and

c. Ms Grzelczak's racially-motivated comments "connotes a deep-seated and harmful personality or professional attitudinal issue."

Whilst I accept these are relevant considerations, I am not persuaded that, without more, they demonstrate conduct of such gravity that a period of suspension would have been insufficient to protect the public, despite the aggravating features. First, the period over which the emails were sent was approximately four weeks. Four emails over four weeks is not a large number of incidents, nor does it necessarily amount to sustained, entrenched or escalating behaviour that might justify a conclusion that suspension is insufficient. Although the Tribunal correctly characterised the behaviour as "repeated", the repetition here is limited and episodic. Indeed, para 6.28 of the Sanctions Guidance identifies evidence of repetition as a factor that may point towards suspension.

Second, many cases of misconduct, including those at the lower end of the spectrum, can properly be said to involve a failure to treat others with respect or risk bringing the profession into disrepute. These are broad, principled standards which require context and degree. A breach of such a principle does not, of itself, establish that the conduct is so grave that erasure, rather than suspension, is the only proportionate response.

Third, I recognise that the Tribunal found that the racially motivated comments "connotes a deep-seated and harmful personality or professional attitudinal issue", and that this might elevate the seriousness of the misconduct. There is no dispute between the parties that Ms Grzelczak's misconduct meant that her fitness to practise was impaired. However, it does not necessarily follow that any attitudinal concern is irremediable. Such concerns are not listed under the 'Erasure' section of the Sanctions Guidance. Instead they appear under 'Suspension', where the Guidance notes that the presence of such a factor might make erasure the appropriate order. In my judgment, the use of the word "might" is significant. It does not create a presumption in favour of erasure, nor does it displace the need for a Tribunal to examine whether the attitudinal concern is entrenched, longstanding, or irremediable. As Fordham J stated in Robert Lambert-Simpson v Health and Care Professions Council [2023] EWHC 481 (Admin) at [24]:

Erasure

In respect of a sanction of erasure, the Tribunal stated as follows:

Insight

The Tribunal's findings on whether Ms Grzelczak's had demonstrated insight are detailed at paras 29 to 31 as follows:

On behalf of Ms Grzelczak, Mr Butler submits that the Tribunal did find that she had demonstrated some insight. Whilst that is correct, it is not the full picture. It is clear from the above that the Tribunal's determination was that Ms Grzelczak's insight was "limited", finding she had "not engaged properly" with the nature of her misconduct, "sought to downplay…culpability" (by referring to her comments as 'illogical', 'nonsense' and 'silly'), not demonstrated that she fully understood how offensive the comments were and their impact on the public's trust and confidence in the profession, and had "provided little in the way of a coherent explanation" for why she used racially motivated language.

In my judgment, the Tribunal was justified in finding that Ms Grzelczak's insight at the material time was limited. First, there was a late admission that the emails had been racially motivated. It was agreed at the hearing that her "Reflections" statement was provided on day one of the hearing, on 22 September 2025. Until then, Ms Grzelczak's position, as outlined at paras 19 and 20 of her witness statement dated 23 July 2025, was as follows:

Ms Grzelczak's July 2025 explanation that she had "erroneously" included the CEO's Indian nationality does not withstand scrutiny. The reference appeared on at least four occasions, indicating that it was not a single mistaken inclusion. It is also relevant that these emails were sent while she was simultaneously engaged in an unrelated fitness to practise hearing, a situation she said placed her "on high alert" to avoid any conduct that might be perceived as dishonest. Against that background, I do not accept her suggestion that she sent the emails simply to avoid "confusion" or to prevent misleading the public.

It is plain from the emails that Ms Grzelczak was upset and angered over whatever had happened between herself and Damira Dental Studios. She desired a speedy disassociation from Damira Dental Studios, seeking to justify this, at least in part, on the basis that Damira Dental Studios was "nhs low quality service and this is Indian company! It is a shame to me." Whilst her subsequent September 2025 statement acknowledged that she used "irrational, racist words to express my frustration and reach my objectives", Ms Grzelczak continued to explain her conduct in these terms: "I was strictly adhering to the rules and aiming to demonstrate a zero tolerance approach to any dishonesty in my life and I lost sight of the need to maintain professionalism and respect towards dental professionals."

In her evidence before the Tribunal, Ms Grzelczak accepted (at page 262 of the Trial Bundle): "…I was driven by anger, frustration, irrational emotions and this is how I lash out." In my judgment, this undermines her later suggestion that her use of racist language arose from an intention to be transparent or to avoid misleading the public. Although Ms Grzelczak did not explicitly describe her conduct as a misguided attempt "to demonstrate a zero tolerance approach to any dishonesty", her explanation implied that the repeated references to ethnicity reflected a wish to be accurate. I do not accept that account given her reference to feeling shame upon being connected an "Indian company." As the Tribunal found, this does not coherently explain the repeated use of racially motivated language. On the evidence, I find that Ms Grzelczak lashed out in anger, using racist comments because she knew they would be hurtful. I therefore agree with the Tribunal's findings that she has not "engaged properly with the nature of [her] misconduct", has "sought to downplay [her] culpability", and has demonstrated only limited insight.

Whilst I agree with the Tribunal that Ms Grzelczak's insight at the material time was limited, I do not accept that the evidence supports a conclusion that she demonstrated the kind of persistent lack of insight contemplated in the Sanctions Guidance as a factor pointing towards erasure. The Guidance identifies "a persistent lack of insight into the seriousness of actions or their consequences" as behaviour fundamentally incompatible with ongoing registration.

However, Ms Grzelczak admitted the allegations in full at the outset of the hearing, accepted that her conduct amounted to misconduct, and accepted that her fitness to practise was impaired. She produced a written reflections document, albeit belatedly, and engaged with questions from the Tribunal concerning the nature and seriousness of her actions. Although at times her explanations were inadequate and revealed attempts to minimise or rationalise her conduct, they do not demonstrate an entrenched or enduring refusal to acknowledge wrongdoing. Rather, they point to an individual who struggled to articulate coherent insight, particularly in relation to the racist nature of her comments, but who nevertheless accepted responsibility for their behaviour and its consequences. In my judgment, this evidence falls materially short of establishing the kind of sustained, deep-seated attitudinal defect or persistent lack of insight that would render erasure the only proportionate sanction.

Remediation

Having concluded that Ms Grzelczak's insight was limited, the Tribunal found (at para 29): "Similarly, whilst the Committee notes that you have taken some steps to attempt to remedy your misconduct, the Committee finds that these steps are minimal." At para 31, it identified "shortcomings in [Ms Grzelczak's] remediation", but did not explain what those shortcomings were.

On 21 July 2023, about a month before the first of the four misconduct emails,

Ms Grzelczak participated in the 'Practitioner Advice and Support Scheme' (the "PASS scheme"), as part of the outcome of an earlier fitness to practise hearing. The skeleton argument on behalf of the GDC submits that on 15 December 2024, upon completion of the PASS scheme, Ms Grzelczak's mentor recorded: "Reflection writing has not been her strength and she accepts it. She has been advised about its importance and ways to improve for the future." The full paragraph reads:

Whilst there was reference by the mentor to Ms Grzelczak's reflection writing as having "not been her strength", that is not the same as saying there were shortcomings. Indeed, the overall finding on her progress was recorded as follows:

There is no dispute that Ms Grzelczak completed relevant CPD modules that were consistent with the PASS scheme's fourth objective, described as "Professional Ethics." The modules were:

a. 'Maintaining Appropriate Personal & Professional Behaviour' on 12 March 2024.

b. 'Professionalism' on 16 September 2024.

c. 'Communicating with Professional Colleagues' on 18 September 2024.

d. 'Equality and Diversity in the Dental Practice' on 9 July 2025.

e. 'Maintaining Appropriate Personal & Professional Behaviour' on 10 July 2025.

The last two CPD modules from July 2025 were completed by Ms Grzelczak after the mentor's comments of 15 December 2024 and after completion of the PASS scheme. The accompanying "reflective learning" from Ms Grzelczak for the 10 July 2025 module reads as follows:

"What did you learn from this course?

I recognise that the completion of relevant CPD modules with accompanying reflective writing may be an area where ordinarily I ought to defer to the expertise of the Tribunal. However, the Tribunal did not adequately explain its finding, as it did not identify the shortcomings in remediation or give reasons for that conclusion. If the Tribunal's finding on remediation was based on the PASS scheme mentor's December 2024 comments, in my judgment this is not a fair assessment of the totality of the evidence, given Ms Grzelczak's continued engagement with relevant CPD modules and ongoing attempts to improve her reflective writing in July 2025. Indeed, there appears to have been little, if any, recognition of this in the Tribunal's determination.

The risk of repetition

At para 31 of its determination, the Tribunal found that the "resulting lack of insight" meant that it "cannot be satisfied that a risk of [Ms Grzelczak] repeating [the] misconduct is highly unlikely." It went on to find: "Your lack of insight is mirrored by, and is no doubt likely to have resulted in, shortcomings in your remediation." At para 32, the Tribunal found that Ms Grzelczak posed "a risk to the public on account of the shortcomings in your insight and remediation" such that she was "liable to repeat [her] misconduct."

Whilst I agree with the Tribunal's finding that Ms Grzelczak's insight was limited, I do not accept that it demonstrated a persistent lack of insight. Nor do I agree with the Tribunal's findings on remediation, for the reasons I have already given. When giving evidence on why she would not repeat her misconduct, Ms Grzelczak stated the following (at page 269 of the Bundle):

When asked whom she could reach out to for support in the future, Ms Grzelczak continued:

I find that Ms Grzelczak's evidence is consistent with her completion of the PASS scheme, the CPD modules completed thereafter, and her improved accompanying reflective learning. Additionally, I find that a period of suspension, with its consequential impact on reduced income and professional reputation, is likely to have a strong deterrent effect that would reduce the risk of repetition. This is not a factor that the Tribunal appears to have considered. Whilst limited insight may increase the risk of repetition, it is not determinative.

Taken together, the passage of time without further incident, Ms Grzelczak's admissions and engagement with remediation, including her limited reflective work, her oral evidence indicating some behavioural change, and the prospect of suspension itself operating as a significant disincentive from further misconduct, all point towards a reduced risk of repetition.

The risk of harm

Even if I am wrong in my conclusion on the risk of repetition, the language used in the Sanctions Guidance in relation to erasure refers to cases "where serious harm to patients or other persons has occurred" or "where a continuing risk of serious harm to patients or other persons is identified." By contrast, when addressing the issue of harm, the Tribunal consistently articulated its analysis in the following terms:

a. "The Committee considers that you are liable to repeat your misconduct, and that such a repetition entails a risk of harm to a person or persons who could receive racially-motivated communications from you in the future." (para 32);

b. "Your misconduct was sustained and repeated over a period of approximately four weeks. Your conduct posed a risk of harm." (para 38);

c. "In the Committee's judgement the public would be placed at unwarranted risk of harm if no action were taken or if a reprimand were issued." (para 39); and

d. "Your unremediated behaviour presents an ongoing risk of harm to a person or persons who could receive racially-motivated communications from you in the future." (para 42).

The Tribunal did not identify either actual serious harm or a risk of serious harm, as contemplated in the Sanctions Guidance as indicating when erasure may be appropriate. Whilst the Guidance does not prescribe mandatory criteria, it provides an important framework against which the proportionality of erasure is ordinarily assessed. On the Tribunal's own findings, the harm it identified fell materially short of the level of seriousness the Guidance associates with the most severe sanction. Its findings were consistently and expressly framed only in terms of a general risk of harm, rather than a risk of serious harm. Accordingly, even if I am wrong in my assessment of the risk of repetition, the Tribunal's findings on harm do not support erasure on public protection grounds.

My own assessment of Ms Grzelczak's emails is that whilst they were plainly offensive, inappropriate and racially motivated, they do not approach the level of conduct that would give rise to a risk of serious harm of the kind contemplated in the Sanctions Guidance for a sanction of erasure. The four emails consisted of disparaging and racially motivated remarks directed at an organisation and at administrative staff, expressing a wish not to be associated with "Indian dentistry", describing Damira Dental Studios as an "Indian company", referring to "Indian implants", and asserting that "Indian should share money with Indian."

Such comments represented a serious departure from the professional standards. However, they were confined to written communications sent to administrative staff at Damira Dental Studios and did not directly threaten or personally target those individuals with abuse. The emails did not involve patients, nor give rise to any immediate risk to patient safety, clinical care, or the physical or psychological wellbeing of others. Whilst they had the potential to cause some distress and harm, their gravity lies in their unprofessional and racially motivated nature rather than in any potential to cause serious harm.

The Appropriate, Necessary and Proportionate Sanction

Taking all of these matters together, a fair and balanced application of the Sanctions Guidance, informed by relevant authority, leads me to conclude that a period of suspension is capable of addressing the public protection and public interest concerns raised by Ms Grzelczak's misconduct. Erasure would therefore have been excessive and disproportionate. The threshold for erasure is met only where the misconduct has caused serious harm or presents a continuing risk of serious harm, or where the behaviour is so fundamentally incompatible with continued registration that no lesser sanction will suffice. That would include, for example, cases where the attitudinal concern is entrenched or irremediable. This is not such a case.

In my judgment, a period of suspension is both appropriate and necessary in the public interest. Suspension is expressly contemplated by the Sanctions Guidance in circumstances where there is evidence of repetition of the behaviour and where a registrant has not shown insight. It is a sanction that will mark the seriousness of the misconduct, uphold professional standards, and provide an opportunity for Ms Grzelczak to demonstrate continued remediation.

The Sanctions Guidance makes clear that when imposing a period of suspension, the Tribunal must decide whether the suspension is to be lifted automatically at its conclusion or whether a review hearing will be required. Para 6.23 states that if a review hearing is to take place, the Tribunal should indicate what information it expects the registrant to provide at that review. Para 6.29 further provides that the Tribunal may specify appropriate and practical actions for the registrant to complete during the suspension period and that such actions should be capable of verification.

Applying those principles, I consider that a period of suspension of 6 months, taking effect on the determination of this appeal, is justified and proportionate. The misconduct was serious, racially motivated and repeated. A shorter period would not afford sufficient opportunity for Ms Grzelczak to undertake meaningful remediation or adequately reflect the gravity of the misconduct for the purposes of maintaining public confidence and upholding proper professional standards. Given the attitudinal concerns identified and the limited insight demonstrated to date, this suspension will be subject to a review hearing at its conclusion.

At the review hearing, Ms Grzelczak will need to provide further evidence demonstrating that she has maintained and built upon the remediation already begun. That evidence should include continued completion of CPD addressing issues of discrimination, respectful communication and professional behaviour, with accompanying reflective learning. Ms Grzelczak should also provide a substantive and updated reflection statement demonstrating insight into her misconduct, its impact on public confidence, and how she will avoid repetition in the future.

Conclusion

For the reasons set out above, I conclude that the Tribunal's approach to sanction was flawed. It misapplied the Sanctions Guidance, failed to identify or explain the asserted shortcomings in remediation, and reached a conclusion on proportionality that the evidence did not support. Whilst I accept that Ms Grzelczak has demonstrated only limited insight into her misconduct, there is nevertheless evidence of remediation, a reduced risk of repetition, and no identified risk of serious harm. In those circumstances, the sanction of erasure was excessive and disproportionate. In my judgment, a period of suspension is both appropriate and necessary in the public interest. Accordingly, the appeal is allowed. I therefore substitute the sanction of erasure with a direction that Ms Grzelczak's registration be suspended for a period of 6 months, such suspension to be subject to a review hearing at which the matters identified above are to be addressed.