Six years after she was suspended for professional misconduct, Singapore surgeon Susan Lim has been dealt a fresh blow by the UK's Court of Appeal.

The UK's General Medical Council (GMC) had taken issue with Dr Lim for failing to notify it of the outcome of the Singapore Medical Council's (SMC) 2012 decision to suspend her from practice for three years after she billed a patient excessively in August 2007.

Dr Lim last year failed in a legal challenge in a London court to stop a GMC probe into her behaviour.

Her appeal against the London High Court decision has now been dismissed by the UK's three-judge Court of Appeal.

"A doctor is expected timeously to notify the GMC of a finding of guilt elsewhere," Lady Justice Anne Rafferty wrote in last month's decision grounds.

Singapore-based Dr Lim has been registered with the GMC for about 30 years and she attained a scholarship-funded doctorate from the University of Cambridge. It is understood, however, that she has never practised in Britain.

At issue in the hearing was when Dr Lim should have informed the GMC about the SMC's decision - which was made on July 17, 2012, following a lengthy, high-profile case.

After a court appeal in Singapore by Dr Lim failed, the SMC notified the GMC on July 15 the following year that she had been suspended from the Singapore register as of July 2, 2013.

Dr Lim told the GMC that her failure to inform it about the SMC's decision was not misconduct because her GMC membership was effectively honorary, among other things.

A GMC spokesman told The Straits Times that based on public records, Dr Lim is currently registered with it, but has no licence to practise - although she did have one between November 2009 and September 2014. Dr Lim should also have notified the GMC, according to its Good Practice Guide.

The GMC referred her case to a fitness-to-practise panel in relation to the SMC's misconduct ruling and Dr Lim's failure to inform the GMC without delay.

Dr Lim, an expert in robot-assisted surgery and stem cell research, sought a judicial review in London in 2016 to clarify the GMC panel's interpretation of the rules, but failed in her bid to stop the inquiry.

She appealed and at a hearing last October, her UK lawyers argued that the judge was wrong in holding that she was under a duty to notify the GMC.

Dr Lim added that the GMC's "five-year rule" prevented the GMC's inquiry of the case from proceeding since the final episode of misconduct occurred in August 2007.

The appeals court disagreed and found that the duty to report started from the time of the SMC's finding in 2012.

"Six years after the misconduct in this case, the GMC remained ignorant of the SMC's proceedings," added Lady Justice Rafferty. "It would be surprising were it permissible, let alone acceptable, that the appellant should have been found guilty of professional misconduct but had no obligation to notify the GMC."