On January 16th 2018, NHS England issued a Specialised Services Circular, entitled:
It states that “regulatory guidance and NHS England’s current commissioning protocol supports a decision by a GP to accept a request made by a private on-line medical service to assume responsibility for prescribing, and for monitoring and testing, in cases where the GP is assured that the recommendation is made by an expert gender specialist working for a provider that offers a safe and effective service.”
In order to provide the necessary reassurance to GPs uncertain about providing transgender healthcare or working in a shared care arrangement, I have outlined my professional expertise which qualified me to treat transgender patients.
Dr Mike Webberley
Consultant Physician and Gender Specialist
MBChB FRCP MD
I am a highly experienced and respected Consultant Physician of 23 years’ standing and 34 years of service to the NHS. My scope of practice has been fully discussed through my appraisals, the last of which was with Professor Anil Dhawan, Professor of Paediatrics at Kings College Hospital, London.
I am more than adequately qualified in terms of credentials, years of practise and experience to diagnose, medically manage, and surgically refer, transgender patients. I act within my professional competency at all times.
I qualified in 1982 and my postgraduate training was undertaken in Birmingham.
I spent 2 years working for Professors Ken Taylor and Ronald Fletcher in endocrinology, before moving sideways into Gastroenterology. Dr Ronald Fletcher was a highly skilled endocrinologist and had particular interest in hypogonadism and delayed puberty and so I gained considerable experience in this field and in particular, hormone treatment. During this time I published twice in this specialty and indeed have published widely in many fields.
As a Registrar and Senior Registrar I spent 3 years in research (running concomitantly with busy clinical posts) and was awarded an MD in 1991 through Ninewells Hospital, Dundee Medical School. This doctorate confirmed that I was able to research, evaluate and appraise clinical papers and data, at a high level.
I gained subspecialty accreditation in Gastroenterology and Hepatology as well as continuing general medical training. As a resident MO I was frequently involved with the medical management of children and adolescents as there were no ‘on-site’ paediatric senior medical staff.
Between 1990 – 1991 as a Senior Registrar, I managed the inpatient HIV ward at Birmingham General Hospital. This was the first ward of its kind in Birmingham, attached to the Birmingham Special Clinic (run by Dr Mohsen Shahmanesh).
This was regarded as a ‘high risk’ post as it involved numerous invasive investigations and interventions. I worked closely with the LGBTQ community.
I was a Consultant in Worcester from 1994 – 2005 and was appointed as ‘General Physician with an interest in Gastroenterology and Hepatology’. I was on call for general medicine once a week and ran a 32-bedded general medical ward. As well as treating adults I was involved in the medical management (including endoscopy) of adolescents with disorders of the gastrointestinal tract, at the request of the local Consultant paediatricians. This was primarily because waiting times at the Birmingham Children’s Hospital were very lengthy. To this end I was trained in child safeguarding and Paediatric Advanced Life Support (PALS).
From 2004 I was a Consultant Acute Physician until I left NHS Wales last year.
As a Consultant Acute Physician I have managed countless patients with diverse general medical problems. I have a very broad knowledge base of all medical specialties at secondary care level, plus expertise in Gynaecology, general surgery, paediatrics and psychiatry. I would frequently see 20 to 30 new patients on a daily basis and spanning my career have looked after tens of thousands (possibly hundreds of thousands) of general medical patients of all specialties.
I have on numerous occasions through my career, referred patients to other specialist surgical services including the referral of transgender patients for consideration of gender-affirming surgery.
As you are aware any referral for consideration of surgery is by definition a request for a second opinion and ultimately it is the surgeon’s responsibility whether or not they agree to operate.
I have held highly responsible senior managerial roles and take clinical governance very seriously.
- I was Clinical Director for Medicine for 10 years.
- Chief of Staff for Emergency care and Associate Divisional Director for Unscheduled care across 3 hospital sites for 8 years.
- I was managerially responsible for all the ED Consultants, Acute Physicians and senior medical staff and was instrumental in setting up Ambulatory care centres for walk-in GP patients on all 3 sites.
- My efforts were warmly praised by the then President of the Royal College of Physicians (Sir Richard Thompson) who came to see my processes for himself and declared them to be a ‘fine example of a future model for emergency medical care’.
- To this end, I was responsible for developing treatment pathways and SOPs for all medical conditions.
- I was responsible for ensuring that principles of equality and diversity were fundamental to the working practice of all the Acute units.
- I chaired a working party, examining the feelings of prejudice and discrimination experienced by the LGBTQ community in the Emergency setting.
- I was Training programme Director (TPD) and Specialist Training Committee (STC) chair for Acute Medicine, Wales.
- I was a member of the RCP question-setting team for the Acute Internal Medicine (AIM) higher specialist examination.
- I sat on the RCP Specialist Advisory Committee (SAC) for AIM and represented the Royal College of Physicians SAC for GIM and AIM on at least 30 occasions, by chairing Penultimate Year Assessment (PYA) committees on behalf of the JRCPTB.
- I have excellent knowledge of the COPMeD UK ‘Gold guide’ and GMC medical training curricula, which identify training curricula for all medical specialties. Consequently I am aware that the words ‘transgender’ or ‘transsexualism’ do not even appear in the training curricula for Paediatrics, Paediatric endocrinology, Endocrinology or Psychiatry.
- I was the Regional Specialty Advisor for Wales for Acute Medicine and represented the Royal College of Physicians numerous times for Consultant appointment committees (AACs) in both England and Wales. In this role I had to approve job descriptions for Consultant posts as well as sit on the appointment committees.
In terms of transgender care, I have been involved in the management of thousands of transgender patients both in the emergency and non-emergency setting, I am widely read in the field. I am a full member of WPATH.
My prescribing of GnRH agonists as well as GAH are both within my competency and within my scope of practice, as identified at my appraisals.
My MD allows me to critically appraise data and research in this field.