Stage 1: Procedural discussions
Stage 2: The GMC to make out their case on each point claimed and the tribunal will then decide which are substantial enough to be a case to answer. Dr Webberley only has to answer the ones which have been deemed substantial enough. (She wins any others automatically.)
Stage 3: Dr Webberley’s counsel has an opportunity to respond and mount her defence and the Tribunal make a decision on the allegations.
On day one of the hearing counsel for both parties determined what evidence would be admissible and what would not. Dr Webberley’s counsel Ian Stern QC requested that the emails from trans people desperately seeking her medical help be included as testimony of the great need her patients were in was key to her decision making. It was eventually agreed that some of these emails (non anonymised and non-redacted) could be admissible.
Simon Jackson, QC, counsel for the GMC, alleged that Dr Webberley has self-identified as a gender specialist but should not be considered one. In particular, he pointed out that there is no specialisation in transgender medicine outside of hospitals.This assertion has been poorly received online, with respondents commenting that there is no pathway for GPs to acquire specialisation. There are no NICE guidelines for transgender healthcare, and the specialisations within hospitals are largely concerned with surgical interventions.
The implication is that GPs who want to help support transgender patients while they wait for an oversubscribed specialist service have no pathway to follow. Some Twitter commentators have identified the catch-22 that this puts doctors in – they can’t help trans patients because they don’t have the relevant specialisations, the existing specialist services are unable to provide care, and there is no pathway in this country to acquire the specialisation.
There was a similar response to the claim that the GMC don’t want GPs to feel forced into prescribing outside of their competency. While many commentors are sympathetic to GPs – who, after all, are in the same position Dr Webberley was – this approach suggests that trans and non-binary patients cannot expect the same treatment from their GP as cisgender patients. Some Tweets suggested that, with trans people making up an estimated 1% of the population (~666,500 people, although the Government Equalities Office has a lower estimate at 200,000-500,000), GPs should be able to access education relating to their treatment. In fact, 40% of transgender people have had a negative experience of accessing public healthcare as a consequence of their gender identity, and 18% have avoided seeking help with a medical issue for fear of a negative reaction. Other commenters following the hearing expressed frustration at the fact that GPs already have a lack of knowledge around trans healthcare, or do not feel empowered to treat trans patients. Testimonials submitted to GenderGP in support of Dr Webberley told stories of GPs who would not even make referrals to the GICs, let alone providing bridging healthcare.
This makes the allegation that Dr Webberley provided of a standard that was not on par with the NHS all the more frustrating, when so many trans and non-binary people are getting little or no care from primary care providers and cannot access specialist services because of the waiting times.
What do you do when the standard becomes “exceptional”?
The rules are assuming a TFRTT of at most 18 weeks. Instead it can be upwards of 5 years, routinely at least 2. https://t.co/23pZS6pi74
— RozRaidReborn😈 🏳️🌈 (@RozRaidReborn) July 28, 2021
Professor Gary Butler, consultant in Paediatric and Adolescent Endocrinology at University College London Hospitals was the GMC’s first witness. When Ian Stern raised the issue of wait times for Tavi and how they might lead people to private clinics Professor Butler requested that they leave this line of questioning and asked the tribunal council to make Ian Stern return to questions surrounding Patient A. The tribunal council refused Professor Butler’s request.
Simon Jackson said during the hearing that bridging hormones should only be used in exceptional circumstances, leaving people online to question whether waiting lists reaching to five years and more qualify as ‘exceptional’. If this level of denial of service isn’t ‘exceptional’, what is? The GMC itself issued guidance to GPs advocating for the use of bridging hormones where doing so would mitigate the risk of self-harm or self-medicating while waiting for specialist services.
During the hearing Professor Butler asserted that puberty blockers should only be used as a temporary measure. However, he conceded during cross-examination that patients as young as ten had been prescribed puberty blockers on the NHS, and that patients of this age would have to wait six years or more to start gender-affirming hormones. He went on to say that the NHS had been considering offering gender-affirming hormones to children under 16, but had not pursued these plans owing to the danger of legal issues.
Simon Jackson also referred to the additional responsibilities involved with prescribing unlicensed medications, alleging that Dr Webberley did not have the relevant competency to prescribe these medications in the context of transgender care. Like Simon Jackson’s suggestion that GPs should not have to prescribe outside their competency, this suggests that there should be one system for trans people and another for cisgender patients. Unlicensed medications, including hormone therapies, are routinely prescribed off-label by GPs in paediatric medicine, reproductive health, and other treatment pathways. The GMC’s own expert witness Professor Butler stated on Day 3 that it is common practice to prescribe and use unlicensed medication, and protested against the description of puberty blockers as experimental.
(For more on the use of unlicensed medication see here)
Simon Jackson claimed that, in the case of gender dysphoria, most GPs will have no experience with dealing with these patients, and that the treatment for transgender patients is extremely specialised and should be provided by specialists rather than GPs. Online commentators reacted with anger at the idea that trans people are being treated as something to be dealt with, and the idea that trans people should expect to have reduced access to healthcare.
An audacious, ill-informed & prejudiced claim from the GMC: “dealing with these patients” or, in non bigoted terms, ‘providing care to patients who are Transgender’, is routine given ~1% of the population is Trans. Treatment no more specialised than any other endocrine condition. https://t.co/QcLe9tCjCF
— TransHealthNow (@DadTrans) July 28, 2021
Simon Jackson also alleged that Dr Webberley could not have properly obtained informed consent to puberty blocker treatment from the patients in question because of the high percentage of these patients who go on to gender-affirming (their words: cross-sex) hormones. The implication is that young people are not only consenting to puberty blockers but to gender-affirming hormones as well and that this is an obstacle to obtaining informed consent. He even went so far as to say that young people who are looking to begin gender transition should have their expectations dampened by psychiatrists with regards to their future. Some people online have credibly described this as tantamount to conversion therapy, because it presents transition as less desirable than an identity that corresponds to the sex assigned at birth.
Sending kids to “a psychiatrist to dampen any unrealistically high expectations of future life and ensure they are informed of limitations for e.g on sex life” is conversion therapy. https://t.co/n9OJlzUtIa
— Dra Jara Juana Bermejo-Vega 🏳️🌈 #HabráLeyTrans (@queenofquanta) July 28, 2021
In our article on puberty blockers we provide evidence showing that supporting gender-variance is important to child development regardless of gender identity, and that even children who later settle into cisgender identities still benefit from being allowed to explore their gender. This is supported by the WPATH guidelines, which recommend “ensuring that the child has ample possibilities to explore gender feelings and behavior in a safe environment.”
In fact, Simon Jackson’s assessment of informed consent puts trans and non-binary people in an impossible position. He claims that gender dysphoria may cause such serious distress that transgender people may not be capable of fully understanding the consequences of treatment. However, this puts the onus on trans people to either A) Not be so distressed that they can access treatment or B) Live with distress so serious that it supposedly impacts their ability to consent to treatment. One person on Twitter responded:
trans people simply cannot win. if we don’t show enough distress, they won’t give us healthcare. if we do, they won’t give us healthcare https://t.co/6rrHFRHNyG
— aaron (@philosophequeer) July 28, 2021
Simon Jackson also asserted that young people presenting as the opposite gender are statistically more likely to be gay adults. This was met online with anger at the erasure of trans and non-binary people and calls for citations, which have as yet not been provided. He may be drawing on studies described in the WPATH guidelines, which suggest that “Boys in these studies were more likely to identify as gay in adulthood than as transgender”. However, there are two important clarifying points. First, the most recent of these studies was conducted in 1995, and so is hardly appropriate in relation to Dr Webberley’s patients, some 25 years later. And secondly, the WPATH guidelines go on to say that persistence of transgender identity into adulthood is significantly higher (100% in their own study) in adolescents. Given that adolescence can be clinically defined as the onset of puberty, and that all of the patients in question had at least begun puberty, it is misleading for Simon Jackson to make this claim with regards to this hearing.
Furthermore, the claim that trans young people are another LGBT+ identity that has been misidentified resembles the debunked theory of Rapid Onset Gender Dysphoria. No clinical basis has been offered for presuming that young people who present with gender-incongruence or gender dysphoria are gay rather than trans, and to make this presumption is both transphobic and homophobic.
We do have evidence that the vast majority of people (~98%) who transition do so happily and without transition-related regret, and that the vast majority of people who detransition (~90% of detransitioners) do so because of external pressures rather than transition-related regret. There does not appear to be any compelling evidence that “young people presenting as the opposite gender” are more likely to be gay adults, OR that transition is wrong for these people.
We have compiled a lot of relevant evidence in our detransition post.
During the hearing Dr Webberley admitted to counts 10a, 28a, 28b and 29. These relate to issues to do with Dr Webberley’s prior conviction when her efforts to register her online clinic were rejected and she was charged and convicted instead. The other issue regards membership of the RCGP. Dr Webberley denies all the other allegations.
After three days of hearing from the GMC’ it seems that much of the case against Dr Webberly rests heavily on discredited anti-trans points from the Bell v Tavi case, (a ruling since partially overturned by the AB case.)
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