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Dr Agnew returned to finalise his testimony, and reiterate his belief that MDTs are the best way to provide care for youths with gender dysphoria. Dr Agnew admitted to having no experience in diagnosing gender dysphoria, nor having any experience treating patients for gender dysphoria. Dr Agnew told the tribunal that his only direct experience with trans patients was approximately 6-12 patients he treated for their autism. He also admitted that if other clinicians indicated that a patient he was seeing had gender dysphoria, that as this was outside of his area of competence, his practice would be to refer them back to their GP. (Perhaps a GP like Dr Webberley?)

 

 

While Dr Agnew acknowledged that gender dysphoria was outside his area of competence he also suggested that his work in the voluntary sector and psychological services gave him the necessary expertise to talk about whether Dr Webberley’s approach to treating trans patients had been adequate. Like Dr Webberley, he said, he has experience both inside and outside of the NHS. The Tribunal Chair asked why this more general expertise should be relevant to transgender patients? Dr Agnew said that he could comment or contribute, even if he wasn’t a specialist in this field. It is hard to understand how a GMC expert (who admits to having no experience in the field of transgender healthcare), is somehow equipped enough with “general” expertise to pass judgment on Dr Webberley’s practice and expertise.

Dr Agnew held firm to his incorrect belief that WPATH indicated that MDTs were the only way to care for trans youth. He stated that MDTs are necessary, despite being prohibitively expensive, to ensure the relevant specialisations are always available to the patient.

Dr Agnew said that the knowledge necessary to refer to other specialists for gender-affirming care could not be developed as transferable skills. This is an odd claim as the basis of most GPs practices is referring on to various specialists, something GPs are well able to do.

 

 

It became clear that the evidence the GMC had given Dr Agnew to report on, had not contained sufficient information about Dr Webberely and her skills and training. Dr Agnew admitted that he hadn’t been aware of the extent of Dr Webberley’s learning or background, saying he thought she was ‘just a GP’. Dr Agnew was also ignorant of the method of care Dr Webberley was using, the ‘hub and spoke’ model.

 

 

Despite Dr Agnew’s repeated insistence that MDT’s are the best way to treat trans children, he later acknowledged that there are other centres of excellence that do not use MDTs and that the WPATH guidelines allow for a variety of approaches. He also testified to the culture of fear and controversy around providing care to trans youth in the UK. He admitted it would be hard for private practitioners to feel confident they would receive a “warm embrace” from the NHS, and thus it would have been difficult for Dr Webberley to work with in conjunction with the NHS in putting together an MDT.

Describing how patients with gender dysphoria came to him seeking support for ASD, Dr Agnew said that “gender dysphoria isn’t an emergency condition”, and that patients with distress from gender dysphoria should not be treated with puberty blockers or gender-affirming hormones. One of the tribunal members asked Dr Agnew did this mean he would leave a child in distress? Dr Agnew replied that he would treat the distress and try to develop coping methods, etc. He even went so far as to suggest CBT as a treatment for the distress caused by gender dysphoria. He gave no evidence as to how or why this would help distress caused by gender dysphoria, perhaps due to his own self-admitted ignorance in this area.

 

 

Anyone familiar with the stress trans children experience – particularly as they approach puberty and if they can’t get access to medication – knows how wrong this is. One of the allegations against Dr Webberley is that she has provided inadequate care, and it is claimed that this led to – or at least could have caused – poor mental health outcomes for her patients. Though as we have seen, the poor mental health outcomes came after Professor Butler removed the gender affirming hormone treatment from Patient A, not from the care Dr Webberley provided. It is hard to know if it is ignorance or callousness that would cause a health care professional to state that gender dysphoria in children isn’t an emergency condition.

 

 

Dr Agnew admitted that Dr Webberley appeared to have a genuine desire to help the trans community, as evidenced by her low rates and the exchanges he had read between Dr Webberley and her patients. He said that this area of healthcare is surrounded by controversy and negative press attention and that you need “a bit of steel” to work in this area. He also said that the vast majority of young patients treated for gender dysphoria “go on to do very well”.

Dr Agnew’s main criticism of Dr Webberley was that she didn’t use an MDT model of care. The Chair correctly pointed out that Patient A and his mother were very unhappy with the care they received from Tavistock and UCLH – who were using the MDT model. Dr Agnew countered by saying that it was the time issues that they were unhappy with and not the model of care. Perhaps we will hear if this is true when Patient A’s mother attends as a witness for the defence. The Chair said that even when there was a sucicde risk with Patient A, that the MDT model had failed to help him. Mr Jackson QC, for the GMC, interjected to say that the issue was with timing and that that aspect wasn’t something Dr Agnew could speak to. Mr Stern QC read from Patient A’s mother’s letter, saying “We’ve been to hell and back, we found CAMHS to be useless and the Tavistock to be of little use”. Dr Agnew then suggested that had the family still been using the services of the Tavistock that they anguish they were experiencing would have been dealt with by the MDT. Mr Stern QC – who appears to know a lot more about the level of service trans youth receive from the NHS – then asked Dr Agnew had he seen the Care Quality Commission’s report into the Tavistock, to which Dr Agnew admitted he had not.

An allegation Dr Webberley is facing is that she acted outside her level of competence. Mr Stern QC asked Dr Agnew if the person at the centre of the hub and spoke model of care would need to have their competency assessed? Dr Agnew then dealt a crushing blow to the GMC’s case by declaring that it’s normal practice for clinicians to decide their own level of competence.

 

 

Mr Stern QC put it to Dr Agnew that the MDT model was too cumbersome and too slow for a patient presenting with distress. He asked what a clinician should do to alleviate this distress. Dr Agnew responded by saying that you would do a safeguarding and risk assessment, call an ambulance where needed and try and get them to the front of the queue.

 

 

Mr Jackson QC then asked what the process should be for a patient who is pressuring a doctor for medication to resolve their distress. Dr Agnew responded remarkably, saying that only the distress (caused by issues such as not receiving the medication they were promised) should be treated.

 

 

Dr Webberley’s counsel Mr Stern QC introduced two expert statements as part of the defence, from Professor Bouman, an expert psychologist in trans healthcare and President of WPATH, and Dr Shumer, a US paediatric endocrinologist. The GMC was quick to challenge these reports. Mr Stern QC expressed serious concern that the GMC were trying to keep pertinent defence evidence from the Tribunal. He pointed out that Prof Bouman and Dr Schumer are world-class experts – experts who, unlike Dr Agnew, have extensive experience of providing gender-affirming care.

 

 

In response to the GMC objecting to receiving this information 5 weeks into the hearing, Mr Stern QC reminded the Tribunal that the GMC had taken the case in 2016, yet only provided their expert evidence to the defence in March 2021. Mr Jackson QC said that he objected to Prof Bouman opining on the care Dr Webberley provided to a 12 year old when Prof Bouman’s statement declared that he himself had only worked with trans youth 15 and above. This was laughably hypocritical, given that the GMC’s last expert witness had zero experience interacting with trans youth patients, and had only ever provided care to, in his own words, “6 to 12” trans adults.

 

 

On day 18 Mr Jackson QC argued against the admissibility of the new defence reports and Mr Stern QC declared that he was astonished that the GMC were not treating reports that vindicate a Dr with joy, as opposed to what he called an “adversarial approach”. After much back and forth the Tribunal informed the GMC that they would like to see the reports of Dr Schumer and Professor Bouman and that they will bear in mind the areas of the reports that Mr Jackson objects to when reading the evidence. It was agreed that Dr Klink will resume his testimony on Wednesday 24th.

The takeaways from the last few days are a slightly terrifying insight into how some mental health practitioners view the distress of gender dysphoric youth, a GMC expert with no expertise in trans healthcare who admitted that Dr Webberley’s expertise in trans healthcare had been withheld from him; and the GMC fighting hard to discount the reports from two of the world’s leading providers of trans youth healthcare, one of whom is the President of WPATH.

Photo by George Becker from Pexels