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MPTS Hearing Days 31-32

by | Sep 23, 2021 | Advocacy Archive, GMC / MPTS, MPTS_Hearing, News

MPTS Hearing Days 31-32

When the hearing resumed the Tribunal requested more information from Mr Jackson QC with regard to the allegations surrounding the GenderGP website. The Chair said they would “value further submissions in relation to this allegation and the evidence in support of that alleged duty.” Dr Webberley’s counsel, Mr Stern QC vigorously objected to the GMC being allowed more time to make a case – after they closed their case.

 

 

The Tribunal recessed to consider and decided to accept Mr Stern’s objections. They then retired to make a final decision on what allegations were unfounded. When they returned the Tribunal announced that 11 of the allegations were unfounded. Some of the allegations the GMC made against Dr Webberley were almost farcical and had no basis in law – there was no duty to do the things that Dr Webberley was accused of not doing. Surely when this hearing ends questions must be asked about why the General Medical Council is making baseless allegations about medical Doctors.

 

 

Mr Jackson QC then asked to submit further documents as part of the GMC’s (closed) case. Mr Stern QC argued that it would be unfair to allow the GMC to enter new evidence at this late stage, and that the GMC’s own experts had not been asked to speak to these new documents. Mr Stern also pointed out that as Dr Webberley is unable to communicate with her legal counsel once she begins to give evidence, it would place her at a disadvantage to introduce new information that she cannot seek counsel about.

 

 

Unfortunately the Tribunal decided to allow this new evidence to be submitted. Day 32 saw Dr Webberley sworn in to give her evidence. Mr Jackson QC asked Dr Webberley about the difference between her approach and that of the Tavistock. Dr Webberley responded by saying that she triaged all her patients, as opposed to Tavistock which triages people with a family therapist and social worker. Mr Jackson QC put it to Dr Webberley that it was a necessary requirement for a psychologist or psychiatrist to assess a Patient before initiating puberty blockers or gender affirming hormones. Dr Webberley replied that gender incongruence is not a mental health disorder and that there is no such requirement in the UK for a mental health assessment.

 

 

Mr Jackson QC asked if it was Dr Webberley’s position that a diagnosis is not required prior to starting treatment. Dr Webberley stated that only an assessment was required to establish if someone fulfilled the requirement for treatment, likening trans patients to someone seeking contraception. “They don’t need a diagnosis, they just need to understand the pros and cons of having the treatment.”

 

 

Dr Webberley reiterated that her model of care came from her experience as a GP with a specialist interest in sexual health. Dr Webberley explained that she doesn’t feel that trans patients need to be treated any differently to other patients to which Mr Jackson QC replied that he wasn’t suggesting they should be treated differently. Later Mr Jackson QC suggested that cis and trans children who take hormone therapy should be treated differently. Dr Webberley disagreed with Mr Jackson’s assertion.

 

 

 

Questioning Dr Webberley’s expertise, Mr Jackson QC queried Dr Webberley’s qualifications to treat trans patients. Dr Webberley said that there is a lack of structured training options and that as the GMC guidance stated that if there was a gap in a GP’s knowledge they should undertake CPD and learning, which is precisely what she did. Dr Webberley said managing hormones in adolescents was a part of normal GP training and therefore not outside her area of competence.

 

 

Mr Jackson QC proposed the idea that without NICE guidelines a Dr should not prescribe to which Dr Webberley replied that she didn’t think it was fair to expect her patients’ to suffer just because there are no NICE guidelines on how to treat them. This line of questioning highlights the deficiencies that existed for trans people during this time period. Why were there no NICE guidelines and did the lack of guidelines mean other GPs felt unable to treat trans patients, who then possibly had nowhere to go for their healthcare needs. Many times through the hearing it has been stated by various commentators online that the wrong Dr stands accused, surely those that failed in their duty to provide guidance to healthcare practitioners should be held accountable for the harm they have caused.

 

 

Mr Jackson QC appeared to be blindsided by the idea that Professor Butler and UCLH had no guidelines informing their care of trans patients and he swiftly moved his line of questioning elsewhere. Unfortunately Mr Jackson then suggested that ADHD is a condition that needs to be “resolved” before gender affirming treatment can be initiated, again showing a lack of understanding or sensitivity for people with ADHD (a condition which cannot be “resolved”).

 

 

In response to Mr Jackson QC’s suggestion that mental health issues should be stable before a trans person could be considered able to consent, Dr Webberley again pointed out the Catch 22 bind in which trans people find themselves when seeking help from healthcare professionals. It is often the lack of affirming healthcare that causes instability, and that cannot be resolved until gender affirming care is provided, but gender affirming care is denied due to instability. A quandary that largely doesn’t exist for other (cis) patient cohorts.

 

 

Mr Jackson QC suggested that Dr Webberley’s practice was to be unduly led by patient wishes, again something Doctors of cis people are rarely accused of doing. It was clearly not Mr Jackson’s day when he again said the quite bit out loud, “Your acceptance of the Patient being the person who knows best leads you to prescribe sooner rather than going through the hoops, I suggest this shows your failure?”

 

 

In response to the idea that she was rushing to give trans patients what they want, Dr Webberley patiently explained that trans people don’t just wake up one day, realise they are trans and rush to the Doctor for hormones. It is often a long slow process that has even led to the point where they visit a Doctor.

 

 

Dr Webberley spoke at length about the harm caused by not treating trans patients in need, stating that she often wondered if she would have ended up before the GMC as a result of the harm that may have occurred if she didn’t prescribe to the then-suicidal Patient A.

 

 

Mr Jackson QC repeatedly asked Dr Webberley about the importance of an MDT in treating trans youth and Dr Webberley replied that sometimes the delays caused by public health MDTs can result in harm. In previous witness testimony of Dr Kierans, from the Northern Irish KOI service, the hearing heard that children have to first see CAMHS before they can be seen by the KOI MDT, and that there are waiting periods to get a KOI appointment and waiting periods to see the endocrinologist followed by a mandatory 1 year period on puberty blockers, all of which are required before adolescents can access gender affirming hormones.