Letter from a GenderGP Patient, in Support of Dr Webberley

Dame Caroline Swift

Chair, Medical Practitioners Tribunal Service

Seventh Floor

St James’s Buildings

79 Oxford Street

Manchester

M1 6FQ

29 July 2021

Dear Dame Swift

I am writing to you to express my concern about the current proceedings against Dr Helen Webberley.

I am also writing to explain my experiences as a transgender person seeking healthcare, and the difficulties that I have experienced in accessing that healthcare.

I ask for your patience and attention, and that you please read this letter fully. I hope that by doing so, you may have more information to help reach a better understanding of the problems faced by transgender people in obtaining adequate healthcare in the United Kingdom in 2021. I also request that you consider this letter as valid evidence of the positive work done by Dr Webberley in providing healthcare to transgender people.

I have not had direct contact with Dr Webberley, but in 2018, had I known about her work, then I would have contacted her for help.

This is because as a transgender person, my experience of the current NHS healthcare provision has been very negative.

I asked my NHS GP for a referral to an NHS Gender Identity Clinic in April 2018. At that time, I became aware of the very dire situation of waiting times for first assessments at NHS Gender Identity Clinics. Once it became apparent that I would face a wait of years to be seen, I became very depressed and desperate.

I am currently waiting to be seen for a first assessment at Tavistock & Portman NHS Gender Identity Clinic. I have been waiting for over three years since referral by my NHS GP.

The first assessment will be followed by a second assessment, and treatment may not actually begin until the second assessment has been completed.

After the first assessment, I will probably have to wait for a further twelve months or more for an appointment for the second assessment. This means that I may have 1 29 July 2021 been waiting for over four years or more for NHS treatment, by the time that any treatment actually begins.

It is very difficult to put into words how it feels to be condemned to death by waiting. Some people may not regard Gender Dysphoria as ‘life threatening’ in the same way as cancer – “It’s not like you are dying, is it” being a typical response. I have to disagree, having spent much of the last three years considering the best way to kill myself while waiting and waiting and waiting for the NHS GIC to see me.

The waiting is compounded by the general lack of support from other parts of the NHS. I have asked repeatedly for help in accessing gender related treatment whilst waiting for the NHS GIC. But the response has usually been the same: “You need to be seen by the Gender Identity Clinic first”. Even when some other branches of the NHS are sympathetic and do want to help, their hands seem tied by the same requirement; to have been seen by the NHS GIC.

Under the terms of the NHS Constitution, I would have expected to have begun treatment at an NHS GIC in late 2018, having been referred by an NHS GP in April 2018. But instead, here in mid 2021, I am still waiting for an assessment. It is very hard not to feel desperation at the thought that by now, I could have been two and a half years into real treatment and real progress – IF the NHS honoured its own Constitution. But it seems that the NHS Constitution does not apply to the needs of transgender people; again and again, there is the feeling that as a transgender person, I ‘do not matter’ to the NHS.

After waiting for almost two years for a first appointment at Tavistock & Portman NHS Gender Identity Clinic, it became apparent that the waiting time for the first appointment could become even longer.

By this time, I had become very desperate. My mental and emotional health was deteriorating, and this had begun to affect my physical health. Despite this, I received virtually no support from my NHS GP.

I had very little information about alternatives to NHS transgender healthcare, but out of desperation I began looking for possible solutions.

Most of the private providers of transgender healthcare were too expensive for me to afford. I am disabled due to deafness, and I have very limited finances.

Many of the private transgender healthcare providers also had waiting lists of their own, and some of these waiting times extended to several months. This seems to be the fallout from the long waiting times for NHS Gender Identity Clinics; more and more people are desperately seeking treatment by alternative providers.

When I discovered more information, GenderGP appeared amongst the possible solutions. Ultimately, I chose to contact GenderGP to ask if they could help me.

GenderGP have essentially provided me with a lifeline.

Once I contacted them, GenderGP responded immediately, and I began a dialogue with them about the help that I needed to transition from male to female. In particular, I explained my desire to begin Hormone Replacement Therapy, and why I felt that HRT is a vital part of my transition.

One of my main problems is lack of funds to pay for private healthcare. GenderGP have been exceptional in being flexible about many of their fees, and when I explained my financial situation to them they arranged to reduce some of their fees. This made a crucial difference to me, since I had struggled to raise the funds. I was now able to afford to start on a treatment path.

In order to begin Hormone Replacement Therapy, there were procedures to follow. My experience of this was that GenderGP conducted themselves extremely professionally and efficiently. Their assessment process was thorough and followed the protocols that I would expect before beginning long term hormone therapy.

Once the assessment procedure was complete, I received my first prescription for replacement hormones. To be able to take this step in my transitioning felt positive and uplifting.

GenderGP’s professionalism is matched by a very human and humane approach to patient care. Throughout the patient pathway process, I felt that I was being treated as a person and not just a number in a case list. My identity has been respected throughout my contact with GenderGP; the affirmative approach that GenderGP takes in providing me with healthcare stands in sharp contrast to the sense of bureaucratic detachment that unfortunately seems to characterize the NHS Gender Identity Clinics.

GenderGP have been able to adapt to increasing numbers of patients, and I have seen the evolution of GenderGP over the last twelve months as their system has been refined. There have been periods where contact between GenderGP and patients was affected by sheer numbers of emails, but GenderGP have been able to modify their methods to overcome the problem. Throughout this time, the human approach of GenderGP to patient care has remained constant. This has also been true throughout the Covid-19 pandemic.

Perhaps the approach taken by GenderGP suggests a model for 21st century transgender healthcare. Based on my experience with GenderGP as a healthcare provider, I would consider that this is a model that should be explored.

I am now beginning my tenth month of Hormone Replacement Therapy, and I continue to have a positive experience with GenderGP as a healthcare provider. In contrast to this, I am still awaiting an appointment for a first assessment at the NHS Gender Identity Clinic.

It is difficult to imagine where I would be now if the NHS GIC had been my only option. This is why I consider that GenderGP has been my lifeline; before contacting GenderGP, I was in a very negative and dark place. It is possible that I may not have come through that time at all, if GenderGP did not exist.

To put this in a morbid perspective, when I was eighteen, I watched my uncle die slowly from cancer. When I was thirty-nine, my mother died from cancer and my father died from a heart attack. They died seven days apart.

The negative effects of the extended waiting time for the first appointment at the NHS Gender Identity Clinic have caused more distress, depression and mental and emotional damage than the effects of both the loss of my uncle and the loss of my parents.

I was fifty-seven when I asked for a referral to the NHS GIC. At the present rate, I may turn sixty-one before I am seen by them. I may then have to wait a further twelve months before the second assessment, at which point treatment may actually begin. At that point, I may be sixty-two years old. You may imagine the impact that this has on my state of mind.

It is hard to believe that the NHS, the organization that supposedly exists to help me, can actually do so much harm and damage to me. But this is the reality of the NHS Gender Identity Clinics in the twenty-first century.

The first assessment at the NHS GIC essentially consists of a sixty minute consultation. To have to wait more than three years for sixty minutes of NHS time seems barbaric when thought of in terms of time and proportion.

But those sixty minutes are vital to a transgender person who is dependant on NHS care. Those sixty minutes also create a ‘bottleneck’ through which everything has to pass before NHS treatment begins, and through which a person has to pass before their identity is ‘validated’ by a diagnosis of Gender Dysphoria. The diagnosis itself can become the person’s whole identity, wrapped up in the focus of a sixty minute window. This focus and the process of waiting for it is dehumanizing.

Bureaucracy is a necessary part of the NHS as a government organization, but it is also a curse. At its worst, the bureaucracy itself reduces medical staff to the role of ‘Gatekeepers’ and creates the sense of dehumanization that is so negative for both patients and staff alike. The NHS Gender Identity Clinics especially are firmly mired in the bureaucratic quicksand that is that worst feature of the NHS system.

We are now twenty-one years into the twenty-first century, but the NHS Gender Identity Clinics themselves are stuck in a twentieth century mindset, and still operate accordingly. Whilst social and cultural changes have shaped a different environment, the NHS GIC environment remains one of outdated practices and an emphasis on centralized Clinics that cannot now keep up with the demands of patient needs and patient numbers.

I know that there are initiatives under way to change some of this. But the core GIC mindset remains, and it remains to the detriment of both patients and medical staff.

It is time to introduce humanity into a system that ironically exists to help human beings, yet which has become so dehumanized.

GenderGP continue to provide me with accessible healthcare.

Dr Webberley’s work and her vision of healthcare for transgender people led to the existence of GenderGP. I for one am immensely glad of Dr Webberley’s humanity in providing effective transgender healthcare. Without that humanity, I know that I would have suffered extreme mental, physical and emotional pain.

I will state very firmly that to remove Dr Webberley from her work as a Doctor would be to act against people who are most desperately in need of help. Such a removal would be an act against humanity.

Thank you for your attention in reading this.

 

Yours sincerely

Ms Elsa Roberts