FAQs regarding recent concerns

GenderGP started when I was an NHS GP in a small practice in Wales. I had a couple of transgender patients asking me for help and when I realised what the long NHS waiting lists were like, and the fact that people had to travel all the way to London from Wales, and that the protocols didn’t suit everyone, I started an Internet based information service called MyWebDoctor. It proved so popular that I started GenderGP and it has grown steadily over the last few years.

Gender specialists can come from any medical specialty – In the NICE Document “clinical models operated by England’s gender identity clinics” it states that “Gender specialists may be from many different clinical backgrounds, some specialising in mental health: psychologists, psychiatrists, counselors or therapists, but they may also be GPs, endocrinologists, nurses etc https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/11/gender-ident-clncs-rep-nov15.pdf

As a GP I feel able to treat all ages. I have learnt and read everything I possibly can on the treatment of the transgender child, and would only ever do anything I felt competent to do.

There is no mandatory training for trans care, although historically it has been delivered by psychiatrists and endocrinologists. I think that we should save the trickier cases for the consultants and bring simple care into the realm of General Practice. This would reduce waiting times and pressures on the NHS and leave the family GP to help those who have uncomplicated needs.

As a GP I am very used to managing hormonal manipulation, stress and depression – common issues amongst transgender patients.

There seems to be a rumour going round that I treated a transman with testosterone and failed to do his blood tests properly. I am totally unaware to which patient this relates to and I am unaware of any of my patients coming to harm. There are many ways my patients get blood tests done – a) via their GP b) via finger-prick tests using my private laboratory c) via venous sample using other private laboratories.

It is important that all medical conditions are properly monitored and I am very happy to help with all aspects of monitoring.

I have a lovely team of people helping me and my patients. I have counsellors, psychotherapists, an admin team and my husband who is a consultant physician. I do not force anyone to have months of therapy, but have someone to suit everyone’s needs should they be required.

I use a variety of methods to communicate with my patients. Email, telephone, video and face to face. Everyone is different and has different needs, so with modern technology, we can really open up access between patients and healthcare workers to provide good care. Not all cases are appropriate for ‘remote healthcare’ but it is surprising what can be achieved.

The GMC have clear guidelines on this issue: http://www.gmc-uk.org/guidance/30549.asp

My LHB (local health board) have been advised of the large number of complaints that have been made to the GMC about me by the consultants at Charing Cross and the GIDS. They have temporarily suspended my ability to work as an NHS GP in Wales. Although I understand they have to take complaints and concerns seriously, they have taken this step without even interviewing me and I feel they have been unfair and harsh.

I provided medical services to Dr Matt Ltd but when they had their CQC inspection recently, the CQC uncovered some areas of concern throughout the business and they have temporarily suspended the service. This service is unrelated to GenderGP.

I have had numerous complaints to the GMC about my transgender service.

1. A complaint from Alec Rook questioning whether I was qualified to provide gender care. This was fully investigated and no concerns were found on my fitness to practice in this area.
2. A letter from Stuart Lorimer, consultant psychiatrist at Charing Cross and GenderCare private clinic regarding my practice with numerous comments and concerns. The GMC decided that the complaint did not need investigating.
3. Another letter from Stuart Lorimer with further concerns. The GMC did not feel this warranted an investigation.
4. I raised concerns about James Barrett, consultant psychiatrist at Charing Cross and the GMC did not investigate but instead opened an investigation about me. This was closed with no fault found.
5. Professor Hindmarsh, via Dr Butler, consultant paediatric endocrinologist has made a complaint about my treatment of a transgender child. This investigation is currently ongoing.
6. A ‘senior doctor’ from Charing Cross has made an anonymous statement to the CQC which has now ben passed to the GMC. He outlines various concerns he has, none of which he can substantiate.

There are currently no NHSE guidelines on the management of gender variant children.

WPATH (vers 7)

‘Adolescents may be eligible to begin feminizing/masculinizing hormone therapy, preferably with parental consent. In many countries, 16-year-olds are legal adults for medical decision-making and do not require parental consent. Ideally, treatment decisions should be made among the adolescent, the family, and the treatment team. Regimens for hormone therapy in gender dysphoric adolescents differ substantially from those used in adults (Hembree et al., 2009). The hormone regimens for youth are adapted to account for the somatic, emotional, and mental development that occurs throughout adolescence (Hembree et al., 2009)’. Also;

Refusing timely medical interventions for adolescents might prolong gender dysphoria and contribute to an appearance that could provoke abuse and stigmatization. As the level of gender-related abuse is strongly associated with the degree of psychiatric distress during adolescence, withholding puberty suppression and subsequent feminizing or masculinizing hormone therapy is not a neutral option for adolescents’

NHS options (http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Treatment.aspx)

Clinical guidelines

In addition to the legislation above, there are also clinical guidelines for health professionals that outline what high-quality care for transsexual people should involve.

Such guidelines include:

the WPATH Standards of Care – produced by the World Professional Association for Transgender Health (WPATH)

the Good Practice Guidelines for the assessment of adults with Gender Dysphoria (PDF, 611kb) – produced by the Royal College of Psychiatrists

Neither the Royal College of Psychiatrists or WPATH guidelines offer specific advice on treating children with cross sex hormones.

As my services are currently provided from mob home in Wales, the CQC registration does not cover this area. I have been told by the CQC that my service does not need to be registered.

GenderGP started as a simple WordPress blog website for advice for patients and doctors. It very quickly grew as the demand rose and I have now given advice to thousands of people. I first applied for HIW registration in October 2016 but they have still not completed their registration processes.

Recently they have told me that I should no longer provide services and that they are mindful to not approve my application.

As there are a large number of patients relying on my care who can’t get the help they need from anywhere else, and because there is a high incidence of self harm and suicide in this patient group, I am going to transfer the hub of my service to my other residence in Malaga, Spain so that I can continue providing care while the regulatory processes are being sorted out.

As part of the NHS ‘Five Year Plan’ there are great development plans for using technology to enhance the provision of safer, more accessible healthcare. In the future, this will be mainstream.

https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/harnessing-technology-and-innovation/