What is the discussion and debate around GenderGP services?
GenderGP is a platform which provides access to services that help and support those who question their gender, and their loved ones. Gender incongruence has been widely debated over the last few years and is a constant cause of heated discussion.
Drs Helen and Mike Webberley advocate the concept that gender variant people know their own identity and have the same right as anyone else to access unbiased healthcare and advice. This approach has caused some unrest in medical circles here in the UK and both doctors have come under investigation by the General Medical Council. Both have had restrictions placed on their ability to practice medicine in the UK. Yet they continue to advocate for the trans community and fight to improve healthcare for gender variant patients in the UK, and abroad.
Why is GenderGP controversial?
GenderGP is the only service of its kind offering access to gender-affirming services for trans and non binary people of all ages, in line with best practise coming out of centres of excellence in the US and Australia.
This means we do not require people to extensively prove their gender experience, we use an informed consent model to look at how we can help them to access the healthcare they need, with as much compassion as possible.
For those who struggle with their gender, having to wait for treatment via the NHS – a period of up to 18 months for younger people and as long as four years for access to adult services – can be excruciating.
What criticisms have been raised about the care given by Drs Webberley?
No criticisms or complaints have been levied against Drs Helen and Mike Webberley by their patients. However, both doctors continue to receive emails from regulators on a regular basis accusing them of treating transgender patients when they are ready and without putting up onerous barriers. This is a ‘crime’ of which GenderGP is 100% guilty.
The key criticisms against Drs Webberley are as follows:
Criticism: The assessment process is not long or robust enough.
Response: No, the assessment process is not overly long and drawn out. This is because we begin from a position of believing our patients and any ‘assessments’ are to work out the best plan for each person’s individual journey, not for proving or validating their gender. As for not being robust enough, we build up a rapport with our patients and their support network over time, this enables us to get a full picture of who this person is, how long they have felt this way and what we can do to support them. Our processes are, in fact, so robust that investigations to date have failed to find fault with them.
Criticism: The doctors are not specialists.
Response: There is no specialist training and no specialist register for gender specialists, and anyone can provide care to this group of patients, as long as they have maximised their skills and knowledge. When the BMA posed concerns to the GMC regarding the role of GPs in the treatment of trans patients, Susan Goldsmith responded with reassurances that ‘we don’t believe that providing care for patients with gender dysphoria is a highly specialist treatment area requiring specific expertise.’
Criticism: Patients are not all seen in physical clinics.
Response: The GMC provides doctors with guidance on what they think is needed to provide care remotely and they advise that ‘Remote consultations (over the phone, via video link or online) are on the increase. They can save doctors’ time, benefit patients and help meet public demand for faster access to medical advice.’ GenderGP users have access to their specialist and share information by email, telephone, video-link or in clinic as required. Many trans people find it very difficult to leave their home – and digital, remote healthcare helps and saves lives.
Criticism: Patients are prescribed hormone treatments such as testosterone.
Response: Where this is the correct course of action, in line with guidance provided by the Endocrine Society and subject to strict protocols, patients can be prescribed hormones.
Criticism: The doctors are under GMC investigation and as such must be practicing in a poor way.
Response: Drs Mike and Helen Webberley are under investigation because they operate according to a model of informed consent. This is the approved approach taken in the USA and Australia. The NHS does not operate according to this model and as such both doctors are under investigation. No fault has been found with patient care.
Criticism: GenderGP is not registered with the CQC.
Response: GenderGP has tried – and failed – repeatedly to work with the UK regulatory bodies, however there have been barriers faced at every turn. Therefore, GenderGP now operates from outside the UK and all medical care is provided from doctors in trans friendly countries. Drs Mike and Helen Webberley continue in a non-medical advocacy role.
Criticism: The doctors are under investigation therefore patients must be at risk.
Response: The investigation into Dr Helen Webberley has been ongoing since 2016. This has been incredibly thorough and yet, no fault has been found with her treatment methods.
Who is making the complaints?
The complaints are all being made by apparently well-meaning doctors. There is a lack of education, knowledge, skills and training in this area and many doctors are fearful of making a wrong decision on behalf of their patient.
The thought of just believing someone when they say that their gender feels different to the one that was assigned to them at birth is at odds with the way things were done historically, when being gender variant was considered to be a mental illness.
The thought of a doctor confirming gender variance without their patient having to prove themselves by undergoing rigid and lengthy assessment and real-life experience, can feel wrong.
For some doctors, the idea of giving a ‘female’ a testosterone medication to encourage their voice to beak and facial hair to grow can feel abusive. However, to a trans person who is clear in their gender identity, this care is both affirmative and life-saving
When patients come to GenderGP for help, we often work out a shared care agreement with their GP. However, when doing their research it is not unusual for well-meaning doctors to look up Drs Webberley and GenderGP. When they see the negative media attention that has resulted from GenderGP affirming trans people of all ages, this reaffirms their caution. Unfortunately instead of picking up the phone or dropping an email, they choose to take their fears directly to the GMC.
What is the role of the General Medical Council (GMC)?
The GMC helps protect patients and improve UK medical education and practice by supporting students, doctors, educators and healthcare providers. They regulate individual doctors that are working from the United Kingdom and to provide care to patients. Doctors working in the UK have to be registered with the GMC.
According to the Professional Standards Authority (PSA), The GMC regulates doctors in the United Kingdom. They set standards, hold a register, quality assure education and investigate complaints.
So the GMC is responsible for creating standards by which doctors provide medical care, and that education is done at three levels, at medical school, foundation years and during postgraduate careers.
What is the role of the Care Quality Commission (CQC)?
The CQC and its Welsh equivalent, the Healthcare Inspectorate Wales, (HIW) are responsible for keeping a register of and regulating care provided by medical services such as hospitals, GP surgeries, clinics and online pharmacies.
In England, both NHS and private surgeries need to be registered, however in Wales only private services are registered as NHS services are presumed to be providing good care.
To inform their inspection criteria, these regulators look to published guidance such as NICE guidance or Royal College guidance to dictate how services should be provided, however none such guidance exists for the care of gender variant people.
Why isn’t GenderGP registered with the CQC or HIW?
GenderGP does not directly provide medical services. GenderGP is platform and conduit from which trans people can access a variety of gender-affirming services. These are all provided by a variety of specialists who are independently registered, regulated and insured to provide their service. GenderGP sets the standards by which services are provided to ensure that all GenderGP partners are positive and affirmative in their approach.
Despite Drs Mike and Helen Webberley repeatedly trying to register, meet and discuss the service and the situation for patients with HIW and CQC in order to move forward and continue to provide care, they have hit brick wall after brick wall. Consequently, both Drs Helen and Mike Webberley are no longer providing medical care to their patients. Instead, GenderGP now works with doctors based outside of the UK. As such there is no longer any need for UK registration. In the future, when the virulent transphobia which has become so institutional, has abated, we will revisit bringing medical care for gender variant people back to the UK.
There is a concern that the CQC appears to find no critical fault when inspecting services that are failing gender variant patients, but when they are asked to consider the application of those providing affirmative care, they are turned away and worse, convicted.
What are the current standards by which trans and gender non-conforming patients should be treated?
The GMC themselves have acknowledged that there is no official training programme for undergraduate, foundation and postgraduate training in transgender health.
In their evidence to the Women and Equality Commission the GMC could only give one example of the inclusion of transgender in any education programme, and that was in the Royal College of General Practitioner’s curriculum.
It is of note that the word ‘transgender’ does not exist in the curricula of endocrinology, paediatric endocrinology, psychiatry, child psychiatry, paediatrics etc etc.
In the absence of a UK training programme for the medical care of trans patients, the standards default to the basic medical commitment to patients:
First do no harm and always act in the best interests of the health of your patient.
Until guidelines are put in place, at GenderGP we adhere to those set out in the Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents: https://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf
Who can provide treatment for trans patients?
On the matter of who may be qualified to provide treatment for trans patients, the GMC gave evidence to the committee that
‘Regarding the numbers of specialists in this field, the GMC has not approved a sub-specialty in this field nor has it received an application to introduce such a sub-specialty. We are not aware of any special interests within curricula for doctors who may have expertise in gender identity medicine/care. The GMC only records on its registers main and sub- specialties.’
There is no specialist training and no specialist register for gender specialists, and anyone can provide care to this group of patients, as long as they have maximised their skills and knowledge.
When the BMA posed concerns to the GMC regarding the role of GPs in the treatment of trans patients, Susan Goldsmith responded with reassurances that ‘we don’t believe that providing care for patients with gender dysphoria is a highly specialist treatment area requiring specific expertise.’
What guidance is there for providing medical care to trans patients?
For doctors who are treating trans patients they would look to guidance. However in the UK there is no NICE guidance, no published NHS guidelines and little other assistance.
The Royal Colleges are responsible for setting out the curricula that inform training and education of their specialists. There is no specialist register of gender specialists so anyone wishing to provide medical care must ensure that they have undertaken personal research, reading and knowledge-seeking to ensure the care they provide is safe.
There are very comprehensive and evidence-based International guidelines which have been written in a way to help clinicians of all levels to provide the best care possible. These are the guidelines that GenderGP follow.
Why does GenderGP follow International Guidance, is it safe?
On recognising that there is a lack of UK guidelines on the treatment of transgender patients of all ages, the Women and Equalities Report at paragraph 251 recommend, ‘As with adult Gender Identity Services, clinicians have ethical and professional obligations to ensure that treatment is appropriate; and they must pay due regard to the internationally recognised guidelines of the World Professional Association for Transgender Health.’
This WPATH guidance page 104 gives the criteria for treatment:
‘Criteria for Feminizing/Masculinizing Hormone Therapy (One Referral or Chart Documentation of Psychosocial Assessment)
- Persistent, well-documented gender dysphoria;
- Capacity to make a fully informed decision and to give consent for treatment;
- Age of majority in a given country (if younger, follow the SOC for children and adolescents);
- If significant medical or mental concerns are present, they must be reasonably well controlled.’
What do we mean by affirmative care and informed consent?
Someone who is gender incongruent will have undertaken a lot of personal research, Internet searching, reading, talking, thinking, ruminating before presenting for services to help them. When they present for help, they are often asking for something specific. Whether that be hormones, counselling, laser hair removal, family therapy, legal assistance.
The important thing is to believe that person from the earliest opportunity, and route them to the service that they need. That is our approach at GenderGP
The NHS works on an assessment model whereby the trans person must in some way prove or validate their gender identity to the professional. This goes against an informed content model where information should be shared in a bi-directional manner so the doctor and patient can come to an agreed management plan.
The informed consent model of care will be commonly accepted in the future, and the outcome of the investigation in to Drs Helen and Mike Webberley, will help to empower and inform tomorrow’s doctors.
In the UK, transgender and non binary people are made to jump through hoops time and again, to access the healthcare they need. In no other area of medicine is this level of blatant discrimination allowed.
Is it legal / safe to treat patients when they haven’t been seen in person?
The GMC provides doctors with guidance on what they think is needed to provide care remotely and they advise that ‘Remote consultations (over the phone, via video link or online) are on the increase. They can save doctors’ time, benefit patients and help meet public demand for faster access to medical advice.’
GenderGP users have access to their specialist and share information by email, telephone, video-link or in clinic as required. Many trans people find it very difficult to leave their home – and digital, remote healthcare helps and saves lives.
The British Medical Journal back in 2004 discussed the merit of email consultations and the authors found that:
- National surveys show that patients increasingly want to be able to communicate with healthcare professionals by email
- Early email use in health care has grown without an adequate supporting infrastructure to address security issues
- Ensuring privacy, confidentiality, and security of information is vital for email consultations, and various user friendly safeguards are now becoming available
- Email consultations mark a radical shift from the traditional oral modes of communication: both patients and doctors need education in how to use them safely and effectively
Many of these issues have been affectively resolved over the past 14 years, making this method of communication extremely safe and secure.
Is my care at risk of being suddenly stopped?
The uncertainty around Drs Helen and Mike Webberley’s investigations have understandably caused some concern regarding continuity of care.
In response, GenderGP is making some changes to future-proof the business and secure continuity of care for our patients. GenderGP has moved its registered jurisdiction and medical provision outside of the UK. This has been done for two reasons, firstly because of the lack of appropriate guidance and standards to support good care. Secondly, because of fears of transphobia amidst some UK public bodies.
Drs Mike and Helen Webberley will continue to play a role as specialist advisors, experts and advocates. They will continue to fight for the rights of trans and non binary people to get better access to healthcare in the UK, but they will no longer be providing any medical treatment directly to patients via GenderGP.
GenderGP has evolved into a specialist provider of gender experts including: nurses, psychologists, counsellors, medical facilitators, gender advocates and patient experts. Once a patient has been assessed by our team of experts, they will be referred on to external doctors to receive treatment.
In the future, when the virulent transphobia which has become so institutional, has abated, we will revisit bringing medical care for gender variant people back into the UK.
How come Dr Mike is now facing the same difficulties as Dr Helen?
The question regarding Dr Mike Webberley’s fitness to practise medicine as a doctor is something we would like to address head on. Mike Webberley has been a consultant physician (the most senior grade you can achieve as a hospital doctor) for 23 years and an NHS doctor for 34 years. During this time he has managed countless patients with diverse general medical problems. While his recorded specialty is gastroenterology, he has a very broad knowledge base of all medical specialties including acute and chronic medical conditions, surgery, paediatrics, endocrinology and psychiatry.
At no point in his career, other than during this period of time working with gender variant people, has his ability to care for patients been called into question. He is the fourth such doctor after Dr Helen Webberley, Dr Richard Curtis and Dr Russell Reid, to be subject to investigation upon investigation – not as a result of patient feedback, but following on from complaints submitted by NHS doctors who do not agree with their gender affirmative approach.
If both doctors get suspended, then things must be bad?
While the GMC are investigating concerns that have been raised by other doctors, they have temporarily suspended Dr Helen Webberley’s and Dr Mike Webberley’s ability to practise medicine and treat patients. It is important to note that, to date, no fault has been found with patient care and this is an interim measure while they continue their investigations.
At the end of the investigation all the facts and evidence will be examined and compared with appropriate standards and a tribunal will make a decision.
The outcome will ultimately come down to whether or not gender affirmative care, such as that provided by GenderGP, is acceptable in the UK.
Why haven't you just given up, retired, gone home - it must be so stressful?
We know from the countless messages of support we have received that many of you have been struck by how unfair it is that those doctors working to provide positive care for transgender patients seem to have a very raw deal from the GMC, whereas doctors who deny or restrict access to care are positioned as the ‘experts’ and applauded for their cautious approach.
It has been incredibly stressful, not to mention expensive and embarrassing. However the cause is a worthy one. Although we both feel so frustrated by the authorities and their lack of understanding, to give up will not help validate the gender-affirmative model of trans healthcare – something in which we wholeheartedly believe.
The NHS has been found to be failing transgender people and yet they have made no concerted attempt to change their model. New pathways must be laid and followed, refined and adopted.
What can be done to help?
Trans and gender non-conforming patients have the same rights as any other person in the UK to be able to access interim services while they wait for care on the NHS. If the doctors at GenderGP are to be blocked from providing this care, alternative provision MUST be provided, or people will be forced online to self medicate with no support or monitoring. Surely this cannot be an acceptable outcome as far as the GMC is concerned?
Our petition calling for urgent interim care is now more important than ever. We already have 7,000 signatures and we are appealing to the trans and non binary community and its allies to stand together and to make the fair and equal treatment of gender variant people a priority in the UK.
What shall I do if I am worried about the way GenderGP operates?
Ask us! We are available by phone, email, video, or in person. We are happy to talk to patients, doctors, nurses, counsellors, journalists, regulators and educators. Gender affirmative care is not our invention. We are not the only people to advocate this approach. It is shared by centres of excellence in the USA and Australia.
How can we guarantee our meds will be safe?
While we are working with qualified doctors outside of the UK, nothing else has changed. Same GenderGP team, same meds, same pharmacy.