Helen Webberley cleared.

[SunbowRainshine31]

Today, I celebrate the news that my appeal was successful and the proceedings are over. Even after intense scrutiny of my work and over a hundred allegations, my fitness to practise medicine has not been found to be impaired, I have no restrictions on my practice and I can resume my life-saving work. The case ends today and the proceedings are over.
The stringent analysis of this case will only serve to assist other doctors wanting to provide care for their trans patients. If I can develop the skills to help this group of patients then so can they. I am simply a well-meaning, well-educated GP who was willing to learn how best to provide this care and I was brave enough to stand against the outdated NHS model of care which is evidently not fit for purpose in its current state.

https://www.gendergp.com/helen-webberley-statement-gmc/?tw=1

No, I mean arrangements managed through a PAG and appraisal process (if you are an English GP).

As far as I am aware (and please correct me if I am wrong) the Performance Advisory Groups are an NHS initiative for doctors working on the NHS. HW was not an NHS GP she was working privately in a company that she set up. So she would not have been subject to this process.

She would have been subject to the CPD and revalidation process that ALL those registered with the GMC are but afaik the GMC do not get involved in telling doctors what CPD they should be carrying out.

You are very insistent that I am wrong about this

I am no more insistent that you are wrong than you are insistent than I am wrong.

What is the pathway by which you think a GP with a criminal conviction relating to failures around regulation could satisfy regulatory requirements (GMC/CQC/NHSEs or devolved equivalent) without showing significant evidence of insight and learning from the incident?

HW was found to have failed by the MPTS. They imposed a sanction which would have provided time for her to reflect on her failings. She did not want to do that so she appealed and won. There is no longer a requirement for her to reflect on anything. (although if she had half a brain in her head she would do so)

We don't know what HW's situation may be with regards to the GMC or PAG, so let's use a fictional example of a GP with the same criminal conviction (failure to register her service with the regulator) but a different clinical concern - say, supplying controlled drugs to addicts without proper monitoring and safeguards (for the avoidance of doubt, there is no suggestion whatsoever that HW has done this - I am specifically using this example because it is fictional).

If the GMC have further information about HW practising unsafely then the whole ftop process will kick in again. If the GMC had good evidence of a registrant supplying controlled drugs to addicts without proper monitoring and safeguards they would be up in front of an Interim Orders Committee PDQ and from there the allegations would be investigated and they would end up back in front of their regulator. It's relatively common for practitioners to end up back in front of their regulator more than once especially if they lack insight. What they can't do though is keep monitoring a person when they have no evidence of ongoing wrong doing.

So this GP - Dr Smith - has a criminal conviction. She is exonerated by an MPTS hearing, so no FtP restrictions, but the GMC and her local PAG have received many concerns about her work. She does not show evidence of insight but instead states very publicly that she believes she has done nothing wrong. Are you saying that you think there will be no barrier to her returning to clinical practice?

If the GMC have received many concerns about Dr Smith's work SINCE her a GMC panel has found previous charges not proven then this would be considered to be new evidence and the whole process will begin again. A ftop panel can only consider past events. Anything after that will have to be considered by a new panel.

@MissLucyEyelesbarrow the trouble is CQC can be got around with the right know how and paperwork (am a registered manager).

I can see that what seem like hurdles to right thinking professionals could be smoothed over. Without going into too many details, where providers have to comply with say rule 18 regulations for fit & proper people employed, CQC want to know that you have a policy & follow your procedures. So it might be possible to write a policy saying that you assess criminal convictions [using your own made up rules] and talk about your special care of the most marginalisedest group ever...

Much as I'd like to believe it won't happen I can't say I'd be surprised.

If HW is the OP, then my question is, do you feel completely comfortable prescribing puberty blockers & cross sex hormones to a young girl who has a diagnosis of ASD?

What do you think went wrong with all the young female adults who are now de transitioning?

I agree with that - which is why I said upthread that a criminal conviction is not an absolute bar to employing a clinician. But, remember that - in this case - there is a criminal conviction relating to failure to comply with the Welsh equivalent of the CQC. So I think any risk assessment would get a fair amount of scrutiny from the CQC or devolved equivalent.

Isn't the OP just quoting some of Wobberley's statement? What makes you think this is her?

HW was found to have failed by the MPTS. They imposed a sanction which would have provided time for her to reflect on her failings. She did not want to do that so she appealed and won. There is no longer a requirement for her to reflect on anything. (although if she had half a brain in her head she would do so)

Are you a GP? That is just not the case WRT to expectations of GPs on a national performers' list. A GP who has a criminal conviction WRT her practice would be expected to show evidence of reflection and improvement around that.

As you say, the concerns brought before the Tribunal are completely set aside (as with a criminal charge if a defendant is found not guilty). But that doesn't mean that other concerns at PAG level have been wiped away. Of course, these concerns can only be treated in the same way as any other concerns at that level (you can't take different action just because the doctor has been to a tribunal), but being exonerated at Tribunal- in our fictional example - of failing to consent patients properly around the risks of controlled drugs doesn't erase a separate concern at PAG level of not having maintained proper CD records.

As covered above, HW does not have to be on a performers' list to practise privately but she is likely to encounter substantial obstacles if she is not, as she won't be able to revalidate.

As covered above, HW does not have to be on a performers' list to practise privately but she is likely to encounter substantial obstacles if she is not, as she won't be able to revalidate...

(distracted by biscuit arriving) ...she won't be able to revalidate without showing evidence of appropriate appraisal. It doesn't have to be through NHSE, but it does have to be considered a sufficiently robust equivalent, and be signed off a such by a Responsible Officer.

Can't open the link now but it didn't match the the statement I saw earlier.

It's extremely chilling to think that people have been taken in by the idea that Webberley's type of prescribing is 'life saving'. I feel profoundly sorry for the parents who have bought medication from Gender GP.

Are you a GP? That is just not the case WRT to expectations of GPs on a national performers' list. A GP who has a criminal conviction WRT her practice would be expected to show evidence of reflection and improvement around that.

I'm not a GP. But I work in the world of healthcare regulation (not MPTS) so I have a degree of awareness of how things work. I'm not holding myself up as an expert though and all the regulators do things slightly differently.

To answer your points, I don't think private doctors who work exclusively for the NHS are required to be on a performers list? HW worked privately didn't she so she would not have been subject to meeting the criteria necessary for working in the NHS.

https://pcse.england.nhs.uk/help/performers-lists/general-enquiries/

But that doesn't mean that other concerns at PAG level have been wiped away.

Again PAG is an NHS initiative. AFAIK HW worked privately so would not have been under their scrutiny or subject to their processes.

https://www.england.nhs.uk/contact-us/privacy-notice/how-we-use-your-information/health-care-professionals/managing-performance-concerns/

As covered above, HW does not have to be on a performers' list to practise privately but she is likely to encounter substantial obstacles if she is not, as she won't be able to revalidate.

Afaik ALL doctors are subject to CPD / revalidation whether or not they are private or NHS. This is a requirement of being registered with the GMC.

https://www.gmc-uk.org/-/media/documents/cpd-guidance-for-all-doctors-0316_pdf-56438625.pdf

In fact @MissLucyEyelesbarrow if memory serves correctly HW was removed from an NHS performers list way back when she first had her difficulties with the CIW. So I you are right that she would have difficulties getting back onto an NHS performers list because she has "history" and zero insight.

Towards the bottom:

Here we are. This tribunal (an appeal against being removed from the PL) had a much better measure of HW than the MPTS committee. It makes it all the more shocking that she still has a career even if it is limited to private practice. Why should private patients have less protection than NHS patients?

"By way of overview a number of complaints have been made regarding Dr Webberley’s practice to the General Medical Council (GMC) which is the body responsible for the registration of all medical practitioners. It is clear that some of these complaints have been closed by the GMC and some are the subject of ongoing consideration by the Medical Practitioners Tribunal Service (MPTS) which is the adjudication body of the GMC."

...

110. We have considered the overall effects of the past incidents and all the evidence in relation to the current situation in the round. We fully recognise that there were no significant issues regard to Dr Webberley’s clinical practice as an NHS performer when she last practiced at the Blaina surgery in October 2015. Events since then and her responses to the LHB and HIW have revealed deep-seated attitudinal flaws in her approach to governance. The issue underpinning the need for governance is the obvious need for assurance in relation to patient safety.

111. We take full account of the impact of the decision upon Dr Webberley’s ability to further her career and her ambitions. We take into account also that she was seriously unwell in 2016 and has suffered from ill health since. We have fully taken into account her past service in the NHS and her wish to practice in the NHS in future. We consider, nonetheless, that removal is the necessary, reasonable and proportionate response to the facts we have found. In our view, Dr Webberley is unsuitable to be included on the MPL maintained by the respondent.

http://phl.decisions.tribunals.gov.uk/Documents/FTT%20Decision%2022%20October%202018%20-%20%5B2018%5D%203251.PHL.pdf

DrW is a gender specialist. There is no current training pathway she could have undertaken. The court accepted that she did all she could to gain enough knowledge to work in the field, and tried working with NHS gender clinics.

some other points:
GPs can prescribe any medication they see fit. This includes prescribing off label drugs. Puberty blockers are one of those, but most drugs prescribed to young people are done so off label including the most common respiratory drugs. https://www.rdehospital.nhs.uk/media/imwiwy04/patient-information-leaflet-unlicensed-and-off-label-medicines-in-children-and-neonates-rde-20-055-001.pdf

She does not need to follow the same set up as gender clinics in the UK, and if she wishes she can continue to prescribe hormone replacement therapy to those under 16 years old.

What this appeal has done is essentially overridden the previous conviction (many allegations) of failing to discuss fertility preservation in person with the young person as though the conviction was never found to be true.

Happy TDOV
🏳️‍⚧️😊

I think you’re confusing the tribunal with the criminal conviction @Plantaseed90?

The criminal conviction was from 2018 after she failed to register with the HIW.
The tribunal was in relation to her practice as a GP, which she just successfully appealed.

She does not need to follow the same set up as gender clinics in the UK, and if she wishes she can continue to prescribe hormone replacement therapy to those under 16 years old.

This is what concerns me. Is it actually illegal to prescribe opposite sex hormones to children? Although she was investigated for doing this I don't think she was prosecuted for it. Perhaps because no law was broken.

Wow the devil looks after his own indeed! That is bloody awful. 😭🤬

"GPs can prescribe any medication they see fit. This includes prescribing off label drugs. Puberty blockers are one of those, but most drugs prescribed to young people are done so off label including the most common respiratory drugs."

It's true that off label use of some medications is common. However, if you're an adult, and you request something off label that the doctor isn't used to using, that isn't so easy. And that's for adults that can consent to the risks, and where the off label medication could be licensed for the purpose in a different country.

I think off label prescribing for young people is often done because there isn't a licensed medication available.

This is way different to using puberty blockers for gender dysphoria. In that case, puberty blockers are being used for the exact opposite purpose to precocious puberty. With precocious puberty you are trying to give someone a normal puberty. With gender dysphoria, you are trying to stop a normal puberty.

That would obviously require a completely new assessment for the safety of the drugs, with the assumption that it could likely be harmful.

It's also difficult to assess the effectiveness of the drug, as if someone feels better taking puberty blockers after a year or whatever, that's only a limited piece of information. What we really need to know, is things like what percentage of young people would naturally recover from gender dysphoria anyway? Are you messing up the natural recovery of many young people by going down this path? And what are the long term consequences comparing people's health?

Point is, this isn't simply "off label", it's experimental.

From a gardeners point of view: Damaging weeds are hard to clear.

Awful that someone with so little regard for children’s health is out there, ready to mint it again.

Ah, so you were just confused when you said ‘conviction overturned’?

The criminal conviction isn’t overturned.

No it's not illegal.
A doctor can prescribe any medication they like - although they could be investigated for this. They would also be made criminally liable if they prescribe a drug that directly links to the patients death.
Hormones aren't that, and hormones aren't prescribed to children per se. It's complicated because legally there's nothing between children and adult. But most wouldn't call a 16 year old a child.
As per WPATH, blockers can be prescribed when the young person is in tanner stage 2. Hormones can be prescribed 1 year later.
I believe that is what Webberley did in the case of the 12 year old, but I haven't read too much into the court case.

This would suggest not only were her actions legal, but also were following suggested guidelines.