The medical practitioners tribunal has found that Dr Michael Webberley, who ran an online clinic prescribing testosterone to men in the UK and Gender GP, an online transgender clinic, failed to provide good clinical care to patients and was dishonest.
Some allegations were found not proved, on the balance of probabilities, the civil standard of proof used by the tribunal.

The decision has detailed consideration of the law and expert evidence and each element of the allegations and is 305 pages long.
The tribunal found Michael Webberley's failure to provide good clinical care for patients related to consultations, history taking, examination, diagnosis, prescribing, delegated communication, follow up, assessment, working within the limits of his expertise and the guidance.
Patient consent forms contained information that was untrue and informed consent was not obtained. Michael Webberley failed to establish an adequate Multi-Disciplinary Team. The tribunal also found his actions were dishonest.
The tribunal will now consider if Michael Webberley's fitness to practise as a doctor is impaired.

Sanctions may be imposed to protect the public, maintain public confidence in the medical profession and proper professional standards and conduct for the members
The tribunal will continue (dates tba) with evidence of Michael Webberley's fitness to practice.

It can place conditions on the doctor's registration, suspend registration or erase the doctor’s name from the medical register, so he can no longer practise.
The determination of facts in the hearing concerning Dr Michael Webberley is here. drive.google.com/file/d/1Xsv8zg…
There were a number of allegations of dishonesty.

Allegations 83- 88 concerning facts on operation of Gender GP & the involvement of suspended Gender GP, Dr Helen Webberley were found proven.

Allegation 89 on dishonesty related to use of the Gender GP name was found not proved. Image
Other allegations regarding Michael Webberley's dishonesty concerned false statements on the levels of normal testosterone on the consent forms were found proven by the tribunal as "self-evidently dishonest & would be regarded as such by the standards of ordinary decent people."
"In particular, the Tribunal considered that the only purpose which Dr Webberley could have had in knowingly making this untrue statement, would have
been to either, in due course, mislead his patient into believing that he had a medical condition requiring treatment..." >
"...namely hypogonadism & that TRT/TT was
necessary or, alternatively to create the impression to others that he was providing treatment to Patient A for a bona fide medical condition as opposed to prescribing inappropriately for the purpose of, for example, ‘body sculpting’...">
".. or enhanced athletic performance.

In reaching this conclusion, the Tribunal considered it significant that within the consent form not only was the upper limit of normal testosterone range
inflated, it was also stated that to obtain the full benefits of testosterone," >
"the purpose of the therapy was to restore testosterone levels to the ‘optimal’ range and
not the ‘normal for age’ range." >
"This specifically meant potentially raising the patient’s testosterone level to the higher (upper) quarter of the untruthful reference
range, stated to be 24/40 nmol/L. "

So the Tribunal found dishonesty proved in relation to allegations concerning consent forms.
There are 90 pages of the Michael Webberley Tribunal’s findings (Paragraphs 515 -939) considering the evidence & the finding of fact relating to 5 patients treated by Gender GP. We reported the evidence given in the tribunal, but not the written evidence which is not made public.
The Tribunal acknowledged demand for services far exceeding the resources available for supply and lengthy waiting lists. “[T]his issue became all the more acute in respect of children or adolescents who were experiencing gender dysphoria. >
These patients, who had a clinical need for puberty blockers, needed to start their treatment before puberty was complete, otherwise the purpose of the puberty blockers would be defeated.”
Patient S, who has been with CAMHS since 13 yrs old, was 17 when S contacted Gender GP. S has been diagnosed with Autistic Spectrum Disorder.

There was some lack of clarity within the CAMHS whether to refer to Tavistock GIDS, or make a new referral to an adult GIC. Image
The Tribunal considered this to be an example of the real difficulties young patients could experience. It notes that inadequacy of NHS provision for patients who may be experiencing gender dysphoria is not be a justification for shortcuts in assessment, diagnosis and treatment.
The Tribunal determined that Dr Webberley lacked sufficient specialist knowledge, experience or training in the provision of transgender care.
Identical allegations made in respect of transgender patients were found proved - that Michael Webberley failed to provide good clinical care to patients because he did not establish adequate Multi-Disciplinary Teams (MDT) for the Gender GP patients.
The Tribunal considered NHS and other guidance, and found that a failure by Dr Webberley to establish an MDT necessarily amounts to a failure to provide good clinical care. As to this issue, the Tribu...
The Tribunal determined that if transgender care was provided outwith an MDT, it would necessarily require the medical practitioner providing the care to have sufficient specialist knowledge, experience and training in the provision of such care.
"[The doctor] would need to consult and liaise with other medical professionals for the purpose of assessment, diagnosis, treatment and decision making."
The Tribunal determined that Dr Webberley lacked sufficient specialist knowledge, experience or training in the provision of transgender care. In practical terms, the only way he could have provided good clinical care was by means of establishing an adequate MDT.
It concluded it was not possible to be prescriptive as to the composition of an MDT in the context of transgender care.

The MDT must as a minimum include "a suitably qualified mental health professional, with specialist knowledge and experience in transgender medicine >
and a suitably qualified endocrinologist or gender specialist and, where children or adolescents are concerned, a paediatric mental health professional and a paediatric endocrinologist or a paediatric gender specialist.“
In the Tribunal’s judgement, the requirement for an MDT means ‘team working’ which “would include, but not be limited to; discussion about patients’ presentation and assessment, joint treatment planning, joint decision making and joint review."
"An individual practitioner who, from time to time, utilises the services of another practitioner is neither a functioning nor adequate MDT.” Image
Patient S, a 17 yr old, sought oestrogen treatment in Jan 2017 & dealt with both Helen & Michael Webberley.

S had contact with Avril [Colette], Marianne Oakes & Jayne Olden, who are not mental health professionals qualified in the assessment and diagnosis of gender dysphoria. The Tribunal next considere...
There was no evidence to suggest that there was any endocrinologist (or gender specialist) involved, or consulted, in relation to Patient S’s care. By 24 July 2017, Michael Webberley had prescribed cross sex hormones. 556.	Avril [Colette] had co...
Gender GP made no contact with CAMHS despite the CAMHS doctor trying to make contact with Dr Webberley, who failed to respond.

After treatment had started, Dr W contacted S's GP for the purpose of seeking to enter into a shared care agreement for the prescription.
The Tribunal found Michael Webberley failed to conduct a physical assessment and had no face-to-face or video consultation with Patient S. There was no evidence that Dr Helen Webberley had ever spoken to him, much less, had a face-to-face consultation. The Tribunal considered tha...
The Tribunal found that Dr Webberley relied on counsellors who conducted a telephone interview of unknown quality or duration & their report was not sufficiently detailed. The evidence on the qualifications and regulatory registration was found not proved. ImageImage
The report was superficial. Avril Colette was unaware of S’s ASD, so could not have read the patient questionnaire prior to the consultation.

There was no exploration of S's dysphoric feelings, mental health or the impact of the ASD. only the beginning of the info gathering The Tribunal, even in the a...
The Tribunal found that Dr W relied upon an inadequate mental health assessment, did not liaise with Patient S’s mental health workers, nor engage with them workers when they actively sought to communicate with him. proforma questionnaire .......
It also found that Michael Webberley did not ensure the assessment process was adapted to account for S’s needs.

S said “I struggle with questions and expressing myself with words’, ‘the stress of talking to people can render me non-verbal, such as when visiting the doctors.’ CAMHS medical records in re...
The Tribunal found Michael Webberley failed to provide good clinical care to Patient S in reaching a diagnosis of gender dysphoria based upon findings resulting from inadequate assessment & prescribed oestrogen and anti-androgens being able to ensure it was clinically indicated.
The Tribunal acknowledged that it could have been that a diagnosis of gender dysphoria and prescription of sex hormones was appropriate. However, the clinical evidence available to Dr Webberley at that time was inadequate.
Furthermore, as the Tribunal previously determined, a diagnosis of gender dysphoria does not mean that the prescription of cross sex hormones is the only appropriate treatment.
Webberley was found not to have discussed alternative treatments with Patient S.

He prescribed oestrogen and anti-androgens without adequate monitoring of the physical & psychosocial responses to treatment.
Webberley continued to prescribe oestrogen to Patient S despite evidence that the dose was excessive and S starting to experience known risks. Although Patient S expresse...
There was no evidence that Dr Webberley had sought, to notify S’s GP of the treatment he had prescribed. Dr W wroteto the CAMHS psychiatrist in August 2017, in error, as if she were the GP and not a psychiatrist, enquiring about the possibility of shared care.
Dr W did not make any changes to the clinical management when S failed to get blood results & check their blood pressure. The Tribunal did not consider that the third element added anything to the allegation & found it not proven. Image
Dr W failed to seek a follow up consultation with Patient S. He inappropriately delegated communications to admin staff & counsellors and failed to adapt communications appropriately to take into account the fact that Patient S is on the autistic spectrum.
Informed consent:- The allegation that Dr Webberley did not obtain informed consent was made in relation to a number of the transgender patients including S. The Tribunal found Dr W did not adequately assess Patient S’s capacity to consent.
Allegations Dr W failed to sign the consent form and started treatment without S having signed the consent form, a pre-requisite to commencing elective treatment, were found not proved. The Tribunal concluded that the absence of a signed form did not vitiate informed consent.
The Tribunal made a detailed consideration of the nature and extent of the doctor’s duty to obtain informed consent generally and, in particular, in the context of transgender medicine, including those cases in which the patient may be a child or adolescent. paras 606-634
It shares emails between S & GenderGP, demonstrating that S had difficulties in comprehension & understanding. One email shortly before Dr W prescribed cross-sex hormones is a striking example of S’s apparent deficits in comprehension & Dr W’s failure to have regard to them. ImageImage
Allegations that Webberley operated outside the limits of his expertise as a gastroenterologist, without the necessary qualifications, training & experience in transgender medicine & assessment of capacity and autonomy in an adolescent with mental health issues were found proved.
The Tribunal found Webberley had exposed patients to risks of androgen toxicity, without clinical need, and testosterone-induced erythrocytosis, which has symptoms including headache, fatigue, blurred vision and numbness, tingling or a burning feeling (paresthesias).
The Tribunal found, in the absence of any other reasonably conceivable explanation, that Dr Michael Webberley's work prescribing testosterone to men and adults and children at Gender GP was financially motivated.
We'll report the findings of the Tribunal relating to 4 other Gender GP patients - Patient T, aged 10, Pt U aged 22, Pt V aged 9 years and eight months and Pt W who was 17 in separate threads.

#MichaelWebberleyTribunal #OpenJustice

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More from @tribunaltweets2

May 19
Good morning! Hopefully today this account will be live tweeting the appeal against the CPS refusal to disclose if Stonewall or other lobby groups were involved in the creation of its Hate Crimes guidance for schools in 2020
crowdjustice.com/case/challenge…
An application was made by a freelance journalist under the Freedom of Information Act but this was refused under section 36 of the Act - prejudice to the effective conduct of public affairs
ico.org.uk/media/for-orga…
The Information Commissioner (ICO) upheld the CPS refusal and the freelance journalist appeals.

Will tweet further if permitted.
Read 187 tweets
Apr 13
Good morning. Sophie is today’s tweeter. Reminder of abbreviations:
MW: Dr Michael Webberley
SJ: Simon Jackson- QC for GMC
RD: Ryan Donoghue - counsel for GMC
Chair- chair of panel
Panel- other panel members
We are due to start at 9.30am.
Continuing with submissions from SJ.
SJ: There are one or two issues with consent to do with Gender GP. Could I focus on Patient B. Patient B relates to time between 15 June 2017 to September 2018.
Read 68 tweets
Apr 12
we are starting
Chair: mentioning documents recently uploaded for the panel [we don't have access to these]
SJ: in addition you will have a copy of our recent statement submissions
Chair: confirms just received and happy to follow as SJ goes through it.
SJ: happy to wait until everyone happy to start
Chair: resume in 10 mins
We are resuming

SJ: the tribunal has been provided with the GMS's case and the evidential matrix, now updated. In addition the tribunal has been provided with all the criminologies.
SJ: And the index to the expert's bundle.
SJ: [all this] will hopefully help the tribunal
Read 71 tweets
Apr 7
Apologies for confusion. Here is this morning's proceedings from the tribunal of Dr. Michael Webberley. This afternoon's live tweeting will appear here.
Now restarting after the lunch break.
SJ: Simon Jackson, QC for GMC
AK: Alanna Kieran, expert witness
RD: Ryan Donoghoue, counsel for GMC
Chair: chair of the tribunal panel
Panel: other members of panel
SJ: discussion of documents regarding Patient W and the statement that there are no medical records available. There apparently are some records, but were not made available until after disclosure was finished.
Chair: documents will be made available.
Read 107 tweets
Apr 1
Checking connections for all
SJ: Before we resume with DQ I need to raise something in his absence [DQ put on mute and leaves room]. One of the issues w his evidence was re MWs competence for TG patients and how long HW worked w Dr A
SJ: GMCs consideration is this statement re DR A shld be disregarded
Chair: we wold have done in any event as quite plain that DQs comment was possibly multiple hearsay and he cldn't properly given his opinion on this
SJ: It's the GMCs position that its not relevant
Chair: His competence is relevant but not this aspect of it
DQ returns
Read 31 tweets
Apr 1
Good afternoon and welcome to the misconduct hearing of Dr Michael Webberley (co-founder of Gender GP) due to start at 1pm.

This is @jeeeez17 live tweeting and we expect to hear the final evidence of GMC expert witness Dr Richard Quinton (RQ) at 2pm.
As his testimony is so important and he speaks extremely quickly I may make notes of his testimony and post this asap. Apologies for any delay.
The GMC counsel are Simon Jackson QC (SJ) and his junior Ryan Donohue (RD).

(RD was the GMC counsel in Dr Adrian Harrop’s case which we reported last Oct)

The counsel are attending online and the 3 tribunal members are in person.

MW is not present.
Read 22 tweets

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