Thread by @tribunaltweets2

Good morning. We will be reporting from the misconduct hearing of Dr Michael Webberley, co-founder of Gender GP in Manchester.

We're due to start at 9.30am.

#OpenJustice tribunaltweets.substack.com/p/tribunal-of-…

Michael Webberley applied for voluntary erasure from the GMC register which was rejected in March. The Tribunal considered requests for adjournment and determined the case should proceed in his absence.

Today, the tribunal will hand down their decision about
Michael Webberley's fitness to practise is impaired.

#MichaelWebberleyTribunal #OpenJustice

Michael Webberley (MW) has not attended the fact finding stage and did not retain counsel. We do not expect MW to be present or have counsel in the sanctions stage.

The GMC counsel is Simon Jackson QC (SJ), and will attend online.

The 3 tribunal members will be present in person. The Chair is legally qualified.

When the impairment decision has been handed down, the tribunal moves on to Stage 3, consideration of the sanctions.

Sanctions are intended to protect the public. They are not imposed to punish the doctor but they may have that effect.

Abbrevs:

GGP: Gender GP
GMC: General Medical Council
MW: Dr Michael Webberley
Trib: Tribunal
VE: Voluntary Erasure
GD: Gender Dysphoria
TG: Transgender
PB: Puberty Blockers
Chair: Legally qualified tribunal member acting as Chair of 3 person tribunal

We're starting now. Also in attendance are:
RD Ryan Donahue QC
SJ Simon Jackson QC

Chair: MWs impairment to practice has been found and is detailed in a 7 page document which has been sent to both lawyers.

Chair: we'd be grateful for written submissions for the next stage and communicate please with us re sanctions. Tomorrow morning would be ok but please let us know when y'll be ready
SJ: Should be able to submit later this morning

Chair: Thank you. Then we'll reconvene this morning if only to update on where we are in the process.

Tribunal goes back into private sitting.

[NB From Memory SJ is QC for the GMC]

I can confirm that SJ [Simon Jackson] Is QC for the GMC.

On 19 May MW requested via email that the tribunal not proceed to stage 2. This was considered but stage 2 resumed the following day

We will post the 7 page determination on Impairment document soon but the stand out messages are:

MW's fitness to practice is impaired by reason of misconduct.

"The tribunal had found the Dr Webberley's conduct in this case amounted to a catalogue of failings. These failings were numerous and wide ranging in the provision of care to 24 patients and spanned approximately 2 years"

"The findings related to two different cohorts of patients, the androgen patients and the TG patients. With regards to the TG patients, a number of them were vulnerable by reason of their age and/or their mental health".

"Further, the tribunal considered that all of the patients were exposed to a real or a potential risk of harm".

Dr Webberley's wide ranging failures in relation to the numerous patients identified included:

-Failures to conduct or obtain adequate psychological assessments or mental health assessments
- Failures to establish adequate MDTs
-Failures to obtain informed consent
- Dishonesty linked to the obtaining of consent
- Failures to provide adequate follow up care

-Making inappropriate diagnoses or diagnosing without adequate information
-Inappropriate &/or unsafe prescribing, &/or prescribing (or allowing patients to be prescribed to) without clinical indication &/or insufficient information

-Providing care outwith his competence and without the necessary qualifications &/or expertise

-Failures to adequately engage with with other clinicians involved in a patient's care

"In relation to all 24 patients...MW lacked the qualification, training &/or experience to provide the care he was purporting to give.

In all of the circumstances... MW had not known or appreciated that he was practicing beyond the limits of his competence, he should have done"

"There were also findings of dishonesty in relation to the androgen patients and the giving of information to the patients that was untrue"

"By reference to Good Medical Practice (2013) the tribunal determined that MWs catalogue of failings across a number of disciplines, demonstrated a disregard for numerous fundamental principles of good medical practice".

"In doing so the tribunal was of the view that MW had breached fundamental tenets of the medical profession and considered that his conduct would be considered to be deplorable by fellow practitioners".

"Accordingly, the tribunal determined that the facts found proved, both individually and cumulatively, amounted to serious misconduct"

"Having considered the evidence before it..the tribunal...found there was no evidence that he had expressed any regret or remorse, demonstrated any insight or taken any steps towards remediation"

On the contrary, the tribunal considered that MWs actions since the commencement of the GMC investigation and interim restrictions being placed on his practice, and, thereafter, demonstrated a significant lack of insight by seeking to deflect criticism from himself onto others"

"In particular, following interim restrictions being placed on his practice, MW...relocated the operations of GenderGP abroad and therefore outside of the UK regulatory framework.

MWs stated intention..was so that in his words.."

"GenderGP could continue to provide "with no change...life saving interim care, something that is unavailable in the UK".

MW further stated that the only change in service would be that patients of GenderGP would no longer be subject to "institutional transphobia" "

"The tribunal acknowledged that MW may well have been making a statement of his genuinely held belief that TG patients are poorly served by the care available in the UK, and his genuine belief that there are transphobic beliefs inherent in the system"

"However, the tribunal considered that MWs failure to appreciate his own inability and lack of competence to provide good clinical care to his patients, & his apparent intention to continue to treat this patients, in all the circumstances, demonstrated a profound lack of insight"

"The tribunal concluded that in the absence of any expression of regret and/or remorse, insight and/or remediation, MW is liable in the future to put patients at risk, bring the medical profession into disrepute, breach fundamental tenets of the profession and act dishonestly"

"Accordingly, the Tribunal determined that Dr [Michael] Webberley's fitness to practice is impaired by reason of his misconduct"

The next public session will resume at 2pm today.

Waiting to go into this afternoon's session

Check that remote access works
Chair: good afternoon and thank you for written submissions which I haven't read in their entirety

SJ: I'm ready to go with my submission. If I can start , preface my remarks on behalf of the GMC, that I understand that you make the decisions. Discussing the guidance. However it's my role to take you through the guidance.

SJ: Why a sanction is brought in and what factors are involved. Protecting the public is paramount, has to be fair re EDI, GMP 2013 re impairment and what makes a good drs working in the |UK

GMC submit that a key issue is the scale, duration and seriousness of the findings. In para 15 of findings - a catalogue of failings to 24 patients in 2 cohorts of patients incl those who were vulnerable. And all were exposed to real or potential risks. Listing failings from b4

SJ: If he had not know he was beyond his competence he should have done. There was also dishonesty re normal ranges and risks of taking / not taking medication.
I won't go through all of the paragraphs from GMP that have been engaged

SJ: MWs catalogue of failings would be considered deplorable by other drs. Mentioned post Shipman changes brought in. Whatever field of med they work in , drs must be able to explain and justify their actions... and not risk undermining trust in drs

SJ: We've considered MWs response to hearing. Para 17 pats must be able to trust drs and publics trust in the profession and the overall trust in the profession is more important than an indiv dr.

SJ: Start w the smallest sanction and work upwards. Significant steps and analysis. Mitigating factors - understanding and remorse and remediation. We'll come back to these factors.
We also look at the age /stage of career.

Remediation - in severe cases you shld look at the actions taken by the doctor.
Future actions - altho MWs actions cld be remediated but you found no evidence of insight or remorse/remediation. In fact you found the opposite and deflection of blame

SJ: Move of GenderGP outside of UK mentioned and MWs beliefs re transphobia. His apparent willingness to continue serving these patients shows a severe lack of insight.
So GMC feel he'll likely bring the profess into disrepute and deliver poor care in the future

SJ: Sustained pattern of poor conduct in all areas and he's trying to avoid scrutiny. He's likely to continue to do this in future.
Discussion of insight: before or during the hearing. There is no evidence in this case, in fact there's antipathy re his conduct througout process

SJ Aggravating factors = failure to work w colleagues. Para 66 covers the sanction options if chosen.
Also discussed potential issues including retraining.
GMC feel remote chances here

SJ: Suspension discussed. Punitive effect and appropriate level if public confidence and patient safety are important.
Serious breach of medical practice not leading to suspension could be qualified by attitude problems/insight but not in this case

SJ: Extend of departure from good med practice happened in over a dozen areas, risk to patients in prescribing hormones and in TG patients.
On erasure: para 107 This may be approp even where doesn't mean a risk to the public, which we say he does

SJ: Reckless care and materially dishonest behav with the consent forms of BMH patients.

GMC Summary: in conclusion we submit it is for the panel but in view of the above erasure is the minimum required to cover the above. A serious risk of repeating this behaviour in the future

Chair: Discussing whether MW had an interim order of suspension or not and what conditions and when this occurred
SJ: Wants 5 mins to find the information. I will get back to you on this.
Chair: It probably won't make much difference but good to know all the details

Adjourn for 5 minutes

Returned 14.38pm

Checking remote hearing of RD and SJ

SJ: Thank you for the time. 1st interim order started on 15 Nov 2018, it was reviewed a couple of times and then MW was suspended in May 2019.

Chair: I hope you've got a copy of the legal guidance aiding our decision making by now.

Having found misconduct, what if any sanctions we should impose in view of this [feeedback]. Our own independant judgement on this: Ranges from no action, suspension up to 12 months

Chair: Or name could be erased from the register.

Needs to forefront that the purpose is not to punish but to protect pats and the wider effects on public interest. Any sanction must be proportionate and bear in mind finances and reputation. Public confidence again

Chair: Always work from the bottom up re sanctions, look at factors, possibility of remediation, mitigating factors will be considered. Do you have any reservations?

SJ No observations

[Should have been observations above]

Chair: we will contact people tomorrow morning at the earliest re possible timings of next public session as we're going back in camera again now. Possibly tmrw afternoon or Thurs, likely am.

SJ: Unlikely to be needed until tmrw lunchtime?
Chair: Yes. 2pm at the earliest tomorrow. Good afternoon Mr Jackson.
SJ: Good afternoon panel

Adjourned

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