I have been asked to provide a comment on the current ongoing case of the GMC v Dr H Webberley. The Tribunal hearing is being held at the Medical Practitioners Tribunal Service (MPTS).
Firstly, this blog is an opinion on matters as they proceed, and I have no part in the case. I am merely viewing aspects from the outside, like many others. I am preparing this in a non-professional capacity, but I do have some experience at giving expert evidence at tribunal over many years.
I am getting updates from ‘live Tweets’ from the hearing provided from the Tribunal service and will see if I can get a press update as well. I am also thankful to @truesolicitor and others for their updates on this case. We are aware of other live feeds but are also aware that these are not as accurate and the reporting is, let’s say, skewed. ‘live tweets’ are taken from them being in the room and hearing and seeing proceedings. Apart from being there, it’s the best we can get.
I am trying to remain faithful to the feeds and comments made, but to report the facts and give a background to the proceedings and how the trial system works.
In this case, and current tribunal hearing, Dr Webberley (Dr W) is accused of practising medicine outside the rules and regulations of the General Medical Council (GMC) during the period March -November 2016, A failure to hold a proper safeguarding policy, and (2018) a failure to be registered as a practice in Wales. But there is more to it than that.
This update is from days 21 & 22
Day 21 is brought to you by, well, nothing actually.
(Tuesday) [week 6] of the public hearing.
Intended start at 10:30am.
After a delayed single tweet, the whole day was abandoned.
No reason as to why, just abandoned.
Day 22 is brought to you by The good old days, ah such memories.
(Wednesday) [week 6] of the public hearing.
Intended start at 10:30am.
After yesterday, and a bit of housekeeping. A few delayed and incorrect links, all was well and ready, albeit late.
Today should see the appearance of Stuart Gale (SG). SG is the former employer of Drs Webberley. We are mainly hearing about Dr H W today.
We should also see the attendance of Dr Dean (Dr D) who is a former GP and the current Clinical lead for GIC in Exeter (known as The laurels). He has a virtual funeral to attend but should be here later.
There is some housekeeping to be dealt with to start with, as per normal.
SG takes the stand. This is an interesting witness for the GMC. As Dr HW’s former employer, you would have thought he might want to be on Dr HW’s side. Maybe he is and has been subpoenaed by the GMC as their witness. Alternatively, SG feels he has some sort of axe to grind and is here to wield its sharpened blade. Odd.
SJ keeps his examination short. “ referring to your supplementary statement, you produced a number of exhibits including spreadsheets, are they correct?”
SG “yes.” There, done. All fine and dandy.
IS gets ready.
SG confirms that Dr MW (Mike Webberley) was also an employee of the Online GP practice.
SG also confirms that “the majority of prescriptions were signed off by Dr MW”. (from May 2017)
IS asks SG how he knows. SG says it can be seen from the records.
Very important opening responses. Remember we are here because the GMC state Dr HW gave poor care.
If Dr MW signed off “the majority” of prescriptions, he has the ultimate responsibility. He is not here being challenged. That aspect of this case is important.
Also, the patient records were destroyed after about 2 years. They should have been saved electronically but weren’t. However, we have some spreadsheet information recovered from a data base.
IS begins to run through these with SG.
It is evident, from the outset, that SG has no idea how the spreadsheet or the system of data analysis works. SG says, “It’s all in a spreadsheet that is impossible to read.”
IS shows him how to open the sheets and where to look for the information. This is important, as we will see.
IS runs through several patients records, general entries, rather than specifically Patients A-C. He establishes, or gets SG to agree:
1) That the records are correct in some instances.
2) That the ‘system’ creates ‘odd’ entries on its own I others
3) That when a prescription is queried, the system ‘denies’ the prescription pending more information that has been requested. A fail safe perhaps.
4) That the system seems to struggle with TWO doctors logging on AND working on the same case at the same time. That would seem odd when sign off is needed and the two doctors (Dr HW and Dr MW) are working on the same case and line management. SG states of this routine “Dr (H)W was very good to make sure we gave the best service possible.”
5) Dr HW logs on regularly and frequently to view the system and ‘manage’ cases to avoid queues.
6) Dr HW asks questions of patients and requests further and better information.
7) There are many prescriptions being written daily (up to 60)
8) Test patients are used to test the system.
9) That another person logged on apparently with the SAME login and ID as Dr W.
10) SG said they never used the logs created by the system.
11) SG said the system “didn’t facilitate” a protocol to contact patients directly.
12) SG accepts, after IS pointed out the system produces codes for different actions, but these codes aren’t always right.
IS ends his questions.
What have we learned?
That YET ANOTHER GMC witness is clarifying, is that Dr W seems to act correctly and thoroughly and that the system shows this, as far as it can. It doesn’t show she didn’t. That protocols were in place to have Dr HWs prescriptions checked by Dr MW.
We also learned that the system is very clunky and the business owner, had no idea how it worked, where to look or what to look for.
SJ asks for the witness to withdraw, to allow him to speak to IS and the chair. (there is a pattern in this behaviour)
Hearing goes into private session for about 30 minutes.
SJ then wishes to ask some further clarification questions.
1) The system doesn’t prevent access if someone else is on it
2) The system doesn’t cut out if someone else is on it
3) The system showed ‘live screen’ information
4) The drs. could see the dialogue with patients regarding extra info requested. This wasn’t done by the drs.
5) That (in our case) Dr MW may not know another Dr (say Dr HW) was in the system at the same time.
6) That both drs. Could see the same screen and the same questionnaire and “its comforting they both said pretty much the same thing”.
7) That no one else should know the log in of another. In our case User 17 is should be Dr HW, but that a note by another person (known to be TL) was added under that user number.
8) That the system didn’t allow Drs to contact patients directly by email.
9) That Dr (H)W was “very good at staying in contact with patients”. She would call patients by phone if there was a need to, “we thought it was best practice.”
SJ ends his questions
What have we learned?
Well, pretty much the same as before. That SG seems happy with what DR HW did and has no concerns. In fact, lauding her protocol as “best practice.”
Why are we here?
The panel are now able to question SG. As such he responds.
1) No staff member knows (or should know) another’s ID.
2) That Drs can’t email patients directly (only the team can), but Drs can phone patients and dd notes to the system. Which, he adds, “she did do.”
3) The telephone is a separate system.
4) That drs. have separate IDs but SG isn’t sure about the incident with ‘user 17’
5) There are no other reported incidents of the same ID/incorrect ID for different Drs.
6) That SG was unaware of the incident before it was pointed out by IS
7) That SG was unsure why a prescription could be declined TWICE by two drs. This relates to two being on the system in the same patient record at the same time.
8) The two Drs. Ask the patient (via the notes) to get an STI but seem to be acting independently on the record.
9) Both drs. were CORRECT in asking for an STI and to report back. The system then declined the prescription, pending the awaited result(s)
That ends the panels questions. SG leaves the stand.
What have we learned?
Well, pretty much the same as before. That SG seems happy with what DR HW did and has no concerns.
The system is clunky and may have a glitch. However, one doctor isn’t giving different or inappropriate advice.
Why are we here?
Dr Dean is due to take the stand. Dr Dean is going to be taken through Patients A’s record. Six questions, according to SJ
SJ advises that Dr D has “introduced” a number of documents. Dr D has commented on Dr Bouman and Dr Schumer (Dr HW witnesses). He has also produced additional reports that will form part of his evidence. This will be passed to the chair in time for them to review.
Dr D should be able to do about 1 hour.
Tomorrow we have Dr Klink back to finish his evidence. (patient C)
We may also have Dr D back again for a short period. (Dr D is very ill.)
Chair asks SJ to liaise with Mr Singh and to follow up points he has raised.
The hearing adjourns until Dr D is ready.
Dr D is sworn in (after a link delay with SJ’s internet – he’s on a back-up)
SJ starts his questions
He gets Dr D to confirm that the evidence is correct and up to date. 1st report from 2018 and second from 2021.
From SJ’s questions of Dr Dean, we establish the following.
1) Dr Dean treated trans adults (not children) – This despite SJ previously complaining that some of Dr Bouman’s evidence shouldn’t be admitted for not treating a child below 13!
2) GPs (particularly Dr HW) “will be able to offer initial management…” to a trans patient ..”but may not hold detailed expertise needed. That GP training (at the time and before) would be an overview of children’s health, incl. MH to understand the “range of common problems of children, how they might be managed and that might require a referral.”
3) That Dr D “can’t recall having seen a child present to him with GD.”
4) That Dr D “doesn’t remember receiving training or learning opportunities relating to GD.”
5) That Dr D “would consider it to be outside” his area of competence and would make a referral.
6) That in his opinion, despite [a GP] having some specialist training for children with GD, Dr D “hasn’t come across a GP who would be willing to induct a PB treatment on their own.
7) That, in the case of a young person (YP) with GD it would be possible for a GP to treat “…but only if they had had additional training and supervision from a specialist.”
8) That Dr D feels it is “not his speciality” to treat a child with GD using the NHS spec for adults.
9) That he “would refer to someone who is a specialist.” Either someone with childcare specialist, Endocrinologist, Pead Endo or someone “with endocrine & hormone interventions.”
10) That the BAGIS group was from a course/training SET UP BY Dr D & PGB (from which Dr HW was excluded from joining).
11) The event was “a trial run and involve may speakers from the UK, US and Netherlands.”
12) That Dr D was taught trans care medicine by his predecessor who was “about to retire” and Dr D “was not aware” of any suitable trans training or courses at that time.
13) He essentially self-educated on this matter from working and learning from others.
14) That Dr D uses WPATHWPATH World Professional Association for Transgender Health https://www.wpath.org as a guide for prescribing hormones on adults.
15) His experience at that time (2006) was limited to very few patients (probably 30) but numbers grew
16) That when working as a GP (or GP service) he would refer regarding GD patients
Slightly more than SIX questions.
SJ continues and refers to Royal College PB section (2013). Dr D responds and we discover
1) The reference is for girls with ‘late’ puberty
2) The implication is hormone prescription should be done in the presence of and Endo
3) The guidelines for GD are from North America
4) In 1999 Dr D had been working primarily regarding sexuality and P/T with people with GD
5) That he also worked in the NHS and wanted to show he had both the necessary skills and had attended training.
6) That GPs are required to have an annual appraisal of additional learning including documents published by the GMC (that was and remains standard for many professions)
7) That the documents are presented, and peer reviewed and a “fit to practice” status awarded.
What have we learned?
Dr D is methodical and works inside his capabilities, as should any Dr He gained his experience over time by learning from others and he decided to learn the extra specialist skills from others but with little other direct guidance and formal training.
Things have moved on and training, of sorts is available but that Dr HW has gained her experience and practices in the same way as DR D. Dr D somehow feels this is unacceptable.
We already know the GMC have failed in providing any serious trans healthcare training and there is little else about. Bu, it would seem there are many experts none of whom have had any formal training as they have learned from others.
Talk about pulling the ladder up afterwards to leave others in the dark.
IS advises how the cross examination will work in this case. This is an exception especially for Dr Dean, given his failing health.
IS has written his questions for Dr D and Dr D will reply to those on the stand.
Whilst this is appropriate in the circumstances, it does miss the nuance of the pathway of questioning by a QC. As I have said before, the questions and responses are carefully choreographed to get the witness to respond in the manner desired. This is more difficult to achieve with written questions, as the witness (who must be truthful, of course) has sight of the entire pathway rather than it being revealed to them. The trip hazards and potholes are more evident.
The questions are based on facts and the responses should reflect those. However, with the map in front of the witness, a more efficient route of responses may be had that misses some of the traps and pitfalls.
This is not because it’s a GMC witness, it’s just how the system normally works. In this case the alternative may not.
Interestingly, the questions are to be submitted to SJ and “if approved” will be sent to Dr D and the panel.
Frankly, I’m not sure why SJ needs to “approve” them, as he wouldn’t in a verbal situation. He might ask for an inappropriate question to be struck off the record. He has to act responsibly here. Yes, it his witness being cross examined but has to be impartial in allowing that process to rum unimpeded.
If there is an unreasonable question, then there may be merit in its removal. That however may lead to further argument(s)
Dr D indicates he will look at the questions overnight and he will be available tomorrow afternoon, (presumably after Dr Klink)
What have we learned overall?
In a way, the two GMC witnesses haven’t really shaken the house with responses.
Both may have scored a few hits against the defence case, but mostly clarifying what other witnesses have said, which wasn’t anything bad.
The only witness who has caused a few ripples is PGB, but some of his statements and responses have been overridden by later witnesses.
In some respects, PGB has the most to lose in this case (apart from DR HW herself) PGB is the main instigator of this hearing process and why we are here at all. He has been found out with his gatekeeping and coercive control of cases and patients in the Tavi. This practice has subsequently been called into serious question with the overall poor CQC report.
Yet we are here looking at the practice of one Dr who most GMC witnesses seem to suggest has followed the rules, as best she could with the resources and training she has gained. This given that there is precious little available as many have confirmed and that the GMC have failed to create any, despite setting up a task force to do just that.
Back tomorrow (day 23) at the regular time of 10:00
To be continued…../