Tomorrow I face sentencing as a result of my work with transgender and non binary people. This means I will have a criminal record. My GMC registration, which I fought so hard to achieve and which has defined me as a person all of my adult life, hangs in the balance. As a mum and a respected GP, had you told me three years ago that I would have ended up in this situation, I would never have believed you.
And yet here I am.
So I wanted to provide an overview of how the current situation came to pass, from my perspective. My hope is that this will go some way towards countering the alarmist headlines pushed out by a media which has been accused, on more than one occasion, of promoting an anti-trans agenda.
In 2014 I created a company called Online GP services Ltd (OLGPS). This was for business and financial reasons to cover any private work that my husband and I carried out. We offered contracted services to other companies which were individually registered in their own right and OLGPS was set up to manage that activity.
In 2015 I wrote some information about health issues affecting the trans and non binary community and added it to my website. I never anticipated the response I received from those needing support – it was overwhelming yet heart-warming, and showed a huge need for this group of people.
In 2016 I was warned that if I took a special interest in the care of transgender patients, I would become the subject of complaints, investigations, tribunals and hearings. This is what had happened to previous doctors who helped transgender patients. However, I came to the conclusion that, as long as I operated according to best practice, there should be no reason for this happen.
In late 2016 I pursued an application for registration with the Healthcare Inspectorate Wales (HIW) and Care Quality Commission (CQC) to operate my growing business, GenderGP, as a clinic. I believed, perhaps somewhat naively, that the registration process would be simple and that the excellent service I had developed, to help patients in dire need, would be applauded. The advice I was given from HIW was that the registration should be in the name of my company, OLGPS.
By early 2017 I had become caught in a spiral. Complaints were being made to the General Medical Council (GMC) by doctors working in the NHS who did not like my approach (my patients never made a complaint). These complaints were reported to my Local Health Board (LHB) where I was working as an NHS GP, and my LHB forwarded them to the HIW. As a result, not only did HIW refuse our application to register, but they felt duty bound to open up a criminal investigation. I asked to meet with them to discuss the situation and find a way forward, they refused.
HIW informed me at this stage that OLGPS must immediately cease providing services to patients. When I pointed out that these patients had no alternative (there was no NHS service in Wales and waiting times for specialised services outside of Wales were significant) I was told to send them back to their GP who would then refer them on to their NHS Gender Identity Clinic (GIC).
The whole reason that people had come to me in the first place was because their GP and GIC had not been able to provide the care they needed. So this was not a viable option. I asked HIW to meet with me to discuss the healthcare needs of my patients and how we might resolve the issue, but they declined. I wrote to them a further two times. I asked for guidance from the Chief Medical Officer for Wales, but I received no clear answers.
With no other timely route to legitimate treatment, and a strong likelihood that my patients would opt to self medicate without any supervision rather than be sent to the back of the waiting list, I chose to continue to provide support and healthcare to the best of my ability.
My own personal regulator, the GMC, clearly states that my professional actions should cause no harm to patients and that hormone treatment for transgender patients should not be stopped abruptly. So I made the decision to continue providing services, while the issues of registration were resolved. I was confident that the care I gave to my patients was safe and in line with Good Medical Practice so registration must surely follow. Although the GMC has a duty to investigate concerns presented to them, no fault has thus far been identified with my work and my treatment was always in line with International guidance and best practice. I was acting in the best interests of my patients in continuing to provide support rather than stop as I had been instructed to do.
The truth is, it was the right thing for my patients, but not for me.
In 2018, I was removed from the NHS GP list in Wales. They felt that, as I was under investigation and as I had provided unregistered services, I was not suitable to be an NHS GP.
In 2018, I was summoned to the Magistrates Court and convicted of being a director of a company that carried on a medical agency without being registered. This conviction will have far-reaching consequences.
As a result of being removed from the NHS GP list, and because of my conviction by the HIW, I have now been suspended from being a doctor in any capacity until matters are looked at in detail by the Medical Practitioner’s Tribunal Service (MPTS). The MPTS runs hearings for doctors whose fitness to practise is called into question by the GMC. Interestingly, when I was last called in front of the MPTS, as part of this process, they lifted some of the restrictions placed on me by the GMC, but now that I have a conviction and I have been suspended I don’t know whether I will get the same fair hearing. There will be a formal Fitness to Practise hearing next year which will examine all of the issues in detail.
My patients tell me on a daily basis how I have changed their lives and in some cases, saved their lives. Many of them wrote to my regulators to plead with them to not restrict my work as it would impact their treatment. But their letters were ignored.
Hindsight is a wonderful thing. Had I have known then what I know now there is no question that I would have applied in advance to register this essential service. But when I started, I was practising as a doctor, not a business and I did not know that registration was required. When I realised it was, it was too late.
The inference has been that by being ‘too accepting’ of the trans and non binary community, that being ‘too quick’ to help, that I somehow may be ‘encouraging’ people to change gender. That I am part of some secret sex change plot that will bring about the end of the world as we know it. In fact I am just trying to hold up my end of the Hippocratic oath to Do No Harm – abruptly stopping treatment would have caused harm. Failing to treat this small group of people altogether is doing even greater harm.
Transgender people globally get a raw deal. I have never seen such terrible medical negligence in any other specialty. The perception is that their medical needs are not urgent, pressing or desperate. Their cries of anguish, their tears of desperation and the self-inflicted wounds are ignored.
Leaving them to ultimately question: Who cares?
I do. I care very much. And so do my team, they are the ones who have actually looked at what we do and who we help and how we help them.
My thanks go to all of the wonderful people at GenderGP who have stood by me in my campaign and have trusted and believed in my mission. Amidst all the noise and fire, they have continued with strength and conviction to help those who still need our services.
Wish me luck tomorrow.