I have been reading the report into prescribing practices at WellBN GP practice in Brighton and Hove with real sadness, and I need to say something about it. The people I know there did not abandon their patients. They did not say no. They opened their doors to people who had gender incongruence and nowhere else to turn, and they provided care. For that, they are now under enormous scrutiny. I know exactly how that feels, because I went through it myself.
What the report actually says
The headline finding is that "the clinical approach to care, including oversight by the GP practice partners, fell short of what could be considered safe or appropriate." That phrase has been doing a lot of work in the coverage of this story. But I keep coming back to the same question: safe and appropriate by whose standard? Considered by whom? Because in the United Kingdom right now, there is no rule book. There is no published national clinical guideline that tells a GP, a nurse, a counsellor, or a psychologist what to do when a young person sits in front of them asking for puberty suppression, or gender-affirming hormones, or mental health support through transition. The WPATH Standards of Care, which are the internationally recognised framework, were apparently the basis on which WellBN was operating. But the report does not seem to treat those as sufficient. So I want to know who carried out this inspection. What specialism did they hold? What knowledge did they actually have about gender-affirming care, about children and young people with gender incongruence, and about the extraordinary pressure practitioners in this field work under? The report does not say, and that matters when you are judging whether care met a standard nobody has bothered to write down.
The competence trap
The investigation found that "none of the clinicians whose care was considered were professionally competent to initiate or assume responsibility" for this treatment. That sentence is both serious and deeply unfair. If no clinician at WellBN was professionally competent, then who, in the UK, is? There is no competence examination. There is no training programme. There is no qualification you can obtain that certifies you as competent to provide gender-affirming care in this country, because the education standards have never been set. No curriculum, no qualification, no exam. The competence the report demands has never been made available to acquire. You cannot fail a test that has not been written.
This is the trap. Regulators hold practitioners to a standard of specialist competence. The pathway to acquiring that competence has not been built. And yet trans people, including young people, still need care. They do not stop needing it because the system has failed to train anyone to provide it. The GP who opens the door is not reckless; they are sometimes the only person left standing.
The absent specialists
The report criticises the absence of referrals to consultant paediatric endocrinologists. I understand why that sounds reasonable to someone who does not know this field. In most areas of medicine, specialist oversight is exactly what you would expect. But the gender incongruence curriculum for paediatric endocrinology in the UK does not include this work. They were not taught it. They were not trained in it. And the only specialist paediatric gender clinic in the country that was actually doing this work, the GIDS clinic at the Tavistock, was closed down. So which consultant paediatric endocrinologists, with appropriate training and current knowledge, were WellBN supposed to approach? There are none. We have not created any. The inspectors demanded a referral pathway that the NHS has not built and shows no urgency in building.
What the "next steps" actually reveal
The part of the report that angers me most is the section on support for families. The message, stripped back to its plain meaning, is this: we have ended the service that was caring for your young person. Here is a phone line. Here is some mental health and wellbeing support, because we know your mental health is going to deteriorate once we take this away.
That is not a safety measure; it is an admission of harm presented in the language of concern. If you know that ending a service will damage people's mental health, the answer is not a helpline. The answer is not to end the service. The answer is to build the education, write the clinical guidelines, fund the training, and then give doctors the framework and the permission to provide this care. A phone number offered in place of actual medicine is not compassion. It is bureaucratic cruelty.
Why this keeps happening
I went through my own version of this. That is why I recognise every line of this report. The logic never changes: identify a practitioner providing gender-affirming care outside the narrow official pathway, apply standards that do not formally exist, find that the care fell short of those phantom standards, and shut the service down. The patients are left without care. The practitioners face regulatory consequences. And nothing is built in their place.
WellBN was not operating in a vacuum. They were operating in the space the NHS left empty. Every single investigation of this kind should be required to answer the same question before it publishes a word: if not this service, then what? If these clinicians were not competent to provide care, which clinicians are? If these standards were not adequate, where are the adequate ones published? Until those questions have honest answers, reports like this one are not improving safety. They are removing care and calling it an improvement.
What needs to change
The answer is not more phone lines. It is not more investigations into practitioners trying to fill a gap the system created. The answer is education: a proper curriculum for clinicians working in this field, a recognised qualification, a training pathway that produces the specialists regulators say they want. It is clinical guidelines, written with genuine expertise in gender-affirming care and grounded in international standards rather than hostility to them. And it is a political willingness to allow doctors to practise this medicine without facing the threat of investigation every time they do.
Trans people in the UK need care. They are not going away. The question is whether they get it safely, from trained practitioners working within clear guidelines, or whether they go without, or find it far from home, or patch something together themselves. The WellBN report, whatever it intended, makes the second outcome more likely, and that is a disgrace.
I will be doing a full assessment of this report and putting it on my YouTube channel. There is more to say.