Guide To Supporting Patients Accessing Specialist Gender Identity Services
GPs are part of a shared care arrangement when the patient is accessing Specialist Gender Identity Services (SGIS). What are the key responsibilities of the GP in this?
- Making the initial referral to the SGIS. Template referral forms can be accessed in the table at the bottom of this page. For convenience, most local patients are referred to the nearest (and largest) clinic - – The Tavistock and Portman NHS Trust Gender Identity Clinic. . Patients can be referred to other clinics, particularly to respond to long waiting times
- Acting as an advocate. SGIS are oversubscribed and accessing them can involve very long waits and be complex and frustrating. Patients may need to be resilient and persistent and GPs have a role in supporting them to navigate the system
- Liaising with the SGIS as necessary in supporting the patient’s care
- Prescribing hormones (and monitoring) following the recommendation of a specialist endocrinologist – further information on this can be found in the Guidance from NHS England and the Royal College of Psychiatrists
- Providing services needed in advance of surgery – e.g. smoking cessation, obesity management
- Post-discharge care following surgical procedures – e.g. treatment for wound-healing, prescription of antibiotics, managing minor surgical complications etc
- Support to maintain the patient’s mental health – accessing SGIS can be frustrating and waiting times are extended (a 1-2 year wait for a first appointment is not uncommon). Appointments can be infrequent and SGIS rarely provide on-going mental health support. GPs refer to local NHS mental health services and sign-post to support services if needed
- Provide reports or other information documenting the patient’s treatment (e.g. for the purposes of changing identity documentation)
Independent Hormone Prescription
GPs routinely prescribe cross-sex hormones as part of the shared care arrangement with SGIS. A more challenging issue arises where patients have been taking (or intend to take) hormones from illicit sources - often the internet - but wish to enter medically managed hormone treatment.
Patients can wait 1-2 years for a first appointment at SGIS and hormones are not usually prescribed until after a minimum of two (assessment) appointments. Instructing self-medicating patients to stop entirely in the interim may be unrealistic and inadvisable in some cases, especially if they have been doing so for some time. This may also deter the patient from medically managed NHS care if insisted upon.
GPs will therefore need to make a professional judgment about the risks and benefits of prescribing medically supervised hormones in advance of a SGIS appointment, and may wish to consult an endocrinologist at one of the clinics for advice. However, the NHS England Guidance is clear: GPs can legitimately at their professional discretion provide a ‘bridging’ prescription for cross-sex hormones in such circumstances as part of a harm reduction strategy.
"However, the GIC physician, the patient’s GP or another medical practitioner involved in the patient’s care may prescribe “bridging” endocrine treatments as part of a holding and harm reduction strategy while the patient awaits specialised endocrinology or other gender identity treatment and/or confirmation of hormone prescription elsewhere or from patient records (page 16)." 10
Introduction Guide Home Page
Section 1.0 About This Guide
Section 1.1 Why This Guide Is Needed
Section 1.2 Current Context
Section 2.0 Developing Understanding About Trans People
Section 2.1 New Thinking About Gender
Section 2.2 About Trans Identities
Section 2.3 About Gender Pronouns
Section 3.0 High Quality Services for Trans People
Section 3.1 Getting It Right
Section 3.2 A Special Note on Children and Young People
Section 3.3 A Special Note on Screening: Screen for the Organs Present
Section 4.0 Understanding the Patient Groups
Section 4.1 Understanding Specialist Gender Identity Services
Section 4.2 The Approach to Treatment
Section 4.3 Treatment Protocols
Section 4.4 Available Treatments - Adults
Section 4.5 Available Treatments - Children and Young People
Section 4.6 The Role of the GP
Section 5.0 Changing NHS Records
Section 5.1 Information Sharing - The Gender Recognition Act 2004
Section 5.2 Medical Reports
Section 6.0 Supporting Patients
Section 6.1 Sources of Information and Support
Section 7.0 Glossary
10 NHS England (2013) Interim Gender Dysphoria Protocol and Service Guideline 2013/14.