Gender Dysphoria prescribing policy

We will continue taking on prescribing and monitoring under shared care agreements for gender dysphoria for patients that have been started on treatment by an NHS gender identity clinic.

 

Gender identity clinics are commissioned by NHS England and there are currently eight clinics available in England. The nearest clinic to Bristol is the Laurels, in Exeter.

 

 

These are multi-disciplinary NHS clinics consisting of doctors, nurses and psychologists, and cover issues such a fertility preservation, psychological support, medication, and surgery.

 

Unfortunately, these clinics cannot keep pace with the growing demand for these services and the average waiting times are currently more than three years. As GPs, we feel this is an unacceptable level of service, and we believe there should be more equitable care for the transgender community. This would involve not only more timely access to specialist care, but also continued resources to fund and train GPs to maintain prescribing and monitoring.

 

As a result of these long NHS waiting times, people are seeking private treatment, often through on-line providers. Many private transgender clinics will initiate medication but then request that further prescriptions and monitoring are accessed from the GP.

 

As a practice, we have carefully considered these requests and unfortunately, we cannot support the prescribing and monitoring of transgender medications from private clinics. There are several reasons for this:

 

1. It is challenging for us to be assured of the quality and governance aspects of private clinics.

 

2. These are specialist medications which need to be shared between GPs and specialists, and there is no guarantee of enduring specialist care within the private sector.  It is highly specialised treatment and is outside the scope of practice for our clinicians.

 

3. The medication is not included in our local NHS formulary to treat gender dysphoria.  Within General Practice we are obligated to prescribe from this formulary which is controlled by the local NHS.

 

4. General practice does not currently have the capacity to meet this additional demand from the private sector. There is no funding available to cover this extra clinical and administrative work.

 

We are aware that this is an unwelcome position for those who are struggling to access the care that they need, but feel it is not safe for us to continue to take on this clinical work from private providers.

 

We can refer new patients to NHS gender identity clinics, and we can refer patients back who have been lost to follow up or discharged and need to gain access to an NHS service again. Please feel free to make a GP appointment to discuss this, or if you need support with your mental health.

 

You can access direct help and information from Gendered Intelligence, a charity that supports patients waiting for treatment Support Line | Gendered Intelligence