NHS England publishes interim protocol for gender identity services

NHS England has today published an Interim Gender Protocol for the purpose of addressing the significant variations in equity of access currently experienced by patients using gender identity services across England.

The protocol aims to achieve national consistency in the commissioning of these services, and is the culmination of extensive work to adapt the NHS Scotland protocol, ensuring that it meets the needs of patients; provides for the safe delivery of services, and reflects NHS England structures.

The document, which has been the subject of extensive engagement with patients and carers, has been introduced primarily to allow time to develop, and publicly consult on, a new NHS England policy and service specification which will be developed through the Gender Identity Services Clinical Reference Group (CRG).

It should be used and read in conjunction with the UK Intercollegiate Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria and is cross-referenced to its relevant sections.  The NHS England Interim Protocol is not intended to be exhaustive in content. Issues not covered in this document should be managed in accordance with the UK Intercollegiate Good Practice Guidelines.


  1. Mandy Cameron says:

    I was diagnosed with GID in 1996 and have been a patient of the NHS since. It was remarked that I was an exceedingly good patient who fulfilled all her obligations and adjusted to female role well. However, I was not receptive to hormones and had minimal physical changes, breast development was below 34AA and not significant on a male chest, so the clinic recommended breast augmentation in 2005, funding was refused by my local PCT. My case was supported by the NHS, GP’s, Clinicians, Surgeons, Experts in GID, Healthcare Commission, Healthcare Ombudsman, Parliamentary Forum on Transsexualism, Support Groups such as GIRES/Gender Trust, but still no funding. My mental health declined as a result of refusal, so funding has had to be arranged for years of local mental health support, plus I have had eight years of sickness benefit at the top rate, as well as housing benefit, etc, as I have been unable to function as female. Madness, but if that’s how the system works in order to deny a £1339 procedure on the NHS, and they’re prepared to carry on like fools. then I guess I can’t argue?

  2. Lisa Williams says:

    The issue around patients accessing more treatments for laser hair removal needs clarifying, i.e. that requests for further treatment should be forwarded to NHSE rather than CCG’s. Also requests for surgery following discharge from a pathway appear to be being referred to CCG’s. If this is for revisional surgery then this feels inappropriate. However it is a cosmetic request a number of years later than I assume that this should be directed to CCG’s.

  3. Becky esplin says:

    My dealing with hammersmith gic has not been a pleasant experience.
    Doctors ask lots of questions and relay the minutes by post.
    No feed back what so ever to demonstrate an understanding of my situation.
    I feel I had to battle for HRT and my first year assessment before hammersmith shows no underlining issues.
    For hammersmith to say I have complex issues to be an over exaggeration.
    2 complaints to PALS in 2 years feeling undermined of my ability to represent myself and directions in my life are being and have been addressed.
    The need to show evidence to sustain some activity of a life in your gender form is needed and the fact of having employment in such a depression on the employment market is overlooked and addressing.
    If a patient has documentation of a respectable attempt at making progress in issues raised by the doctors at the gic, then credit should be given to the patient.
    If doctors say 3 months return and the receptionist gives you 6 months without consulting the doctor is very bad practice for safety.
    My trust in the doctors dealing with me do not gain my merit.
    If the gic has such comPlications….. I can not see how this department can continue practicing if numbers of people breach accurate practices

  4. Daira Hopwood says:

    I have several specific criticisms of the protocol:

    * The protocol only requires “treatment for complications related to surgery and revision surgery for unacceptable outcomes,” up to the point of discharge from the service. But in some cases complications may occur years after the surgery itself (for example, puncture of a breast implant, or vaginal prolapse), when the patient would be expected to have been discharged. It is unacceptable in my opinion for such revision not to be funded and provided by the NHS.
    * Only 8 sessions of facial hair removal can be funded. This is likely to be completely inadequate for many, probably most, trans women patients.
    * The hurdles put in the way of trans women seeking a breast augmentation, even if they pay for it themselves, greatly exceed anything required of cis women. (Private providers tend to follow guidelines set by the NHS.
    * There is a distinct lack of any concrete waiting time targets, or even an acknowledgement that waiting time targets that already exist, should apply equally to treatments for trans people. (GICs have up to very recently denied that they should.)

    It would also be helpful for the protocol to use terminology that is less dependent on a binary view of gender (for example, “feminising” and “masculinising” to describe treatments, rather than MtF and FtM).

  5. Henry Hall says:

    The referenced document “UK Intercollegiate Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria” contains the statement:

    “In the UK, individuals may apply to the Gender Recognition Panel for a Gender Recognition Certificate. Applicants applying under this process must demonstrate that they have had a diagnosis of gender dysphoria and that they have lived in the gender role that is congruent with the gender identity for at least 2 years.”

    That statement is false and misleading, as a matter of fact and as a matter of law. Throughout the UK Gender Recognition Act (2004) Section 1 (1) (b) applies. Moreover, application under 1(1)(b) is not only less expensive but is preferred where it is available because it circumvents the stigma that is so often, and so unfairly, associated with psychiatric disorders such as dysphoria.

    It is plainly wrong and a gross abuse to suggest, as do those guidelines, the persons who hold a GRC qualify for surgery because they have, BY DEFINITION, lived in a gender role for two years. Rather it should be acknowledged that they qualify for surgery because they are, for all purposes, members of their acquired gender and should receive surgery on a same-sex (not transgender) basis. In the absence a desire for so-called detranstition, certificated people do not have gender dysphoria and must not be treated for a dysphoria that they do not have.

    And when (if ever) are we going to see acknowledgment of a need for medicine for transgender transsexual people who do not have, and never have had, dysphoria?