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Helping doctors respond to the needs of transgender people – Will Huxter

The Chair of the NHS England Gender Task & Finish Group looks at how new guidance and training packages promote best practice in the treatment of transgender people in the NHS:  

I am always pleased to draw attention to examples of good practice from the transgender community, voluntary organisations and other stakeholders in this field.

Attached to this blog is a link to some e-training on gender commissioned by the Royal College of General Practitioners from GIRES.  I have also received from the Men’s Forum a publication called Your Body Your Health:  Health choices made easy for trans men, trans masculine and non-binary people, as well as a shortcut to another useful document,

The Stakeholder Network has consistently brought to our attention many concerns about accessing treatment in primary care – particularly with regard to getting prescriptions for hormonal and other medications – and doctors’ training , and knowledge of, trans health issues.

The regulatory body for doctors in this country, the General Medical Council (GMC), has just published a helpful Guidance for doctors treating transgender patients.

This document reaffirms previous guidance published by NHS England on the responsibilities of GPs in the prescribing and monitoring of hormone treatment for transgender people.

The GMC sought community input to this and this guidance was reviewed by two Network member community representatives and by the Chair of NHS England’s Clinical Reference Group for Gender Identity Service before its publication. Their recommendations helped to shape the final document.

All registered medical practitioners in the UK will receive an email from the GMC advising them of this guidance and encouraging them to read it. I really welcome this approach by the GMC.

I hope this publication will be of assistance to all doctors working in the NHS in responding to the healthcare needs of trans and non-binary people, and to further develop the excellent services that many already provide.

I also hope that it will lead to significant benefits to trans and non-binary people throughout the UK, making it easier for them to get referrals for specialist advice, have appropriate changes made to their medical records, get prescriptions for essential treatments recommended by specialists, and, by reducing delays in treatment, enhance the efficiency and capacity of GICs, and help to reduce waiting times.

I have written in previous blogs about meetings that I have convened with the Gender Identity Clinics to discuss what can be done to increase capacity and reduce waiting times, and to share best practice so that people seeking support receive consistent access to core services, whichever GIC they attend.

Earlier this month, I chaired a meeting with the Imperial, Nuffield and St Peter’s Andrology providers to look together at the volume of surgery undertaken in 2015-16, and plans for 2016-17.

In 2016-17, more surgical procedures will be commissioned by NHS England, including additional work undertaken by Aspen at Parkside Hospital.  We also discussed workforce, and the need to ensure that we have sufficient trained and experienced surgeons available to clear the current backlog of people who have been waiting far too long, and then to meet the maximum 18 week standard consistently after that.

The providers highlighted some differences in the approach to referral between the different GICs, and we agreed that it would be very helpful to convene a joint meeting of the surgical providers and the GICs, to help ensure a joined up approach to service delivery for people across the country.

We held a second symposium meeting in February, focussed specifically on establishing shared ownership among partners for developing clinical workforce in GICs, and starting to develop an initial plan to support delivery of workforce development on a multi-agency basis, including in particular Health Education England.

In a future blog, I will describe the development of a joint plan with Health Education England and, as an example of what can be achieved in terms of service transformation, I will be sharing information on future models for provision of speech and language therapy, which I know is a key service for many transgender people.

Finally, just to remind you that the consultation on the proposed service specification for the children and young people’s Gender Identity Development Service, and proposed clinical commissioning policy on prescribing cross sex hormones for young people, remains open until 20 April 2016.

Thanks for the questions and feedback from my last blog on transgender services and I would welcome any comments on this latest post. Please get in touch via this blog, or Twitter, #NHSgenderid

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19 comments

  1. stacey leah micheals says:

    Good Morning
    I am a trans gender male to female have been referred to charring Cross Gender Clinic and have my referral papers stating my psychologist recommends me for surgery all my personnel papers and id have been changed.

    But I have to buy my hormones ect online from unknown sources because my doctor will not give me them ‘ and I have been fighting for my womanhood for many years.
    Sincerely,
    Stacey leah Micheals

  2. Dr Luke says:

    Dear Will
    I am very pleased that you have replied to some of the comments on this blog. It is a pity that your technical team were having a busy period which resulted in a delay.
    I note your advice to Jay to raise a complaint, is there a similar process for us to complain about your service?

  3. Anonymous says:

    so lots of people asking questions and raising important points, but no replies from Mr Huxter.
    Does NHSE have any duty to reply?

  4. Jerry Luke says:

    comments and questions seem not to be working,…..again

  5. jeremy Luke says:

    I am unable to find any reference within this current or previous blogs to you having consulted with GPs. Have I missed something?

  6. Jeremy Luke says:

    I have still not had my email from the GMC, is this because their advice may not be consistent with ‘The Duties of a Doctor’? From what I have read it would open GPs up to massive prescribing risks in all areas of medicine. Unless the GMC views transgender health as different to other aspects of medical care.

    You were vague here; The GMC sought community input to this and this guidance was reviewed by two Network member community representatives and by the Chair of NHS England’s Clinical Reference Group for Gender Identity Service before its publication.
    Does that mean the GMC consulted real GPs or just those who now run GICs?

    A few answers would be useful on these points.

    • Will Huxter says:

      Dear Dr Luke,

      Apologies you have experienced technical difficulties with posting comments, the technical team have had a busy period which resulted in a delay in submitting posts.

      I would advise that you get in touch directly with the GMC regarding your queries on their latest guidance.

      Kind regards

      Will

  7. Dee Livesey says:

    Being both transsexual and a service user, it appears that those responsible for commissioning and monitoring healthcare are unable to truly empower transsexual people. To be empowered as other patients in deciding who, where and when provides them with quality healthcare to meet their expectations.locally I’ve just collated a transgender primary care survey report which produced a practice and a doctors name who delivers first class health care consistently to patients, this information isn’t available from the NHS. Most GPs here are Locum doctors and the Regular GP’s just haven’t time to educate themselves or dis-interested. Rather than educate 1,000’s of GP’s why not just focus on those interested and advertise their “champion ” status locally.The whole healthcare model for trans patients isn’t delivering, quality, fairness and consistency.I personally have 3 serious complaints of discrimination being investigated by the NHS in Lancashire and 3 separate complaints against Blackpool clinical commissioning group. All were so avoidable. I will be joining the new practice very shortly.

    • Will Huxter says:

      Dear Dee,

      I appreciate you taking the time to share your views with us, and I am sorry to hear of the difficulties that you are experiencing within primary care. We have heard from others with similar experiences and are aware of the need to further develop training and awareness amongst GPs and primary care staff in Transgender and Non-binary care. We are developing a work plan with involvement from the relevant bodies and will be giving an update at the next symposium of progress made.

      Thank you for your suggestion of “GP champions” being available locally; however the GMC says that all GPs must be aware of their responsibilities to the general population. NHS Choices does have a facility where services near you, such as GP Practices and Dentists, can be rated and reviewed (http://www.nhs.uk/service-search).

      Delivering quality, fairness and consistency is absolutely our aim for gender services. We have made progress and we will continue to pursue this.

      Kind regards

      Will

  8. Francis Varley says:

    Emailing them all is great news, saves me and other volunteers supporting trans people a bit of unpaid work. But there’s oddly no mention of the gaping loophole that means years after an agreement was supposed to have been made, GPs still don’t /have/ to prescribe hormones!

    • Will Huxter says:

      Dear Francis,

      Thank you for your message, I am glad you feel there has been progress and your point is helpful. NHS England issued guidance in 2014 that clarified GP prescribing responsibilities. The new GMC guidance was prompted in part by the difficulties which people have reported with getting hormones prescribed.

      Kind regards

      Will

  9. Jay duggan says:

    I hope this new guidance by the Gmc will help with my current situation. After 15 months on waiting list, 8 months assessment at the Gic I finally ( four weeks ago) got my letter recommending my gp start me on hormones. I was so excited. However my gp/ practice would not prescribe them due to, firstly the gps lack of knowledge of trans healthcare and was concerned that would not be able to analyse my bloods. After much discussion and several appointments my gp prescribed me hormones when I explained that for now the Gic would be checking them at my next appointment in 3months same time as my bloods are due. However they would not prescribe the blocker and still will not. My gp and Gic are currently argueing over who prescribes and who funds this.
    As need to be on hormones for 6 months before I can be referred for surgery so this delay is extremely frustrating.

    • Jay says:

      Update: well my gp practice has now said they cannot prescribe the blocker recommended by the Gic as there is no funding and has written to the Gic to say that they will not give me it.

  10. Dedilhar says:

    beautiful content, thanks for posting.

  11. Hiya,

    Just to flag up a technical issue with this page – all the links but the last one take users to the nhs.net email login page.

    I’m very keen to take a look at these resources and link them from the information we hold for GPs in Brighton and Hove here: http://www.gp.brightonandhoveccg.nhs.uk/supporting-patients-accessing-gender-identity-services

    If you could fix the links, that would be very much appreciated,

    Many thanks,

    Christopher Roskelly

    • NHS England says:

      Hi Christopher,

      Thank you for bringing this to our attention. I can confirm that the links have been corrected.

      Kind Regards
      NHS England