Future specialised gender identity services

NHS England’s Medical Director for Specialised Services reports on the national review of specialised services for trans and non-binary people:

In the month that’s celebrates trans awareness across the world, I want to update you on the consultation on new service specifications for adult services, which took place over the summer.

The consultation lasted 14 weeks and during that time NHS England ran face-to-face events in Leeds, Cardiff and London, and a number of focus groups. In order to increase participation for people who could not attend an event in person we ran three webinars.

We also attended the Sparkle Weekend in Manchester and Trans Pride in Brighton.

The team’s experience of the events was of good and challenging debate, with some really meaningful contributions based on personal insight of the challenges that we face. I was pleased that we had good representation across the diverse trans and non-binary experience.

We had a high response rate – more than 800 people responded via the online survey and through written responses.

I am pleased that so many people got involved and I want to thank everyone who took time to come to one of our events or submit a response.

All of your responses are now being analysed by an independent third party organisation who will report on NHS England’s consultation, as well as NHS Scotland’s Gender Reassignment Surgical Service consultation, which ran at the same time.

The final report will be available in the New Year and this will be carefully considered by us, and we will seek advice from our relevant Clinical Reference Groups and external groups and organisations in forming the final versions of the service specifications.

Once we are clearer on the future shape of the service specifications, having considered the outcome of consultation, I will provide you with an update, including the plans for a process of national procurement to identify which organisations are best placed to deliver specialised gender identity services in the future.

I will also update you on our priority areas of work for 2018 including our intention to develop meaningful indicators of quality for surgical and non-surgical services.

If you would like to keep updated on NHS England’s work on gender identity services, you can register as a stakeholder of the Gender Identity Clinical Reference Group (adults) and the Paediatric Medicine Clinical Reference Group (children and young people). Or, if you have any questions or comments about the gender identity review, please get in touch or respond to this blog via the comments section below.

James Palmer

James Palmer has been Medical Director for Specialised Services since NHS England’s inception in 2013. He is a member of NHS England’s Specialised Commissioning National Team. He is a Consultant Neurosurgeon at Plymouth Hospitals NHS Trust.

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  1. Michael says:

    Hi James,

    We’re into April now, and you still haven’t updated us on the consultation. We haven’t seen the report that was coming out ‘in the New Year’. Are the final service specifications still expected to be agreed in Spring (ie the next 6 weeks or so?)

    Given the lengths of waiting lists, it is really important that clear information about procurement processes is made available early, to avoid uncertainty or worry for people who may have already been waiting months or even years at the time procurement is started.

    There also seems to be growing inconsistency between care at different clinics – e.g. some clinics, such as the Porterbrook, refusing to refer patients to surgeons that are routinely used by other clinics. I know the intention is that procurement will iron out these inconsistencies, but at present we have no idea of timescales.

  2. Nicola says:

    Hi James
    Any update on facial electrolysis funding as the current current funding per person does not allow sufficient treatment for most male to female transfemale to remove their beard growth fully.
    When the funding increase last happened this was not backdated for persons who had already undergone treatment but required additional electrolysis. I’m keen to begin electrolysis treatment, but I’m waiting to hear if there’s going to be any changes to the funding for this.

  3. Louise Roberts says:

    Dear James, do you have an update on the review of specialised services for trans and non binary people. I suspect there are a lot of people waiting for some news.I had my screening interview with my GIS in November 2017 but due to demand they cannot even give me an estimate of first appointment date. I now am at the point of not being able to afford private care and hormones after two and a half years of paying. The consequences of stopping after this long is unlikely to be favourable.

  4. Rachael says:

    We need loads more flexible local GP lead gender providers with links to their local GICs for support and complex case management. These supermassive services with half the country forced to go to Charring cross or Nottingham severely limit choice and prevent healthy competition ever developing in the future. Don’t think it will reduce RRT or save money either. Talk to GPs and keep care local.

  5. Sophie Cee says:

    It’s been 2 months since the last update. During which time transgender individuals have been continually and repeatedly berated in the press. This has lead to the government taking the cowardly step of kicking the tiny cost neutral crumb of gender self definition into the long grass.

    We want adequately funded comprehensive healthcare that meets our needs. Some reassuring words from NHS England would be appreciated.

    • NHS England says:

      Dear Sophie,

      Thanks for your comment. I’m sorry that we’re not yet in a position to give an update. Following the close of public consultation in October 2017 we’re now in the process of analysing the consultation responses, with a view to agreeing new service specifications in the spring of 2018. I will write with an update in the next few weeks.

      Kind regards,


      • Sophie Cee says:

        Hi James,

        Still waiting for this promised update. Some sort of clarity on where this currently is would be appreciated.


      • Jerry says:

        Hi James
        could you let us know what NHSE consider to be ‘the next few weeks’?
        I count 13 weeks so far from your last posting

      • jerry says:

        do we have an update yet, nearly 3 month since last post

  6. James Hopkisson says:

    I am a consultant in Reproductive Medicine We are getting increased referrals fr sperm banking in trans male to female patients. I run an HFEA licensed service. Who will be funding the banking and long-term storage of sperm is it centrally contracted or down to local CCGs to agree?

    • NHS England says:

      Dear James,

      Responsibility for forming a commissioning position on gamete storage rests with an individual’s own Clinical Commissioning Group.

      Kind regards,


  7. Alex O'Rourke says:

    NHS England’s CharingX service is a disgrace. I was treated like dirt there and finally the clinicians blatantly lied about me when I asked to be discharged.

    There is legislation, the NHS constitution and an abundance of good practice guidance, which should have been more than enough to ensure I wasn’t treated in that way. Of course, all of that doesn’t add up to a row of beans when clinicians feel able to discard the lot of it during assessments.

    I am seeing no improvement in the treatment of non-binary and trans people from NHS England. We’ve been here before. NHS England needs to get its finger out. To date, you have been useless.

  8. Anna-Jayne Metcalfe says:

    I completed treatment over 15 years ago, so don’t have a direct stake in this anymore, BUT I know many people who are currently being badly failed by the current approach which keeps then on hold for extended periods with zero treatment or support (I hate to even think of the suicide risk that poses).

    So I will be interested to see how in future you plan to offer trans people the support they need when *they* need it rather than when you deign (as is currently the case) to provide it.

    Hence if your new plan does not include measurable and actionable steps to clear all current backlogs in a reasonable time (not years) and offer much more flexibility, it is plainly not going to be fit for purpose.

    We’re watching.

    • NHS England says:

      Dear Anna-Jayne,

      Thank you for your post. I will provide an update in the next few weeks about our plans for addressing the problems that we know currently exist in the NHS pathway of care for trans people.

      Kind regards,