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Improving awareness and understanding of transgender issues
The Chair of the NHS England Gender Task & Finish Group looks at what NHS England is doing to improve health services for transgender and non-binary people
You may be aware that West London Mental Health NHS Trust recently announced that it will, over time, stop providing gender identity services. The Trust’s statement can be found here. I have been working with the Trust’s management and clinicians to begin the process for agreeing future arrangements for a gender identity service hosted by an appropriate alternative provider, and we will be meeting again to review progress in September.
I appreciate that any potential change can cause anxiety for people who use the services, and for staff who work in the service. The Trust has given a commitment that it will continue to provide services as normal until such time as a new provider is able to take over, and on our part NHS England will put in place a process that identifies an alternative suitable provider as quickly as possible. I would like to assure you all that there will at no point be any pause in the delivery of services and as commissioner of the service we expect the Trust to continue its initiatives to reduce waiting times. I will keep you updated on future arrangements via my blog and the Trust will post updates on its own website.
I’m sorry that I wasn’t able to make the July meeting of the transgender network, but many thanks to colleagues from NHS England, NHS Choices and the Race Equality Foundation for running the sessions. The agenda can be found here and a video of the event can be found here.
There are some specific actions that workshop members will help us to take forward, including a refresh of the NHS Choices web content about NHS services for transgender people, and a look at ways in which we can begin to share learning and outcomes of the various initiatives that are being pursued in the statutory and voluntary sectors to improve access to transgender services for people from black and minority ethnic groups. The workshop also discussed how NHS England can best engage with the Transgender Network in the future, perhaps moving away from the national events in favour of regional events that are more focused on local networks and local services. Our engagement team is currently considering the feedback and ideas that were offered, including a pilot of a regional event, and I will come back to this in a future blog in the autumn.
A request was made at the workshop that we share more information with the network on the work and progress of the Task & Finish Group, and in my next blog I will post details of our work plan.
One of the themes that is raised regularly with me is about services for non-binary people. As a commissioner, NHS England is very clear that all GICs are required to offer services for non-binary people. Until recently, the website for the GIC at Northamptonshire Healthcare NHS Foundation Trust stated that it was not commissioned to provide services for non-binary people. This is incorrect – we have taken this up with the Trust and the website has been changed as a result.
We also recently published a new clinical commissioning policy for prescribing cross sex hormones to transgender young people, and a new service specification for the Gender Identity Development Service for Children and Young People. These documents were agreed following stakeholder engagement and public consultation earlier in the year, and following recommendations from the independently-chaired Clinical Priorities Advisory Group. The policy and service specification (separate documents) can be found here.
At the multi-agency symposium that we held in March, Gerald Chan, Director of Policy and Public Affairs from the Royal College of Obstetrics and Gynaecology, undertook to lead some work on good practice in relation to trans people. Gerald has undertaken a number of actions as a result, including updating RCOG’s training curriculum to clarify that transgender is not a sexual issue; began preparations to engage clinicians in the field and with commissioners over the planned revision of the curriculum; and has spread general awareness of trans-issues at meetings and other forums, including the findings and recommendations of the Women and Equalities Select Committee report on Transgender Equality.
I’m pleased that the Royal College of Obstetrics and Gynaecology is considering how to educate its members in supporting trans and non-binary people including competencies for specific clinical procedures (such as hysterectomy and urogynaecology), cultural competence, and screening requirements.
Finally, congratulations to Dr John Dean who has been appointed for a second term as chair of NHS England’s Clinical Reference Group for adult Gender Identity Services, which plays a key role in providing advice to NHS England. We are currently in the process of recruiting three patient and public voice representatives to join him and the confirmed professional representatives, who were appointed following an open recruitment process, and are listed below:
- Mr James Bellringer, Consultant Urologist, Parkside Hospital
- Matthew Mills, Head of Speech Therapy Service, Charing Cross clinic
- Christina Richards, Senior Specialist Psychology Associate, Nottinghamshire GIC
- Dr Grainne Coakley, Clinical Lead, Sheffield GIC
- Dr Helen Greener, Clinical Lead, Newcastle GIC
- Mr Philip Drew, Consultant Specialist Breast Surgeon, Royal Cornwall Hospital Truro
- Maria Morris, Clinical Team Leader, Laurels GIC
I look forward to working with them and future PPV representatives on continuing to develop quality services that transgender and non-binary people want and need.
Please feel free to post comments to this blog and I will respond as soon as I can. Or you can take part in the discussion at #nhsgenderid.
The decision to seperate GIC from mental health is entirely understandable. The decision to announce the closure of the clinic before a new provider is in place leaves a person such as my transgender son to feel abandoned.
He is currently undergoing assessment at the Tavistock but is shortly to turn 18. Devon and Northampton are a long way to travel.
I have had a look at the service specification for the Gender Identity Development Service for Children and Young People.
This states that GPs are expected to prescribe and administer hormone/blocking drugs to young people on the instructions of the GIC.
I think you will find this is not accepted by the BMA as this is clearly specialist prescribing. BMA Focus-on-gender-incongruence-in-primary-care.pdf.
May I ask what GP input there was into what seems to be an ill thought through document?
Hopefully more care will be taken when re-procuring the Charing cross GIC
Dear Dr Luke
Thank you for both of your posts.
NHS England’s position on prescribing hormone treatments for transgender people is consistent with the GMC’s guidance, published earlier this year. The GMC guidance describes that prescribing and monitoring these treatments in primary care is safe, and it reiterates NHS England’s position on the importance of good collaboration between primary care and the specialist gender identity clinics in the best interest of patients.
The draft service specification and the draft clinical commissioning policy on prescribing cross sex hormones to young people (and the supporting evidence review) were published for the purpose of public consultation earlier this year, providing all stakeholders with the opportunity to comment. We will also consult widely on draft service specifications for adult gender identity services in the new year, and we would welcome engagement from primary care colleagues.
The BMA has published a ‘focus on’ document re the less than helpful recommendations produced by NHSE and GMC.
How does NHSE propose to ensure that GPs have input into the specifications for the retendering of the Charing Cross GIC so that the new service does not have unrealistic expectations of GPs.
Dear Dr Luke
I understand that the GMC has concerns about the BMA’s document and we have asked the Chair of our clinical reference group to keep us appraised of any discussions that take place with the BMA.
We do invite the BMA and Royal College of GPs to our multi-organisation symposiums that are designed to encourage a coordinated and collaborative approach to improving the patient experience for transgender and non-binary people.
We will put the proposed service specifications out for consultation in the new year and we absloutely welcome contributions from GPs and other primary care staff.
How can you justify the statement you’re looking forward to working with PPV representatives when recent actions suggest the opposite?
PPV wants to surround itself with nodding dogs, unrepresentative organisations, and ignore and sideline PPV members.
Can NHSE not see that the system WILL remain broken, and policies and priorities flawed unless proper and meaningful engagement takes place?
Tokenism kills engagement permanently.
Thank you for your comments.
Engagement with people who use transgender services is a critical piece of our work, and I am personally committed to making sure that our engagement is as effective and meaningful as it can be. I’m sorry that you have concerns, and if you want to provide me with details please feel free to write to me at Skipton House, 1st floor, 80 London Road, London SE1 6LH and I will respond.
In a previous blog I have referred to plans to pilot some new ways of engaging with the transgender network, with a more local focus, and I will come back to this in a future blog.
Any idea on what will be happening to transgender patients in Wales? Its about time they got a clinic up and running in Cardiff or Swansea.
The Welsh Health Specialised Services Committee is responsible for the commissioning of specialised NHS services in Wales, and I understand that it is currently developing a number of options for a potential model of gender identity services in Wales. I suggest you contact Richard.Hughes6@wales.nhs.uk for more details.
It would be interesting and perhaps useful to develop a schedule of NHS procedures for NHS GIC patients outlining what the NHS will/will not provide in trms of Trans treatments: Typically GRS is NHS funded but FFS is not, Breast Augmentation is not funded on NHS but speech therapy is and so on, could prove to be a really useful guide in terms of perosnal planning for future procedures such as Facial feminisation Surgery (FFS)and so on.
Thanks for your comments.
Currently, this description of services is provided by NHS England’s interim protocol for adult gender identity services that can be found here: https://www.england.nhs.uk/wp-content/uploads/2013/10/int-gend-proto.pdf.
We are currently developing new service specifications for adult gender identity services that are planned for public consultation in the next few months.
Thanks very much for addressing the confusion over the commissioning of services for non-binary people at Northamptonshire GIC. This is much appreciated and is very reassuring for non-binary patients.
Thanks for taking the time to give positive feedback.
Thanks W Huxter.4update.
Was disappointing not to have seen you at the Workshop on 14th July in London. Seemed more questions than answers at this Workshop !
I expect there are now lots of service users wondering about this issue of ‘a new Gender Services Provider’ ? I’m a patient of Charing X Gender Clinic ( I was not offered a choice ) and living in Stoke that means a round trip of well over 350 miles each time I attend. In my own case the interval between my 1st & 2nd.assessment appointment was 38weeks – which clearly is not an acceptable standard in any terms. However I’m happy that Dr. Dean has been re-appointed as Chair for a second term & the new list of Professional Reps. looks excellent, and I’m very glad that Mr James Bellringer is one of them!
Yes definitely more ‘regional’ events that are more focussed on Local Networks &services. As an active member of Healthwatch Stoke I have been advocating this for years!
Jan Evans – GICRG Member & Stoke CCG Patient Congress Member.
Thank you for your comments.
I will provide a much more detailed description of the process that we will follow to identify suitable alternative provider/s in a future blog. The immediate priority is to conclude work on the development of new service specifications for surgical and non-surgical gender identity services as these documents will underpin that process. We plan to consult on these documents in the next few months, and their development is the priority of the newly constituted CRG which meets for the first time in September.
Thanks also for your comments on future engagement. I welcome the support for a regional approach to engagement, and this is something that I will come back to in a future blog.