Gender dysphoria specialist interface
We have recently had several enquiries regarding the interface between general practice and gender identity clinics (GICs).
Gender dysphoria can lead to mental health difficulties and can severely affect individuals’ quality of life. It is important that assessment and, where necessary, treatment is available.
GMC and BMA both advise we should cooperate with gender identity clinics, supporting patient wishes to have referral and treatments.
If a patient approaches their GP, we should ideally refer them to an NHS GIC.
GMC states that gender specialists should have evidence of training including at least 2 years in an NHS GIC ideally. Due to long waiting lists for NHS clinics, some patients are seeking care under private GICs.
The Royal College of Psychiatrists suggests that GPs may prescribe a bridging prescription to cover the patient’s care until they are able to access specialist services. The GMC advises that GPs should only consider a bridging prescription when:
- the patient is already self-prescribing, or seems highly likely to self-prescribe, with hormones obtained from an unregulated source (online or otherwise on the black market)
- the bridging prescription is intended to mitigate a risk of self-harm or suicide, and
- the doctor has sought the advice of a gender specialist and prescribes the lowest acceptable dose in the circumstances.
NHS England’s guidance states that when clinical responsibility for prescribing is transferred to general practice, it is important that the GP is confident to prescribe the necessary medicines.
Once the patients has been seen by the GIC, if you were to decide to prescribe any medications either a NHS or private clinic requests, then you should be satisfied that:
- The clinic was able to appropriately assess your patient.
- You felt competent and have to knowledge to prescribe and monitor treatments. (If you do not, then GMC suggests you address any training need you may have)
If you do not feel that either or both of these elements are satisfied, then you would not prescribe. In that case prescribing and monitoring should remain with the specialist provider.
BMA suggest GPs may want to approach treatment and prescribing in the same way they would shared care with another NHS provider. As with other private providers, having shared care outside of the NHS does not usually happen.
There have been reports of some GICs asking GPs to review patients who had already been referred to the GIC, due to long waiting times. It is the responsibility of GICs to manage their waiting lists – not practices – and they should be approaching patients directly to explore whether they still want access to their services.