RCGP calls for whole-system approach to improving NHS care for trans patients

Publication date: 25 June 2019

Education and training for healthcare professionals, NHS IT systems, and access to gender identity services must all be addressed in order to improve the care trans patients receive across the UK, the Royal College of GPs has said today.

The College has also stated that there is an urgent need for more independent research into the effects and impact of interventions for gender dysphoria, particularly for children and young people – and that there needs to be greater consistency around regulation of gender identity care and services, as well as greater clarity for doctors from the General Medical Council on the issue.

Its new position statement on the role of the GP in caring for gender-questioning and transgender patients, was approved by the College’s governing Council on Saturday.

Recommendations in the paper include that:

  • IT systems are updated to enable GPs to treat trans patients in a safe and respectful manner – and that NHS systems record codes for gender identity and trans status as well as biological sex
  • The GP curriculum covers gender dysphoria and broader trans health issues – and that more training programmes be developed to support GPs and their teams to appropriately engage with and advise trans patients
  • The principles of oversight and regulation applied by the Care Quality Commission in England and equivalent bodies in Scotland, Wales and Northern Ireland should be applied to all providers of gender identity services, not just NHS services
  • Waiting times for Gender Identity Clinics are addressed, and that expanding services in all four UK nations is prioritised, and that
  • Independent research into the effects of various forms of interventions for gender dysphoria is funded – particularly into the impacts of treatments for children and young people. 

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "It goes without saying that GPs and our teams should treat our trans patients on the basis of need and without bias, as we would any patient. This includes being mindful of the terminology and language we use when talking to our trans patients, based on each patient's individual preference.

"It sounds simple, but there are barriers to this, not least with our current NHS IT systems that only allow us to record a patient's gender in a binary way. As well as unintended misunderstandings and the apparent lack of respect that can result from this, it also has serious health implications, for example, around referring trans patients for appropriate screening.

"This is an important area of medicine, and one for which GPs need greater clarity from regulators on where they stand. There is also a distinct lack of high-quality research in the area, and a lack of reputable clinical guidance available – particularly in respect to gender-questioning children – and addressing this must be a priority."

The position statement also clarifies the GP's role in delivering care to trans patients. It recognises that GPs are not trained or experienced in treating and managing patients with gender dysphoria and trans health issues, and as such treatment should be initiated in specialist care – but it also recognises that current NHS gender identity services, across all four nations of the UK, are under severe strain with increasing patient demand.

In England, for example, GICs have seen a 240% overall increase in referrals over five years, with referrals to the Tavistock and Portman clinic alone increasing 8.43% between March 2018-19.

It notes that although under the NHS Constitution for England, the maximum waiting time for an initial specialist appointment following referral is 18 weeks, in 2018 the average waiting time for an initial appointment at a GIC was 18 months.

Systems are equally as strained in Scotland, Wales and Northern Ireland.

It says that role of a GP in delivering care to transgender patients is to:

  • Holistically assess the patient's health needs, collaborating with other healthcare professionals and services as relevant
  • Promptly refer patients to a GIC or equivalent if they exhibit signs of gender dysphoria and request treatment or wish to consult with a gender identity specialist for further advice
  • Liaise and work with GICs and gender specialists - in the same way as any other specialist – to provide ongoing care following discharge from a GIC via a shared-care agreement
  • Recognise that the family members of a patient experiencing gender dysphoria also face significant challenges and refer these family members to further support services where appropriate and
  • Provide appropriate treatment or signposting to patients presenting with gender dysphoria alongside other social or medical issues, which may include referring the patient to mental health services or engaging with social care, safeguarding or sexual health colleagues.

Professor Stokes-Lampard continued: "GPs and our teams make the vast majority of NHS patient contacts, and in the vast majority of cases, trans patients will present to the GP with the same conditions that any other patient does.

"But new presentations of gender dysphoria in general practice are infrequent, and therefore initiating treatment sits outside of a generalist's role. However, we know that specialist services are overstretched and struggling to cope with increasing demand.

"The situation is hugely frustrating for all involved – for trans patients and their families, those working in GICs and GPs - but as a result, GPs are often being put in a position where they are being asked to prescribe treatment that they are not trained to prescribe or monitor safely without expert support.

"NHS bodies in all four nations are committed to improving access to gender identity services, and the overall care trans patients receive – and encouraging work is ongoing - but there is a long road ahead, and the potential challenges are not insignificant, so we urge them to take note of the recommendations made in this paper."

The position statement highlights the current pilot scheme in Greater Manchester, which is trialling a new trans health model whereby multi-specialty teams, including GPs, deliver care to trans patients and people who may have gender dysphoria, working closely with existing GICs to develop their diagnostic skills. It also welcomes the forthcoming postgraduate diploma in Gender Identity Healthcare Practice being developed by the Royal College of Physicians and NHS England.

In addition to this position paper, the College is currently funding and developing a new e-learning course for GPs on gender variance, which should be launched later this year.

It has also received funding from the Government Equalities Office to develop resources to support GPs and other healthcare professionals to deliver the best quality care for our LGBT+ patients.

Access the position statement here.

Further Information

RCGP Press office: 020 3188 7633/7574/7575
Out of hours: 0203 188 7659

Notes to editor

The Royal College of General Practitioners is a network of more than 52,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.

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