GenderGP welcomes any policy statement such as the one issued by the British Medical Association (BMA) which supports the rights of trans individuals to be able to access the care they need.
The motion calls upon the government to:-
- allow transgender and non binary individuals to gain legal recognition of their gender by witnessed, sworn statement;
- ensure that under 18s are able to access healthcare in line with existing principles of consent established by UK Case Law and guidelines published by the public bodies which set the standards for healthcare;
- enable trans people to receive healthcare in settings appropriate to their gender identity;
- ensure trans healthcare workers are able to access facilities appropriate to the gender they identify as;
- ensure trans people are able to access gendered spaces in line with the gender they identify as.
Roughly translated, it seems to be saying:-
- We agree that trans people should be able to self identify without the need for a doctor’s report
- That all people under the age of 18 should be involved in the decisions made about their own treatment
- That the environment in which trans people access their healthcare matters
- That trans healthcare workers should have access to the appropriate facilities
- That trans people should be able to access the spaces they feel comfortable with
However, given the recommendations made by the Women and Equalities Commission on Transgender Equality in 2016, we feel the lack of progress is disappointing.
What trans people actually need is:
- The legal right to identify as they wish
- Access to timely and accessible medical healthcare (something that is not possible through the current network of super specialist clinics)
- For trans healthcare to be driven down into general practice
- For specialist care to be available for any complex cases
- Informed consent and joint management planning so that the patient is fully informed in the decision making around their medical care and that the care is not driven by archaic protocols alone
Crucially, and somewhat frustratingly, while the statement does show positive progress, the BMA is not the policy maker or decision maker in such matters. It is the General Medical Council that needs to step up and raise the standards of education for doctors providing trans healthcare.
The Royal College of GPs and Royal College of Physicians need to put out clear guidance as to the basic level of medical care that should be provided by all GPs, as well as the specialist level of care that should be provided by consultants.
Additionally, we need uniformity across the country. At GenderGP we see that different Clinical Commissioning Groups are advising their GPs and local hospital consultants in different ways. Despite NHSE providing clear guidance in its Specialised Services Circular on how to work with online gender specialists, some CCGs go as far as advising GPs against helping this cohort of patients under the guise that it is outside of their medical competency. We have received three examples of this in as many weeks and it is very, very worrying.
We also see a wide range of approaches taken by GPs, in terms of their desire to help trans patients. We see three very distinct groups: those who are happy to help, those who need more guidance from us on what to expect, and those who flat out refuse to get involved. This is driven by multiple factors including the individual doctor’s own perception of their ability and accountability in terms of helping trans patients. But this should come as no surprise given the lack of clear direction coming from those who make the guidelines.
Indeed, in a recent communication, again published by the BMA (07.09.20), on the subject of bridging medication and its prescribing by GPs, it was felt that the advice given failed to: “address the resulting significant medico-legal implications for GPs.” If GPs feel there is a legal implication to their prescribing to transgender individuals how can they proactively provide the necessary help and support?
For this statement to be truly meaningful rather than just a statement of basic human rights, that should have been in place many years ago, it needs to go further. Doctors need specific guidance and advice outlining the healthcare provision they must give to their trans patients: How are they going to do it, where are they going to do it and when are they going to do it. Without this, any statement of support is just lip service.