Accessing a Gender Identity Clinic (GIC) in the UK is notoriously difficult. It can be especially difficult to get onto the waiting list if your GP refuses to refer you for any reason. However, if you find yourself in this position, you may be able to self-refer. Self-referral should not be used as a blanket substitute for GP referral, as GP referral is preferred by GICs in all cases. This guide aims to provide some insights on how to manage the process of self-referral.
In June 2019, the NHS protocols governing referrals to Gender Identity Clinics were updated to include the following:
- ‘Individuals may self-refer should they choose to do so. Providers will respect the right of an individual to self-refer. These individuals should not be disadvantaged by a Provider’s insistence on obtaining a prescriptive set of data from the individual’s GP as a pre-condition to assessment as this may, in practice, deny an individual the right of self-referral’.
This means that you can contact the GIC directly to refer yourself for assessment if your GP won’t do this on your behalf. You will still need to be registered with a GP and may need to present their details as part of the referral process. If you are concerned that your GP will not support the referral, you can explain this in your initial communication with the GIC.
It is important to note that people under the age of 17 cannot self-refer, and in Scotland, Edinburgh and Grampian, clinics do not accept self-referrals.
This process can be helpful if your GP refuses to refer to a GIC outright, or if they try to make you ‘prove’ that you are transgender (e.g. by saying you must live for a set period of time as your desired gender).
Most GICs have referral forms available for download online. These are tailored for use by GPs, but there is no reason you cannot use them for self-referral. You should explain why you are self-referring in the form. Alternatively, you can write your own self-referral letter and use the form as a guide for the kind of information you should include (for instance, the London GIC template is here). You can also find information online about where self-referral forms or letters should be sent.
If you decide to write your own self-referral letter, you should include a summary of your medical history. You should be able to obtain a copy of this from the practice where you are registered, although you may have to pay an administrative fee. If, for whatever reason, you cannot obtain your medical history, you should make sure your letter includes any current medical conditions (physical and mental), any past conditions or procedures that might be relevant, and any extenuating circumstances that might affect future treatment (e.g. allergies).
You should also include the following information:
- Full name, title, and your preferred name
- Date of birth
- Sex assigned at birth (so if you are a trans woman who was gendered male at birth, this would be ‘Male’).
- Gender (so if you are a trans woman who was gendered male at birth, this would be ‘Female’. If you are neither male nor female, regardless of birth sex, you can put ‘Nonbinary’ or similar)
- NHS number (or equivalent identifier)
- Full address and postcode
- Contact telephone number (include mobile and home if available)
- Email address
- Communication preferences, including preferred contact method and any communication needs you have (e.g. large print, braille, signing, interpreter)
- Relevant contacts (e.g. next of kin, main informal carer, emergency contact)
You will need to explain why you are referring yourself in a detailed and succinct manner. This means that you will need to include any history and information relevant to your referral, but avoid telling personal stories or criticising your GP. You may find it helpful to refer to the NHS definition of gender dysphoria. While some of the terms, like ‘biological sex’, are considered outdated by GenderGP, it could help your referral to use the language preferred by the NHS. For instance, you might write:
You can then support this with any relevant personal or medical history. You will also need to explain why you are self-referring. If your GP has refused to refer you on personal, political or religious grounds then you can include this, but be factual and objective. If you feel that not being referred will put you at risk of harm, including poor mental health or self-harm, it is important to include this in your letter as it may affect your referral.
Once you have included all the relevant details, you can send your letter to the GIC. Unfortunately there is no guarantee that your self-referral will be accepted. Some GICs may still be operating on the 2013/14 interim protocols, which do not allow self-referral, or they may not be applying the current protocols consistently. They may not accept referral without GP authorisation, in which case you may want to explore the option of changing your GP.
If you have any questions about how to deal with GPs or the referral process you can always contact our Help Centre to talk about your options. The most important thing is not to lose hope. Be persistent, stay aware of your rights, and you’ll get there.