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We have received reports that some NHS GPs are being advised against helping patients who are under the care of GenderGP. In response we have written this guide to inform healthcare professionals and our patients about what GPs should be doing to support transgender patients under their care.

We would like to reassure any of our patients who have been adversely affected by their GP refusing to support private treatment via GenderGP, that they are fully able to continue their treatment directly with us. This can be done by arranging blood tests directly through GenderGP and paying for hormones through ClearChemist. While this route is more expensive, it is an option used by many of our patients.

Where at all possible, our aim has always been to provide the specialist care to support NHS GPs, so that they feel able to provide the necessary blood test and prescriptions for free on the NHS.

The suggestion that NHS GPs are being advised NOT to provide this additional support is punitive to trans patients and at odds with the NHS constitution which states that it has a duty to provide treatment within 18 weeks of referral or to provide you with an alternative.

Indeed, many NHS patients have treatment provided by healthcare providers outside of the UK, when that care is not available locally.

Neither of these options are being made available to transgender patients. Instead they are left to wait, often years, for NHS specialist appointments, while their mental health deteriorates and lives are put on hold.

NHS England has given direction to GPs that they should prescribe hormones and carry out blood tests if asked to do so by a gender specialist. They do not specify that this has to be an NHS gender specialist, or one from the UK. GenderGP has a full team of highly experienced gender specialists and as such is well positioned to provide essential and much needed guidance.

NHS England has given specific advice about working with online services such as GenderGP. The advice is as follows:

  • The NHS should not withdraw NHS care because a patient chooses to buy private care, nor should patients who access private care be placed at an advantage or disadvantage in relation to the NHS care they receive
  • The NHS should continue to provide free of charge all care that the patient would have been entitled to had they not chosen to have additional private care
  • Where the same diagnostic, monitoring or other procedure is needed for both the NHS and private elements of care, the NHS should provide this free of charge and share the results with the private provider

The advice continues:

“A GP may decline to accept responsibility for prescribing, monitoring and testing if the GP is not assured that the provider offers a safe service, or is not assured that the request has been made by an appropriate gender specialist, as long as the GP is also satisfied that declining responsibility would not pose a significant clinical risk to the individual.”
– NHS England

The General Medical Council (GMC) has said this recent advice:

“Should reassure doctors who wish to prescribe for their trans patients that it wouldn’t be against GMC guidance to do so, without forcing those doctors who did not feel that prescribing would be in their patient’s best interests, down a treatment route.”
The General Medical Council

GPs have given many reasons for not prescribing or withdrawing support for their transgender patients and we wanted to take this opportunity to address each of these in turn:

“GenderGP is not registered.”

>> GenderGP moved outside of the UK in April 2019 and therefore does not require to be registered with UK regulators such as the CQC. All of our psychologists, counsellors, nurses and doctors are fully registered with the relevant bodies.

“GenderGP does not have a doctor.”

>> GenderGP does indeed have fully qualified doctors and nurses, psychotherapists and counsellors. All whom have been fully trained in gender-affirming care to the highest international standards.

“My GP does not feel knowledgeable enough to provide the care.”

>> It is not good enough that your GP does not feel able to perform blood tests and prescribe hormones. The GMC has advised GPs that if they do not feel that their knowledge and skills are sufficient then they should undergo training.

The medicines prescribed are not licensed for this use.”

>> The GMC has agreed that although gender hormones are unlicensed for this use, they have been proven to be safe to use and doctors are able to prescribe them.

“My GP does not want the responsibility of looking at the blood results.”

>> GenderGP doctors and nurses are fully able to give your GP all the advice they need in relation to blood results, prescriptions, medication and doses. We will tell your GP exactly what to do and take responsibility for the advice given.

“My GP will only work with the advice of an NHS gender clinic.”

>> As outlined above, the GMC says that GPs should work with gender specialists and gender identity clinics. They do not say that they should only work with NHS clinics.

“My GP is not qualified to diagnose gender dysphoria.”

>> Your GP does not need to “diagnose” anything. GenderGP will provide you with a “diagnosis” and treatment recommendation. More information about how we can work with your GP can be found here.

Guidance for NHS GPs working with transgender patientss - GenderGP

 

If your GP is refusing to help with prescriptions or blood tests, then you should write to them explaining how this will affect you.

A sample letter is available here:

Dear Doctor,

I am very disappointed that you do not feel able to carry out blood tests and prescribe for me under the expert advice of GenderGP.

GenderGP comprises a team of highly specialised and compassionate gender specialists and they are very happy to give you all the advice that you need, in order to prescribe and monitor hormone therapy for me. The waiting lists for NHS gender care are approaching three to four years now, which is one of the reasons I have sought treatment through GenderGP.

The NHS constitution clearly states that there will be alternatives made available for me, if it is not possible for me to receive specialist treatment within 18 weeks. If I do not have access to this medication in a safe and properly monitored way, then {insert here what effects this will have on your physical and mental health}.

NHS England has issued advice on working with gender clinics such as GenderGP. If you do not accept responsibility for prescribing and doing blood tests, under the complete supervision of GenderGP, then my mental health will be at serious risk.

I am attaching a copy of this NHS guidance here {print out a copy of the advice that can be found here} If after reading this letter you still feel unable to prescribe and do blood tests under the complete supervision of GenderGP, then I request that you put your reasons down in writing so that I can take appropriate advice.

Transgender patients deserve the same right to care as other patients who are under shared care agreements with specialists. It is vital that the care you provide to me is no different to that, for example, of someone with rheumatoid arthritis who is on specialist medication that is supervised by a specialist.

 

We hope that the information we have provided is useful. Trans patients deserve the same treatment and care as any other patient. To treat someone differently due to the fact that they are transgender is in breach of the Equality Act 2010. Your GP must do what is in your best interests and what is good for your health and must provide very good reasons why they feel unable to help you, and acknowledge what may happen if they refuse.

If you need any further advice then please contact us at: info@gendergp.co.uk