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Risk Assessment and Management

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The evidence for affirmative trans healthcare

Any pharmacy looking to provide care to this patient cohort must be able to satisfy themselves that they are working with organisations that are safe and well-regulated. This page provides an overview of the key information to enable you to carry out a robust risk assessment.

Evidence base for the affirmative treatment of all trans and non-binary individuals.

World Professional Association of Transgender Health

The criteria currently listed for Gender Dysphoria are descriptive of many people who experience dissonance between their sex as assigned at birth and their gender identity.

The World Professional Association of Transgender Healthcare (WPATH) provides a clear overview of the medical necessity of treatment for this population. The statement can be found here.

Legal interpretation – Tavistock v Bell

The recent High Court determination raised concerns around the way in which the NHS Tavistock clinic relayed information to its patients. GenderGP consent processes are explained in full here. GenderGP operates a different model to the Tavistock, and more information can be found here.

The WPATH statement on the harm that may be caused by this ruling can be found here.

Diagnosis

All GenderGP patients who are prescribed gender-affirming medication, have been through an assessment and diagnosis consultation process.

They have been shown to fulfil the criteria for a diagnosis of gender dysphoria of ICD-10 F64.9 and according to the criteria in the DSM-5.

This is as follows:

  • A strong desire to be of a gender other than one’s assigned gender
  • A strong desire to be treated as a gender other than one’s assigned gender
  • A significant incongruence between one’s experienced or expressed gender and one’s sexual characteristics
  • A strong desire for the sexual characteristics of a gender other than one’s assigned gender
  • A strong desire to be rid of one’s sexual characteristics due to incongruence with one’s experienced or expressed gender
  • A strong conviction that one has the typical reactions and feelings of a gender other than one’s assigned gender
In accordance with the World Professional Association for Transgender Health criteria, they qualify for a diagnosis.

Consent

Consent is obtained from all patients, regardless of age, at multiple stages throughout the process.

An informed consent model of care ensures patients are provided with all the available information about gender-affirming care, so that they can weigh up the risks and benefits associated with any decision relating to their health and decide on the right path for them.

This approach serves to protect individual autonomy. You can view our medical consent forms here.

For younger patients (under 16) parental consent is strongly encouraged. Where safe parental consent is unavailable, the patient must demonstrate that they are Gillick competent in order to be able to consent to their own treatment.

 

For further information please visit the following blog posts:

Gillick competency and body autonomy for transgender youth - Are children and young people under 16 capable of making a decision about their gender? - GenderGP

Gillick competency and body autonomy for transgender youth

Gillick competency and body autonomy for transgender youth - Are children and young people under 16 capable of making a decision about their gender? - GenderGP

Gillick competency - A question of consent

Parental Consent in the Management of Gender Dysphoria in Adolescents

Parental Consent in the Management of Gender Dysphoria

GenderGP follows guidance on consent laid out by the Endocrine Society and World Professional Association for Transgender Health.

For a comparison of the different approaches taken to consent around the world please visit our comparison table.

Medicines

It is well known that many medications that are prescribed are unlicensed for use in trans healthcare. You can read more about this here.

However, it is important to note that the medication used and the monitoring required within this patient group, is no different to patients who are being treated for menopause, endometriosis, prostate cancer, precocious puberty, constitutional delay in puberty.

Gender dysphoria is not a highly specialised field that involves dangerous medication requiring comprehensive monitoring. The benefits of having access to care far outweigh the denial of care, particularly in light of NHS waiting times that are in breach of the NHS constitution.

Risk of barriers to care

In balancing the risks of providing essential pharmacy services to this patient cohort, there must also be an analysis of the risk of NOT providing services. Patients who struggle to get access to medical and pharmaceutical healthcare services often turn to the grey or black market.

Government guidance for UK based pharmacists on dispensing prescriptions from the EEA and Switzerland

If you are asked to dispense an EEA or Swiss prescription, you should:

Identify the prescriber in the same way that you do now. The name, professional qualifications and contact details of the prescriber (including work address, email address and telephone or fax number with the appropriate international prefix) should be clearly stated on the prescription along with the name of the country in which the prescription was issued.

Refer to the prescribing-approved countries and professions list to check whether:

  • the prescription was issued in an approved country
  • the prescriber is practising in a profession recognised by the UK in relation to that country

You may contact the competent authority in the country in which the prescription was issued in order to check the registration of the prescriber and whether they are authorised to issue a prescription of that kind in that country. You may dispense the prescription if it has been issued in an approved country on the list and is signed by a qualified prescriber practising in an approved profession on the list.

If the prescription is from a country or prescriber that is not on the list, you should not dispense the prescription and instead use your professional expertise to help the patient.

This does not affect your right to exercise your professional discretion to refuse to dispense a prescription if any of the following apply:

  • it would not ordinarily be dispensed in the UK
  • there are doubts over its authenticity
  • there are concerns about the clinical appropriateness of the medicine(s) for that patient
  • it would cause any issues of health and safety

 

Legal Notice

All prescriptions issued on behalf of GenderGP comply with legal prescription requirements. To view a prescription sample please click here.

All prescriptions issued on behalf of GenderGP for use in the United Kingdom adhere to clinical guidelines published by the Royal Pharmaceutical Society.

Required information for dispensers – Checklist

The following checklist provides an overview of the information required for inclusion on a valid prescription being dispensed in the UK.

Prescribing Information

Country of issue

Has this prescription been issued by a country included in the approved list.

Valid prescriber

Is the health professional legally entitled to issue a prescription of that kind in the country in which the prescription is issued.

Signature

Has the prescription been signed in ink by the prescribing professional.

Prescription

Is the prescription written in ink or otherwise so as to be indelible.

Patient Information

Surname

Is surname visible and written out in full?

First name

Are both given and legal names visible and written out in full?

Date of birth

Is the date of birth visible?

Issue date

Does the prescription feature an issue date?

Prescriber Information

Surname

Can you see the prescriber’s surname?

First name

Is the prescriber’s first name written out in full?

Professional qualification

Can you tell the prescriber’s professional qualification?

Location

Is the name of the relevant member State in which that professional works visible?

Contact details

Is there a way to contact the prescriber:

  • email address
  • telephone number
  • fax number (with the appropriate international prefix)
  • work address

Product Related Information

Prescribed product

Does the prescription include details about the prescribed product, including where applicable the common name of the product and brand name?

Quantity

Is the quantity of the medicine being prescribed clear?

Product strength

Is the strength of the medicinal product visible?

Dosage

Is there a clear dosage regimen included on the prescription?