At GenderGP our aim has always been to improve access to care for trans and non-binary individuals of all ages, wherever they happen to be in the world. A key part of this task is looking at the current state of play and challenging it to see how it can be improved. To do this effectively we often ask the difficult questions that no one else seems to be asking.
One such question that comes up time and again is around the ethics of NHS clinicians providing both private and NHS services to trans and non-binary people in the UK, at a time when NHS waiting times are stretching into years.
We know that the numbers of people being referred to gender specialist services has increased exponentially, we also know that the existing GICs and GIDS services are struggling under the pressure of demand. Recruitment into this area of medicine is a challenge and training is notably thin on the ground, meaning there is currently no clear pathway for trainee doctors to develop their specialist skills in trans healthcare. The pool of specialists is small and getting smaller.
At the same time, the UK operates a system whereby medical professionals are entitled to deliver healthcare on both a private and public basis simultaneously. This means that often a patient will see the same doctors, of which there are only a handful, whether they access care on the NHS or privately. With only a limited time available in the working week, time spent by doctors working in private practice is time spent away from servicing, and reducing, NHS waiting lists.
Key issues that have led to long waiting lists:
- Trans healthcare treated as a specialist area of medicine
- Only recently recognised area of medicine so specialists are limited
- Referrals have increased exponentially
- Lack of training for student doctors has failed to fill the specialist pipeline
- Limited numbers of specialists split their time between private and NHS clinics
Of course, patients have the right to choose between a service provided free at the point of need and a paid-for service that may provide quicker access. Just as clinicians and other healthcare professionals have the right to provide their service, help, and care, in the way they see works best for their patients. However, over recent years we have begun to see the consequences of this approach.
The elephant in the room
If we’re going to be able to meaningfully move forward with significant improvements in trans healthcare, transparency and honesty are going to be key. Luckily due to a combination of factors we are seeing an increasing drive towards accountability:
- Patient testimony
- Freedom of Information Requests (FOI)
- Regulatory body tribunals
- Investigations by the Care Quality Commission (CQC)
- and very public interventions such as The Cass Review
Until such time as GPs in primary care are empowered to step in and breach the gap, these factors combined will play an important role in opening up the conversation, which can only have a beneficial impact on the public services being provided.