GPs can continue prescribing puberty blockers for some children and young people if they ‘feel competent to do so’, NHS England has said in new advice.
It comes as the Government has recently extended the legal ban on private prescribing of puberty blockers, which was first introduced in May under the Conservatives, until 26 November.
In a letter to GPs last week, seen by Pulse, the commissioner set out guidance for dealing with patients under 18 who want to access puberty suppressing hormones, in light of the new regulations.
On prescribing, NHS England said that young people currently taking the medicines who are no longer able to access further prescriptions ‘are being advised they should speak to their GP’.
In this case, GPs should ‘offer to see any young person’ and assess whether a referral to the Children and Young People Gender Service or for mental health support are required.
However, from 1 September, GPs will no longer be able to refer young people directly onto waiting lists for children gender services, with referrals only accepted from paediatric or mental health services.
‘The continuation of puberty suppressing hormones can be considered where the GP feels competent to do so, and where confirmation that treatment had been underway in the six-month period before 3 June 2024 is available,’ the letter added.
If GPs decide to continue prescribing puberty blockers for gender incongruence, the prescription ‘needs to be endorsed “SLS” to satisfy NHS Regulations’.
NHS England also told GPs that they should advise patients not to buy ‘GnRH analogues (or any other medicines) from unregulated sources such as the internet, friends or from street dealers’.
If a child or young person is accessing puberty blockers from these sources, GPs should consider whether ‘safeguarding procedures’ need to be explored.
It advised that any patients stopping the medicines ‘may benefit from psychological and potentially psychiatric support’, due to the ‘incidence of mental health presentations’ for young people with gender dysphoria who seek ‘sex reassignment interventions’.
The letter, signed by NHSE primary care director Dr Amanda Doyle and specialist services director Professor James Palmer, also advised GPs to meet with patients to ensure the ‘risks of continuation/initiation are fully understood’, due to the ‘limited evidence base’ which is laid out in the Cass Review.
GPs must also ‘take due diligence’ to determine whether the patient had initially been issued the prescription in the six-month period before 3 June 2024, as per the regulations.
The letter said: ‘This would need to be in the form of documentary evidence. The form of the evidence (letters, prescriptions…) which a GP should rely on to decide whether a course of treatment has started has not been specified in legislation, but whether treatment has previously started is ultimately a question of fact.’
The current regulations
It is a criminal offence to supply puberty blockers to patients under the age of 18, unless:
- They have been provided with a previous NHS prescription;
- They have been provided with a private UK prescription that is either:
- Dated prior to 3 June 2024 (or 27 August in Northern Ireland);
- A repeat prescription annotated ‘SLS’ by the prescriber and bearing the patient’s age, but only when the initial prescription was issued in the six months prior to 3 June 2024 (27 August in Northern Ireland)
- Is the same as above but is for a purpose other than treatment for puberty suppression.
From 26 June 2024, GPs are only able to provide NHS prescriptions for GnRH analogues if:
- The patient is aged 18 years or over
OR
- The patient is 17 years or under and the purpose is for a medical condition other than gender incongruence/dysphoria
OR
- The patient is 17 years or under and has been issued a prescription for puberty suppression in the six-month period prior to 26 June 2024 (in this case they may continue to be issued with prescriptions).
Prescriptions for puberty blockers from a European Economic Area (EEA) or Switzerland-registered prescriber are banned in all circumstances for patients under 18.
Source: NHS England letter to GPs
Before the introduction of the ban on private prescribing in May, NHS England had banned routine prescription of puberty blockers on the NHS for children with gender dysphoria, after a working group found there is not sufficient evidence to support their ‘safety or clinical effectiveness’.
In July, health secretary Wes Streeting said he is ‘defending’ the emergency ban on private prescribing, which was being challenged at the High Court by transgender rights activists.
Following this, claims were made on social media that suicides have ‘risen steeply’ since a High Court decision to restrict puberty blockers in 2020.
But a suicide prevention expert then discredited these claims, warning against puberty blockers being used as the ‘touchstone issue’ in the debate.
Last month, the BMA called for a pause to the implementation of the Cass review’s recommendations on treatment of transgender children.
The doctors’ union intends to undertake its own evaluation of the the independent report following ‘concerns’ voiced by doctors and academics, which it expects to complete towards the end of the year.
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There must be a vanishingly minute and insfignificant number of GPs who are sufficiently skilled and experienced (ie through being for several years a consultant/specialist in the topic), in the wholistic specialist care of such patients to initiate prescription of puberty blockers in children without the appropriate assessment and ongoing monitoring of a specialist consultant, so, essentially, there should not be any GPs ‘prescribing’ puberty blockers. And that is it.
Article in the Times suggesting that the BMA’s rejection of the Cass report has precipitated an exodus of members.
Perhaps Pulse could investigate?
Not for me and any GPs I know. We are not trained or able to take on this service safely . Why should GPs have to take this on?