GPs should work with gender identity services ‘in the same way as any other specialist service’, including consideration of prescribing under a shared care arrangement, the RCGP has recommended.
The college has published a new position statement on the role of GPs in transgender care in response to recent developments including the Cass Review.
It set out that the RCGP considers that the ‘core role’ of GPs includes to ‘liaise and work’ with specialist gender identity services ‘in the same way as with any other specialist service’, and that this includes consideration of prescribing ‘under a collaborative or shared care arrangement’.
Once a patient has had a specialist assessment and requires ongoing prescribing, NHS bodies need to ensure that shared care arrangements and locally commissioned services are adequately funded, with the role of the GP ‘clearly defined’, the college added.
It added that while some GPs may have developed additional expertise and feel able to offer ‘bridging prescriptions’ for adult patients waiting for specialist assessment, many will not feel confident or competent to do this.
For GPs without additional expertise or extended role, the RCGP considers that the GP role ‘would not include initiating prescriptions’ before a patient was seen by a specialist gender identify service.
It warned that with specialist waiting lists of several years, the risks associated with long term prescribing without specialist team support need to be carefully considered.
The statement said: ‘Transgender patients, those experiencing gender incongruence and/or questioning their gender identity deserve a full, multi-disciplinary assessment by a specialist team.
‘It is unreasonable for patients to have to rely on cumulative prescriptions from the same or different prescribers as a mitigation to excessive waiting times.’
The RCGP said it would be open to exploring the creation of a framework for a GP with extended role working with specialist supervision in providing gender care for adults.
The college welcomed the findings of the Cass Review and said it ‘broadly supports the model the report recommends’, including the role of the GP in referring to either mental health or paediatric teams in the first instance.
Children and young people experiencing gender incongruence or questioning their gender identity should receive care ‘openly, respectfully, sensitively and without bias’, the statement said.
‘The RCGP does not consider that the GP role in relation to children and young people would include prescribing gender affirming hormones to address gender incongruence in a patient aged under 18,’ it continued.
It also calls on the NHS to address issues with IT systems that pose safety risks around factors such as appropriate screening invites.
NHS systems must ensure patient safety is not jeopardised because clinicians are not aware of a patient’s sex assigned at birth while also enabling patients to express their preferences for how they wish to be named and referred to.
The statement added: ‘NHS bodies must find a solution to this which allows for the recording of sex assigned at birth as well as gender, while ensuring appropriate confidentiality and compliance with the Gender Recognition Act.’
A RCGP spokesperson told Pulse: ‘The care of transgender and gender questioning people is a complex area of medicine and the RCGP has members with widely diverging views on the issue.
‘We are clear that all GPs should provide “whole person” care, taking into account a person’s individual physical, psychological and social health needs.
‘However, as expert generalists, GPs are not trained to have the specialist skills required to address the specific needs related to gender incongruence.
‘GPs will always aim to do the best for all their patients, treating every consultation with sensitivity to ensure they get the care they need.
‘The college remains strongly committed to the improvement of services for patients experiencing gender incongruence – and we will continue to call for significant expansion in resources and dedicated services to ensure timely access to high-quality care.’
Earlier this year, a GP practice which served notice on providing gender dysphoria medication and monitoring faced a push-back from its ICB, despite the service not being contractual.
Last month, an independent Government-commissioned review concluded that the NHS should stop issuing new NHS numbers and changed ‘gender’ markers to any individuals, because losing data on sex puts people at risk.
RCGP definition of GP ‘core role’ in transgender care
The RCGP considers that the core role of the GP includes the following:
- To provide a holistic approach, contextualising a person’s presentation of gender incongruence alongside an individual’s physical, psychological and social health status within the broader environment.
- To provide appropriate primary care related to gender incongruence. This may include the use of non-oestrogen hormonal contraception to manage distressing periods in those who are assigned female at birth.
- To provide appropriate signposting to patients presenting with social or medical issues alongside gender incongruence. This may include referral to mental health services or engaging with social care, safeguarding, social prescriber or sexual health colleagues.
- To ensure that all patients can express their preferences for how they wish to be named and referred to and that these are respected.
- To recognise that the family members of a patient experiencing gender incongruence may also face significant challenges and refer these family members to further support services where appropriate.
- To liaise and work with specialist gender identity services in the same way as with any other specialist service. This includes consideration of prescribing under a collaborative or shared care arrangement.
Source: RCGP
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READERS' COMMENTS [4]
Please note, only GPs are permitted to add comments to articles
Yes, I suppose it makes sense.
we would not give a ‘bridging prescription’ for antibiotics to a patient who has not yet been assessed in some way by a suitable Doctor; and we would not prescribe lithium to a patient prior to a specialist assessment, or Digoxin before doing an ECG, etc
Specialist services may be inadequate, but this is a good reason not to start prescribing before assessment, given that it removes the impetus to provide sufficient service levels to monitor those under treatment, and may result in patients being actually denied timely assessment.
Plus, it is a bit late once treatment is started.
It would be like stopping half-way through a cholecystectomy, to get a serum bilirubin, to see if the patient was jaundiced, and an USS of the kidneys to see if the pain was caused by a kidney stone.
These patients need an increase in appropriate service, not pressure on inexperienced GPs to bypass the assessments they need.
Now we are moving back to realism can we stop using the term ‘sex assigned at birth’. Instead we should use ‘sexy’. If there is a reason for ‘gender identity’ or similar later in life that could be used in that category, but there is no need to add ‘assigned at birth’. We don’t add write ‘number of fingers assigned at birth’.
lol can someone correct my phone autocomplete – we should use the term ‘sex’ not ‘sexy’!
@Simon
“What’s wrong with being sexy?”
Nigel Tufnel, 1984