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RCGP drops gender dysphoria course due to 'unrealistic expectations' on GPs

The RCGP has dropped an online course on gender dysphoria following GP concerns that they are being expected to prescribe outside of their clinical competence.

The e-learning course, launched in 2015 in partnership with the charity Gender Identity Research & Education Society (GIRES), was developed in response to the ‘lack of high-quality clinical guidance’, the RCGP said.

However, the RCGP decided to remove the course from its website in December as it could create 'unrealistic expectations for patients regarding the role of the GP in initiating treatment’. 

GP leaders said they should not have to 'bear the brunt of poor access to specialist gender reassignment' and argued they do not have the training to prescribe some of the treatments mentioned.

In 2017, NHS England published a consultation on gender identity services, asking for views on GPs’ involvement in prescribing hormone therapy.

This followed a row between the GP Committee and GMC over GPs’ concerns that they were being forced to prescribe to gender dysphoria patients without the necessary expertise. The GPC responded by advising GPs to ignore GMC guidance on the matter.

The RCGP gender dysphoria course provided guidance to GPs on how to prescribe and monitor the medication recommended by the specialist clinicians in the gender identity clinics.

Prior to the removal of the course, the RCGP made a series of changes to lessen the burden on GPs, which included the insertion of additional wording and the deletion of references.

But in a statement, GIRES – which paid the RCGP £7,837 to run the course – said the changes were made without authorisation, and undermined 'the responsibility of GPs to precribe and monitor the medication recommended by the specialist clinicians in the gender identity clinics'.

'Refusal of primary care support is a major detriment and GIRES could not agree to changes in a resource that was meant to help GPs to support transgender people with confidence, when the changes made are in direct contravention of NHS and GMC guidelines, and give GPs excuses to deny access to healthcare for transgender people,' the statement said.

RCGP honorary secretary Dr Jonathan Leach said: 'GPs should not have to bear the brunt of poor access to specialist gender reassignment services by being put in a position where they are being asked to prescribe treatment that they are not trained to prescribe or monitor safely without expert support'. 

'In the vast majority of cases, trans patients will present to the GP with the same conditions that cisgender patients do. But new presentations of gender reassignment are exceptional in general practice - it is a specialist area of medicine, and treatment should be initiated in specialist care,' he added.

Pulse reported last year about the lack of progress on an awaited transgender service in Wales, expected to be in place by the end of March 2018 but later set to open in October.

The RCGP said it is currently funding and developing a new e-learning course for GPs on gender variance, which is set to be launched later this year.

Readers' comments (21)

  • 'GIRES – which paid the RCGP £7,837 to run the course ' - a pressure group is allowed to fund an 'educational course' to promote their ideological agenda amongst GPs!

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  • Cobblers

    This is worth repeating, if necessary ad nauseam. "GPs should not have to bear the brunt of poor access to specialist gender reassignment".

    In fact one could remove 'gender reassignment' and insert almost any secondary or tertiary care service.

    GPs are not a dumping ground!

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  • Does anyone, with a single brain cell, think that initiating these treatments in general practice is a good idea? When we might see a single case in 10 years? What are these utter morons smoking?

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  • @John Gillespie
    It tells you a lot about the workings of the RCGP.

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  • Interesting how the honorary secretary of the RCGP is adopting the language of radical cultural politics 'cis-patients'. Wasn't aware there was such a patient group. Perhaps the RCGP could create a learning module to deal with my DEN.

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  • Never heard of cisgender ?
    Perhaps a training course is needed.

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  • Took Early Retirement

    I heard about Cisalpine Gaul, but then I had a decentish education.

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  • I would never attend such course. Glad it has gone.

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  • "Unrealistic expectations on GPs" sounds like the RCGP Mission Statement. Any chance of ending the RCGP as well?

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  • I am glad it ended. Taking money from a pressure group to brainwash us is clearly wrong. Specialists exists for a reason and GPs should not be doing these.

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  • The response from the pressure group who paid the RCGP( I resigned my subscription after 25 years as this issue was the final straw following numerous others previously) says it all as to what they think of us ordinary GPs
    At least when Big Pharma paid the RCGP their agenda was obvious!!!
    Ashok Rayani

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  • I have said you GPs must do as you are told.
    My website points you to an educational resource
    I know it is now empty but you must still do what the pressure groups want.
    GIRES bribed the RCGP but nobody needed to bribe me.
    I hate you all and will throw you to my dogs

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  • why did RCGP not tell us they had dropped this crap course and that GMC had nothing to hold us to?
    somebody has fcccccked up here.
    GMC hate GPs but RCGP is supposed to support us
    They really need to explain themselves

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  • Indeed, this seriously questions the RCGPs governance procedures which is also exemplified by its recent blatant political statement on brexit.

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  • It's pretty disgraceful that basically the RCGP took a bribe from a pressure group to help bully GPs into taking completely inappropriate responsibility for managing a complex specialist issue - when they should have been protecting GPs from this expectation

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  • RCGP planning a new e-learning course on gender variance. RCGP has sold itself to the much is another pressure group paying for this?

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  • David Banner

    Re Moniker

    Spot on. The labels “cis” and “trans” are gradually being imposed on us by the trans lobbyists, despite the fact that they have fought hard to reject labels applied to them by society for years.
    Plus, “cis” and “trans” are such ugly pejorative terms, if I wanted to label people I would suggest “classic” and “nouveau” instead!

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  • GIRES appears to be only interested in forcing GPs to issue damaging treatments to patients who have self-diagnosed and decided what treatment to have.
    Declining this is not contrary to GMC guidance, it is in line with declining a patient demand for inappropriate antibiotics for a cold!
    Patients NEED appropriate diagnostic services for their psychological difficulties, not blind tratment with harmful interventions.
    Lots and lots of psychological support is needed, not poisoning.
    GPs should feel supported in following the mandate in 'FIRST DO NO HARM'.
    Actually, in view of the lack of availability of suitable specialist services, GPs are probably best skilled to handle and assess initial presentations, but certainly GIRES does NOT appear to be. These people need help and support to cope with their difficulties. They need FULLY INFORMED consent to any treatment, and ONGOING support during transitions IF the joint decision of patient and GP is that the dis-ease of their situation requires such a massive harmful intervention as gender reassignment, which is major, not minor 'surgery'. It is NOT the ONLY option, and patioents should be supported towards the options that would suit them best and enable best functional outcome - which as we know in gP-land is sometimes what they NEED rather than what they want (eg antibiotics, Valium!)
    GIRES might as well say radiographers should issue hormone prescriptions, I know at least some who would be better at it than our current system!

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  • Our society and the "medicine" we are forced to practice is completely FUBAR in the UK.
    Rotten to the core and totally without anchor or purpose.
    The farcical mess of Brexit is a apt monument to the utter moral bankrupcy of our politicians, media and "the great British public".
    And if GPs want to survive or do anything to change it, we all have to leave the NHS and go completely private as did the dentists years ago. Stop expecting and hoping and pleading like pathetic victims praying that people will listen to us and do the "morally right" thing like have a properly funded service,an accounatable GMC, fines for DNA appts, jail terms for abusive patients, lifelong bans on registering with any GP service , compulsory fee attendance at forensic medical services instead, manned by police for serial offenders/serious abuse etc..
    When the F*** are we going to wake up and tell "them" to shove their glorious NHS up their a**???

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  • I emailed the GMC about this and this was the reply I got a few days ago. I am glad I saw this article as it affirms my belief and those on resilentGP fb group that this is not for us to do. I am not prescribing at all.

    Dear Dr

    Thank you for writing to the GMC. I understand that you are looking to clarify whether you have a duty to prescribe treatment for transgender patients, which you feel lies outside of your professional competence and whether failure to do so will be regarded as discriminatory.

    First, you are not expected to prescribe particular medications or treatment to any patient if you are not satisfied that they meet the patient’s needs. In Good Medical Practice we say doctors must prescribe drugs or treatment, including repeat prescriptions, only when they have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs (see paragraph 16a).

    We ask all doctors to balance duties to act within the limits of their competence with making the care of their patient their first concern (as well as providing effective treatments based on the best available evidence).

    The advice that we have provided on our ethical hub regarding the treatment of transgender patients (which can be accessed here) aims to clarify how our guidance applies in these circumstances. It is intended to support doctors to provide effective care in the best interests of their transgender patients, signposting sources of information and setting out the ethical framework for decision making. When a transgender patient approaches their GP to discuss the options available to them, we don’t want that GP to feel that they can’t help because they’re not a specialist.

    Our advice is not intended to force doctors down a specific route that they don’t feel is in the best interests of their patients, or to suggest they provide treatment on demand. However, we have questioned the assumption that prescribing treatment for a transgender patient is automatically outside the limits of a GP’s competence. For example, the hormones prescribed to transgender patients are routinely prescribed and monitored in primary care (albeit to patients assigned the opposite sex at birth). We are clear that prescribing off-licence is acceptable where there is no suitably licensed medicine available that would meet the patient’s needs (see paragraphs 67-69 of Good Practice in Prescribing).

    On our hub page we are also clear that GPs must co-operate with GICs and experienced gender specialists, as they would with other specialists, collaborating to provide effective and timely treatment for transgender people. This may well include prescribing medicines on the recommendation of an experienced gender specialist for and following recommendations for safety and treatment monitoring (for more information see the hub page here).

    Our ethical hub doesn’t have the same status as our formal ethical guidance. Rather, it is intended to show how the guidance might apply in practice, in specific situations doctors commonly face. We recognise that this is a source of some confusion and are currently considering how we might make this clearer.

    It is also worth remembering that even the formal guidance is guidance, not a rule book. There may be some circumstances that justify a departure from it. As long as a doctor makes the care of their patient their first concern, acts in good faith, and records their reasoning, they will be able to justify their decisions and actions if their fitness to practise is called into question.

    I hope this response is useful to you.

    Best wishes,

    Policy Officer
    General Medical Council

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