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The waiting game

GPC complains about GMC gender dysphoria prescribing guidance

The GPC has written to the GMC to complain about its new prescribing guidance for gender dysphoria patients.

According to the GPC, it places GPs ‘in a difficult position’ by forcing them to prescribe specialist drugs beyond their competence.

The GMC’s Guidance for doctors treating transgender patients advises GPs to consider prescribing ‘bridging prescriptions’ in cases of delays in patients accessing specialist treatment in the NHS, to avoid the harm of self-medication.

But the GPC said it was ’extremely concerning that the GMC is recommending that GPs should consider prescribing medication that is clearly outside their expertise and competence’.

It said that if the NHS was ’denying appropriate access’ to specialist services then the GMC ‘should be highlighting this as a risk to patients which needs to be corrected through appropriate commissioning arrangements’.

In response, the GPC is now also seeking legal advice from indemnity organisations about the risks of complaints following this type of prescribing.

The GPC’s letter said: ’Current guidance is unequivocal that initiating hormonal treatment for patients with gender dysphoria should be done by a specialist as part of a comprehensive assessment process…

‘In the case of gender dysphoria, most GPs will have no previous experience of managing such a patient.

‘Our key concern is to ensure that GPs can prescribe safely within their limits of competence, and this includes the ability to decline to prescribe, where appropriate.’

It said GPs should also be at liberty to decline to prescribe continually under shared-care arrangements unless they volunteered to do so under a specific locally-commissioned service.

It said the GMC guidance placed ’a worrying expectation on any GP, regardless of their competence or knowledge regarding such hormonal treatments, to continue to prescribe specialist medication in this instance’.

Dr Nagpaul is also writing to NHS England regarding their commissioning responsibilities for gender services, ‘so that patients can have access to the specialist treatment they need’.

Prof Terence Stephenson, Chair of the GMC, said: ’Transgender patients have the right to be treated with the same respect, sensitivity and understanding as all patients. As the BMA says: ”there is a legitimate and moral need to ensure that patients with gender dysphoria receive prompt and timely care”.

‘Our new guidance, which is based on national guidelines endorsed by several medical royal colleges, is intended to support doctors with an area of care which we know many find challenging. It is only right that we provide further clarification if necessary and we will respond to the points raised by the BMA as quickly as possible.’


Readers' comments (11)

  • Excellent

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  • Very good

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  • The GPC is completely correct - I would not feel that I had the expertise to start such treatment and in the absence of full counselling from a specialist clinic, I think I could easily be open to justified criticism for doing so.

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  • The GPC standing up for GP's against the bullies. Well done and may it be the first of many

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  • Over medicalisation of behavioural problems

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  • Surely this guidance is outside the remit of the GMC? What has it got to do with regulation or safety? Me thinks it was done to rubber stamp nhses position on this issue. What a waste and we are funding this dumb organisation.

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  • I'll just give out some "bridging prescriptions" for diamorphine to my heroin using patients until they can get into the specialist drug rehab clinic...

    The GMC will back me all the way!

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  • I have a pop star patient who cannot sleep. Can I give him some 'bridging' prescriptions of propofol until he sees the sleep clinic? He says if I don't he will get some from the black market.

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  • I've got a patient who has been waiting endlessly for a total knee op. He says he will go to a carpenter to get it done as he cannot wait any longer. Can I....

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  • Thanks Dr Nagpaul. Shows the BMA truly understands the conditions GPs have to work under. The GMC is shooting themeselves in the foot asking GPs to prescribe UNLICENSED and outside their COMPETENCE.So much for patient safety. What if they get PMT and commit suicide? Or testosterone fueled rage attacks? Who's responsible?

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