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New GPSIs in gender dysphoria could take on prescribing of hormone therapy

New GPs with a special interest in gender dysphoria could take on prescribing responsibilities for hormone therapy under plans proposed by NHS England.

A consultation into changes, sparked by concern that GPs are being forced to make prescribing decisions which are beyond their competence, suggests that GPs with the new qualification could issue prescriptions for all relevant patients in their area.

It comes after a row broke out last year over GPs' responsiblity for prescribing hormone therapy to patients with gender dysphoria, which saw the BMA's GP Committee (GPC) issuing advice telling GPs to ignore GMC guidance on the matter.

NHS England's consultation suggests the option of training GPSIs to manage the care of transgender patients would be ‘convenient for patients as primary care retain responsibility, while also developing local expertise among GPs, both the trained experts and others who will learn experientially'.

But it added that it will ‘cost more’ and could ‘impact on certain patients, such as the disabled, who will have to travel to a different GP practice for their hormone treatments'.

The other options presented in the consultation include keeping the current arrangements, where ‘the patient’s own GP remains responsible for prescribing on the recommendation of the specialist team', alongside options for specialist teams to either make out the first prescription, or taking on the responsibility for prescribing for the first year, before handing over responsibility to the patient's GP.

As for keeping the current arrangements, NHS England says that this would be ’convenient for the patients as hormone treatment is managed by their GP alongside their general healthcare needs’ and ‘will require no additional resource'.

It adds that ‘GPs will be supported by the specialist team when this is needed’ but does acknowledge that ‘a small but significant and increasing proportion of GPs do not feel able to accept responsibility for prescribing’ and ‘additional primary care training and service development may be required'.

The consultation says: ‘BMA’s GPC has asked us explore possible alternative models that fulfil the needs of patients as it feels that the current common practice is not clearly defined and does not provide adequate support for prescribing practitioners.’

Dr Andrew Green, clinical and prescribing policy lead at the GPC, said it was now 'vital' that 'all LMCs, and as many GPs as possible, reply to this consultation'.

‘This is the opportunity we have to ensure that this vulnerable group of patients have services commissioned for them for their entire patient journey, not just for the relatively short period they are receiving care from the gender identity clinics.’

The four options consulted on by NHS England

A. The patient’s own general practice remains responsible for prescribing.

B. Specialist team is responsible for issuing the first prescription; the patient’s own general practice will be responsible for issuing subsequent prescriptions.

C. Specialist team is responsible for issuing prescriptions for around one year (or until the patient’s endocrine treatment is stabilised); the patient’s own general practice will be responsible for continuing to issue prescriptions after this time.

D. A new role will be developed called ‘GPs with a Special Interest in Gender Dysphoria’.

NHS England said it also welcomes alternative suggestions.

Source: NHS England

 

Readers' comments (7)

  • E - Consultants who are experts in gender dysphoria are empowered to look after their patients properly and prescribe for their patients for the duration that is required. Even if it is forever.

    Why does NHSE always put saving money ahead of expert care. This is almost the definition of specialism. It is a relatively small number of patients, with a high risk of harm, using very specialist drugs, in a complicated way.

    Anyone who starts their system design with quality care (rather than saving money) would say these patients deserve specialist care. What they don't need is the advice of a GP, who has one of these patients every 5 years.

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  • F - consultants get Physician Assistants to check up on these patients and report back to consultant who maintains prescribing responsibility. Cheaper source of labour than GP and GP does not have to risk prescribing beyond their comfort zone. Happy patients, happy consultants, happy PAs, happy GPs, happy Jeremy.

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  • Doctor McDoctor Face

    That's one less GP to do......general practice!

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  • Either E or F for me. We need GPs concentrating on general practice.

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  • Is not realistically commercially indemnifiable for a GP. End of.

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  • They don't understand that it's not that we intellectually couldn't read the significant guidance, do some personal learning to understand our unknown unknowns, and set up monitoring and recall systems for this cohort in primary care.

    It's that the opportunity cost is significant and entirely inappropriate for what is a small cohort of patients / practice that need non urgent treatment.

    It is far more productive for GPs to concentrate their time and practice staff time of conditions that are common and chronic or, if uncommon, need identifying and treating urgently due to the time sensitive risks of delayed diagnosis and management.

    Most GPs don't have time to the all that, so expecting upskilling in practice for Gender Dyshphoria prescribing is a complete waste of time and money. The only reason to choose the 'GP just prescribe' option is if the NHS won't spend the money and is happy to accept the inevitable poor quality service these patients will get, or accept the decline in services and access to other patients if GPs spend time on this cohort of patients.

    Nothing is free, especially time.

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  • I will walk away from general practice if this is pushed onto GP services. I am sick of becoming the dumping ground for everything 'due to the convenience of the patient'.

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