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NHS England leaves GPs to pick up specialist gender dysphoria care

Exclusive GPs are being left to take on specialist care for people undergoing gender reassignment, after NHS chiefs refused to designate this as non-GMS work in service specifications drawn up for commissioners.

Guidance from NHS England stipulates that GPs are expected to provide what they call ‘the non-specialised element’ of the care pathway, including prescribe hormone therapy and carry out safety monitoring proceduresinterpreting blood test results and hormone therapy prescription.

However, the GPC said these services fall outside the GMS contract, require specialist input and should be commissioned separately – and urged LMCs to take up the issue with local NHS England area teams to insist they are.

The new guidance on GPs’ responsibilities in the ongoing management of patients undergoing treatment for gender dysphoria was put out for consultation early last year.

But the GPC said that while some changes had been agreed, NHS England had still ‘refused to specify that these services should be commissioned outside the GMS contract through shared care arrangements’.

The commissioning policy on gender dysphoria has subsequently been put out for wider consultation, and states that GPs are responsible for patients’ ‘long-term treatment needs, including hormone therapy, safety monitoring and health maintenance/promotion’ once patients have been discharged from specialist clinics.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, told Pulse said the specification would leave GPs holding full responsibility for patients and picking up the tab for ongoing medication.

He said: ‘Under normal shared care arrangements the patient remains under the overall care of the consultant, with the GP providing specific services to allow this to happen safely and efficiently. Here the patient will be discharged, and the responsibility for ongoing care will rest solely with the GP.’

He added that NHS England’s plan ‘specifically excludes the ongoing provision of medication’, meaning that ‘either patients will not be able to get the drugs that they need, or GPs will be the only providers of this care who receive no resources to allow them so to do’.

Dr Green also warned that GPs are personally responsible for prescribing the hormone treatments – many of which are unlicensed – even if directed to by a specialist.

‘GPs should also be aware that even if they have asked to prescribe by a specialist if they sign the FP10 they are personally responsible for it, and the GMC has made it clear that these responsibilities are greater for drugs used outside their license,’ he said.

He added: ‘We have made our position clear, and it is now up to individual practices with the support of their LMCs to decide if they can safely and financially undertake this non-contractual work. If they do not, then the BMA publication “Quality First” provides them with the tools they need to decline.’

Readers' comments (18)

  • There are some simple principles when deciding who 'should' look after patients.
    One is that anything that is uncommon, yet needs a recall system or regular monitoring, is much more likely to be safely carried out by a department that sees these patients regularly.
    A recall system for something affecting 1 patient in each practice is doomed to failure.
    Something like DMARDS however affects more patients in a typical practice, so a recall and result checking system can be instigated safely.

    And that is without looking at payment for such work.

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  • I had a nightmare trying to sort out ongoing care for a gender identiy patient recently.

    The bottom line is that we absorb a lot of the soft ongoing care anyway - doing prescription for specialist, monitoring testosterone/hormone levels etc. WE ARE COMPLETE LACKEYS in this regard.

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  • GP will of course pick up the slack being the only person that can't dump the patient and run.

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  • just prescribe and hope for the best using the patient information leaflet the specialist kindly sent. If anything goes wrong the patient, gmc and lawyers will know I was just trying my best with no time or money...

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  • Anon 9:11pm. Doing your best, no time, no money. As if that will save you.

    Your arse is toast.

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  • I can't remember the exact wording, but I think the GMS contract says we should refer if it is something I am not competent of managing.....

    There is nothing to say it has to fit with NHSE specifications.

    I would be quite happy to make a new referral monthly if needed. If they can't be seen in time, I might admit them via A+E weekly.

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  • Im not sure how anything is more specialized than this. As said its best that doctors stick to things they do regularly to reduce mistakes although im happy giving testosterone replacement for men how much different can it be? with a little info and guidance from specialists perhaps were over reacting. furthermore It can produce that much work as not common but more evidence that fee for service is needed. no one would be complaining about more patients if paid accordingly

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  • Oh FFS. Its bad enough being handed a stupid monthly search for FGM, and now we have this as well. Feels like general practice has a speculum firmly wedged down its throat and is having the contents of the NHS portaloo poured down. New day, new sh*t.

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  • Can someone please draw up a list of what is in and what is out, that is both comprehensive and comprehensible? I don't know, perhaps our union could do it for us.

    Then we might actually stand a chance if every Johny-come-lately cardy-wearing idiot didn't bloody well do it all for free and out of the kindness of their own saintly heart. We'd stand a better chance if we set up a national charity and called it something like 'GPs for free'. Then we could carp on about how our thing is the most important thing and insist all policy revolved around it as every other health charity does.

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  • Why dont they put it out to tender or is there not enough money to be made by vested interest.Ah thought so!

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