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.’
