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The waiting game

GPs should initiate gender dysphoria hormones in 'exceptional circumstances'

The GMC has said that GPs should initialise hormones to patients with gender dysphoria only in 'exceptional circumstances', after its original guidance was questioned by the GPC.

A letter from GMC chief executive Niall Dickson to GPC chair Dr Chaand Nagpaul said these 'bridging' prescriptions, while a patient was awaiting a specialist appointment, should only be considered when three criteria were met. 

He defined these as:

  • The patient is already self-prescribing with hormones obtained from an unregulated source (over the internet or otherwise on black market);
  • The bridging prescription is intended to mitigate a risk of self-harm or suicide;
  • The doctor has sought the advice of a gender specialist, and prescribes the lowest acceptable dose in the circumstances.

Mr Dickson said the GMC will now 'review the wording' of its new guidance 'to make sure it's clear to doctors that it's only in these exceptional circumstances that bridging prescriptions should be considered'.

The GPC had also raised concern regarding continued prescriptions under shared care arrangements, which it said went against GMC Good Medical Practice by 'forcing' GPs to prescribe 'outwith the limit of their competence'.

But Dr Dickson said that 'this principle' cannot 'be a bar to doctors taking on new responsibilities or treating unfamiliar conditions'.

He said: 'We would expect GPs to acquire the knowledge and skills to be able to deliver a good service to their patient population... Having said that, we don't believe that providing care for patients with gender dysphoria is a highly specialist treatment area requiring specific expertise.'

He added that he 'sympathetic' with the 'difficult position' GPs were placed in with regards to long referral waits, offering to be 'part of conversations' with NHS England on how to 'help make sure that trans patients are able to access the specialist services they need'.

Readers' comments (25)

  • This guidance is very worrying and contradictory as the GMC states not to manage conditions out of your area of expertese. We cannot be an expert in everything. What's the college doing to address this?

    Where will this end? Will we have to do our own tummy-tucks if our patients feel their stomach is giving the
    significant anxiety and the CCG won't fund it?

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  • Maybe the GMC should pay for our indemnity then,and I still wouldn't do as we have absolutely no experience in this area.The lunatics have well and truly taken over the asylum.

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  • This is clearly bonkers - but there's an interesting point when they say that they require that "the doctor [GP] has sought the advice of a gender specialist, and prescribes the lowest acceptable dose in the circumstances."

    Our local gender service refuses to advise for patients who have not completed their lengthy assessment pathway (a pathway that typically only starts after a 3-year-plus wait).

    So in my region there would automatically be no patients for whom the GMC "exceptional circumstances" apply.

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  • The only reason this is happening is so that the GP can be sued when the patient on the waiting list for psychiatrist assessment commits suicide. Blame the useless GP!

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  • Someone please put us out of our misery. The joke is now over. GP is the most miserable farcical job in the UK. Go on Maureen et al hiding away - any chance of someone supporting your colleagues?, thought not. Just shoot us all, the thought of another 20 years of this brings me to tears.

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