Working Life: Working in trans health
Dr Sophie Quinney shares a typical day in the life of a GPSI in trans health
Profile - Dr Sophie Quinney
Roles - GP with a special interest in trans health at Meddygfa Canna Surgery, Cardiff, and former associate medical director for the Welsh Commissioner
Hours worked per week - 40
The kettle is on and I’m checking the new GP referrals. I support prescribing for gender-diverse people across Cardiff and the Vale, but also further afield in Wales, where endocrine support is unavailable. We are shortly launching a DES to incentivise GPs to prescribe long-term maintenance HRT.
A fellow GP arrives, along with a sexual health consultant, both from neighbouring health boards. They are here to shadow me for the session and will soon join the local gender team, initiating HRT on behalf of mainstream GPs as part of the new Welsh service model. Also with us is Eve, a fourth-year medical student inspired by a workshop on gender diversity that I delivered for the RCGP Discover General Practice day.
It’s time for clinic. Patients each have a 30-minute slot. The guys are keen to show off their new facial hair, but for my trans-feminine patients this is often a source of significant distress. In Wales, unlike in England, facial hair electrolysis isn’t funded by the NHS, and it’s not cheap. Carly asks me if £585 sounds like a good price for nine sessions.
Gamete storage, however, is funded, and Andrew recounts his experience of egg retrieval being positive, although the forms assumed that he was cis-gender.
I administer injections, review bloods and advise on sexual health and screening.
Every one of these patients tells a difficult story of battling to be their authentic selves and at times feeling let down by their GP.
It’s part of my job to explain that we also face barriers, particularly with feeling adequately skilled in this area.
It’s lunch time, and I’m off to visit a practice that isn’t currently prescribing HRT. We sit around the table and mop up food left over from an earlier drug rep visit. The younger salaried GPs are keen to prescribe, but want more training. Older partners are concerned about workload and inadequate shared-care support. I offer reassurance that the DES will address these concerns. We discuss other ways to have a positive impact, such as changing the name and gender marker on a record, the correct use of pronouns and setting up screening alerts.
Bringing everyone together is an important part of my work, as is championing policies that support GPs.
There’s a web page on GP One calling for my attention. GPs and other non-specialists want to access information in one place, so I’m creating a trans health section.
I also add the final touches to my presentation for the upcoming series of national GP CPD events.
I dial into a conference call with gender leads from the seven Welsh health boards. They are responsible for setting up the local gender teams, ensuring all patients have guaranteed prescribing support close to home. I talk through the new treatment flowcharts that I have devised as a way of demystifying the hormone initiation schedule.
The kettle is back on and the Welsh cakes are warmed. Nick, from the charity Umbrella Cymru, is helping with a proposal for peer support – people with lived experience to provide a community presence at the new Cardiff gender identity clinic and support patients on the waiting list.
Gareth, the manager at Leeds gender identity service, joins the meeting via conference call. His outreach team provided the inspiration for this project.
It’s the last Thursday of the month, and time for the Trans Social Meet-Up, a get-together in Cardiff for the community, and a vital place to build bridges and to become an advocate.
Bedtime reading is Transgender Health: A Practitioner’s Guide to Binary and Non-Binary Trans Patient Care by Dr Ben Vincent, which I recommend to all GPs.