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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)

  • But Dr Dickson said that 'this principal' cannot 'be a bar to doctors taking on new responsibilities or treating unfamiliar conditions'.
    Shouldn't that be "principle"?

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  • these pt's needs a psychiatry referral not a prescription

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  • If the patient develop PMT type symptoms and kill themselves due to you prescribing outside your competence an UNLICENSED medication you will be charged with manslaughter.

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  • Remember Nigel Dicksons background is journalism. . What does he know?

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  • “The bridging prescription is intended to mitigate a risk of self-harm or suicide;”

    “I’m going to top myself if you don’t prescribe” is not an uncommon coercion used by manipulative individuals who want to get their way. I am unhappy that this is being cited by an organisation that, itself, is implicated in some 28 doctor suicides as they take their languid time investigating.

    And what protection is the pressured prescriber to have if the patient suffers or dies from the drugs that are clearly outside the remit of GP?

    Devil and the Deep Blue Sea. That’ll be a NO then.

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  • 1. Why are the GMC getting involved in clinical issues I thought they were a regulator. NICE might stick thri nose in sure but GMC??
    2. Why are the GMC telling us to break their own guidance of good medical practice and start treating conditions were not trained to treat and have no experience of.
    3. They are suggesting we give patietns hormones appropriate for the opposite sex without the proper psychiatric assessment and other ( I have no idea) work up which is required before embarking on suck life changing treatment.

    How about accepting there is a wait time and in the interim attempting to increase the number of doctors working in the area of gender reassignment.

    This is just more dumping because we are free. This eat all you like contract is not only bad for GPs who foolishly agreed to unlimited workload for a fixed fee but also bad for patients as it encourages even those bodies set up to protect doctors and patients to push work on un were not qualified to do purely becase its the cheapest way of getting it done.

    Terrible really. The NHS is truly becoming 3rd class. The DM readers wouldn't want their tax money going on sex changes. I can imagine the headlines.

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  • a pt of mine has no difficulty obtaining branded oral contraceptive pills which appear genuine via the internet and (s)he equally has no difficulty understanding that I wouldnt prescribe them outside of a specialist treatment plan.I can't think of any other conditions where a risk (or threat) of suicide would be best treated by an otherwise unlicensed prescription. (nb please don't anyone start a debate over the gender pronouns)

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  • These patients are suffering from severe mental and emotional issues that are beyond the scope of practice of the GP. They require specialized treatment by properly trained psychiatric personnel. IMHO dumping this mess on the GP to score a few points with the constituents is a huge mistake.

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  • Cynical outrageous dumping
    Dangerous nonsense from GMC ., and what on earth has this clinical issue to do with them?
    Beyond ludicrous
    Exceptional circumstances is NEVER
    No GP should ever manage anything outside their competence .. Would you not agree GMC?
    I say again
    What an utterly pathetic piece of grossly dangerous nonsense
    Whoever came up with this feeble drivel should be reported to the GMC!

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  • Every time I read pulse there is yet another example of the surreal incompetence of our out of touch delusional London bureaucracy

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