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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)

  • "we don't believe that providing care for patients with gender dysphoria is a highly specialist treatment area requiring specific expertise."

    In that case, why do gender clinics insist on months of psychological assessment before they will consider issuing hormone prescriptions?

    Whereas you seem to be advising that a GP should just print out a prescription in a 10 minute consultation.

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  • Vinci Ho

    More interested to know the 'story' behind , driving this so high profile announcement by GMC?

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  • Vinci Ho

    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.'

    Mmmm , logically and potentially this can apply to virtually all other 'specialist' therapy . The happiest organisation is our medical indemnity agencies with all reasons to ramp up the fees higher and higher. And to the patients , really safe enough , seriously ?

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  • I read this as a pretty straightforward plan to dump a really very tricky area of practice on to GPs. It is only a matter of time before someone commits suicide while waiting for a clinic appointment - "If only the idle GP has just done what the GMC said and prescribed the hormones."

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  • "'We would expect GPs to acquire the knowledge and skills to be able to deliver a good service to their patient population... "
    Correct- in the 50 hours of postgraduate learning per annum specified by the GMC;
    based on an assessment of the practices populations needs and most benefit from time spent as per appraisal and revalidation.
    The thorny issue is the circumstance arises so infrequently that spending the time for one or two individuals looses out to the hours of " mandatory" child protection; Information governance etc.
    and keeping abreast of the changes in therapy that benefit hundreds of patients in a what little time remains after an increasingly complex and expanding service delivery of care.

    Definition of a specialist "someone who looks after a small section of health needs in a 30-60 minute outpatient appointment because the condition is "beyond GP capability" - until the condition rises in prevalence at which point it becomes a "GP problem" but unfortunately still in a 10 minute slot and not a sixty minute one........

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  • Dear All,
    Err but "The patient is already self-prescribing with hormones obtained from an unregulated source (over the internet or otherwise on black market);"

    If the source is unregulated and its self prescribing how can anyone be certain they are actually receiving bio active compounds? More likely the 90% talc Viagra discovered above a north london shop years back.

    if there is no certainty that the patient is actually on a hormone treatment then the GP would in effect be initiating treatment.......

    I think Mr Dickson should re-consult his advisers on this aspect.

    Regards
    Paul C

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  • Vinci Ho

    The falsification in philosophy is worrying . Specialist defines oneself by seeing multiple cases sharing similar pattern in a specialised field and it is exactly the number of cases one seeing daily also defines the word 'experience'. That is why cardiologist cannot see a patient with rheumatoid arthritis and one can argue GP is a specialist of upper respiratory tract infection because of the number of cases we are seeing every day. Training and experience are clearly completely separate concepts.
    If the clause 'exceptional circumstances ' is adopted by GMC , it means logically 'minority' cases . Why is it not even more essential that they should be treated by those with more experienced in the therapy in question ?

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  • err....shouldn't this be initiate?

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  • Peter Swinyard

    Good luck with the MDO's when you are sued. Working within your scope of expertise is a fundamental of good medical practice, if not Dickson's idea of Good Medical Practice with the capitals.

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  • No. This is not general practice.

    I find it quite astonishing that efforts are being made to force GPs to take prescribing responsibility outside their competence and against their better judgement in this one very specialised area and wonder if it's a lack of specialists willing to see and medicate that is the issue. We retain prescribing responsibility so have to retain prescribing independence; that is the principle (rather than Mr Dickson's "principal") at stake here.

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