An LMC has advised GP practices that they can refuse requests to take on hormone prescribing responsibilities from private clinics for transgender patients due to a lack of resources.
Kernow LMC said that GPs in its area are ‘increasingly fielding requests’ to take on hormone prescribing responsibilities from private provider clinics and that this can lead to patient tension.
It has published advice including a template letter supporting practices that decide to reject the requests due to not having skills or staff.
The LMC said in an update: ‘Most GP practices are not carrying out these requests, indicating they do not have the requisite skills and resources to do so.
‘Additionally, there is no way of GPs easily assessing the governance and standards of private transgender clinics.’
The template letter said that unfortunately these clinics ‘cannot keep pace with the growing demand for these services’ and the average waiting times are currently more than three years.
And it added: ‘As GPs, we feel this is an unacceptable level of service, and we continue to campaign for more equitable care for the transgender community.
‘This would involve not only more timely access to specialist care, but also continued resources to fund and train GPs to maintain prescribing and monitoring.
‘As a result of these long NHS waiting times, people are seeking private treatment, mainly through online providers.
‘Many private transgender clinics will initiate medication but then request that further prescriptions and monitoring are accessed from the GP.’
Reasons given for refusing to take on such responsibilities include:
- It is ‘challenging’ for practices to ‘be assured of the quality and governance aspects’ of private clinics.
- These are specialist medications which need to be shared between GPs and specialists, and ‘there is no guarantee of enduring specialist care within the private sector’.
- General practice does not currently have the capacity to meet this additional demand from the private sector.
Practices were also advised to tell patients to contact their MP to highlight the issues around care for trans patients.
In June, NHS England made a U-turn on its plans to limit who can refer patients to its service for transgender children, after proposing to shift all responsibility for referring onto just GPs and healthcare professionals.
NHS England will instead form a separate second service specification that ‘will describe in greater detail the process for making referrals onto the national waiting list’ held by NHS Arden and GEM commissioning support unit (CSU), due by the end of the summer.
The confirmation came as part of NHS England’s finalised interim service specification for caring for children with gender dysphoria, published at the beginning of June.
Less than half (47%) of transgender people believe their GP meets their needs, compared to 61% of cisgender people, according to a recent survey.
However, Kent and Medway ICB is preparing to commission a gender incongruence service for adults following ‘concerted and recurrent’ pressure from local GPs via the LMC.
We don’t take any shared care from any private provider. It’s a no brained. Why would you ?
No shared care from any private provider, but when it’s a no for trans- treatments you are accused of discrimination easily. So this guidance is welcome