This site is intended for health professionals only

GPs should not lead gender identity treatment, ICB tells NHSE

GPs should not lead gender identity treatment, ICB tells NHSE

An ICB has called on NHS England to ‘urgently’ clarify the role of primary care in adult gender dysphoria services, highlighting that responsibility for treatment and medicines should not lie with GPs.

In a recent letter to NHSE, Hertfordshire and West Essex ICB highlighted the consequences of this service provision gap for both patients and local GPs. 

The local commissioner said that a specialist provider should manage treatment, with GPs only being involved once a patient’s treatment is ‘stable’.

A spokesperson for Hertfordshire and West Essex ICB told Pulse: ‘We believe that it is in patients’ best interests for their treatment and medicines to be initiated and led by a specialist provider with the knowledge and experience to provide care safely, not an individual’s GP.

‘We have written to NHS England to outline the concerns that we and our GPs share. We have asked NHS England to urgently bring forward plans to set out the role of primary care in supporting patients with gender dysphoria only at a point when a person’s treatment is stable and where there is an individual shared care agreement in place.’   

Bedfordshire and Hertfordshire LMC welcomed the letter, saying the ICB listened to feedback from local GPs and understood that ‘pressuring GPs to prescribe isn’t the solution’.

The LMC’s recent update for members said: ‘For the last two years we have been raising the unacceptable provision of services for the management of gender dysphoria in primary care, with our local commissioners, and regional NHS England. 

‘The responsibility for commissioning currently sits with NHSE, not the ICB, and it is clear that there is a commissioning gap when it comes to the prescribing for, and monitoring of, these vulnerable patients.’ 

Kent and Medway ICB recently agreed to start the commissioning process for a gender incongruence service following ‘concerted and concurrent’ pressure from local GPs via the LMC.

There are eight NHS gender dysphoria clinics in England which are commissioned nationally and to which a GP can refer adult patients directly – but patients face long waits as these services experience high demand.

GPs in Kent called for a local service that includes the appropriate set of specialists who can safely manage prescription and monitoring for these patients.

In September, a survey by the LGBT Foundation found that less than half (47%) of transgender people believe their GP meets their needs, compared to 61% of cisgender people.


Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.


Please note, only GPs are permitted to add comments to articles

Not on your Nelly 10 November, 2023 5:45 pm

Thank god there is finally some comeback. No GPs have any training in this highly specialised area of medicine. There are very few people who actually understand and have the knowledge to safely do this work. It is a disgrace that GPs have for so long been forced to work outside their knowledge and experience, and put these group of patients at risk of getting incorrect and harmful treatment. This needs to be a fully commisioned specialist service (much like HIV services) run by specialist with the appropriate knowledge and skills to be able to assess, prescribe, monitor and treat. There should be minimal if no GP involvement for their gender dysphoria, though all normal routine things that GPs treat like hypertension and diabetes will still fall under normal routine care. This took too long to happen and the damage has already been done to patients and GP – many who have broken the first rule of the GMC guidelines “work within your competence ” and never prescribe things you have no knowledge and skills about.

Chris Holdridge 11 November, 2023 7:34 am

I would go further and suggest that ALL prescriptions should be created directly by specialists. There should be no GP involvement at all because many gps have ethical objections. We did not sign up to deliver this type of service and should not be obliged to do so.
* please note I accidentally hit “flag” on the other comment and now can’t undo it- please ignore it, I agree with every word!

Iain Chalmers 11 November, 2023 8:43 am

100% agree with above, it’s clear in GMC guidance.

Push back should be all ICB’s not one

Some Bloke 12 November, 2023 11:57 am

100% agree. And patients expectations of what we can and can’t offer need to be adjusted to reality

Browned Off 13 November, 2023 10:03 am

The problem is that the majority of GP Medical Directors and indeed all other Directors on ICB boards are there because they don’t rock the boat. They will do whatever is necessary to preserve their cushy roles, even if that means dumping this and anything else on General Practice.

Just Your Average Joe 13 November, 2023 4:06 pm

General practice should have no role in specialist gender care and all prescription and MDT care including the mental health consequences of the delays to be seen and treated.

We are continuing to provide non gender related care in the same way we help all our patients.

We should never be expected to work outside our competence and training.

People with specific specialist needs deserve a decent MDT service that is commissioned to meet their needs.