Lack of access to training a barrier to caring for transgender patients, say GPs
A survey of GPs and other healthcare workers has found insufficient medical training is a frequent barrier to supporting transgender patients.
The survey of 646 healthcare professionals, carried out by charity TransActual, included 253 respondents working in general practice.
It found less than a third of respondents thought they’d received sufficient medical training or supervision to support their trans patients, and those who had accessed training often had to proactively seek it out.
The report also argued an inability to access shared care agreements with private clinics or NHS-funded gender identity clinics (GICs) prevented GPs being able to prescribe GAHT.
Nearly a quarter of prescribers described having difficulties getting the specialist support they needed to be able to prescribe GAHT for their trans patients.
One GP quoted in the survey described ‘no shared care agreement with (GICs) and an abject disinterest from specialists in appropriately supporting general practice in providing this – a badly commissioned pathway’.
Another said they were ‘limited by the difficulties accessing specialist transgender care’.
The report advised GPs who felt unable to prescribe GAHT to ‘reflect on what could make you feel differently and take steps to make that change – for example by accessing training or seeking advice from a more experienced colleague.’
Chay Brown, TransActual healthcare director, said: ‘This report highlights how little access there is to high quality training on trans-inclusive care. Too often, trans patients themselves are the only source of CPD that GPs have access to, and this needs to change.
‘It is essential that all GPs – and the wider medical professions – are trained to understand trans people’s healthcare needs and to offer high quality trans-inclusive care.’
Responding to the survey, the RCGP said it ‘would support the development of a framework to upskill more GPs’ in care for adult transgender patients.
An RCGP spokesperson told Pulse: ‘GPs are trained to have open, sensitive and non-judgemental conversations with patients about all aspects of their health, and trans patients should feel confident that this will be the case for them.
‘The care and treatment of gender dysphoria is a complex and specialist area of medicine. Whilst GPs will be able to support trans patients with many health complaints, as with any other patient, for specialist areas of medicine, including gender dysphoria, the most appropriate way forward is to refer patients to specialist care.
‘In some cases, GPs will also manage the care of patients undergoing treatment for gender dysphoria under a shared care agreement with specialist colleagues – but only if GPs feel this is within their competence.
‘It is clear from this survey that while some GPs may have developed additional expertise in gender dysphoria, many do not feel confident or competent to provide treatment without specialist input and advice.
‘To this end the College would support the development of a framework to upskill more GPs in the care of adults with gender dysphoria – and explore options for how they could help to improve access to appropriate gender dysphoria care in the community.’
Earlier this year, the college recommended that GPs work with gender identity services ‘in the same way as any other specialist service’, including consideration of prescribing under a shared care arrangement.
The position statement said the ‘core role’ of GPs includes to ‘liaise and work’ with specialist gender identity services ‘in the same way as with any other specialist service’, and that this includes consideration of prescribing ‘under a collaborative or shared care arrangement’.
The guidance, published in response to developments including the Cass review, said the college did not consider prescribing GAHT to patients under 18 as part of the GP role.
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READERS' COMMENTS [2]
Please note, only GPs are permitted to add comments to articles
‘Training’ implies some kind of consensus on diagnosis and long term management based on peer reviewed evidence in longitudinal studies.
Reading accounts of clinics like the Tavistock it is not clear there was space for heterogenous views and scientific inquiry. This is still an extremely experimental field, in diagnosis, psychological support and physical medical management, with uncertainty re long term outcomes from irreversible treatment.
There should be no pressure for GPs to be involved in this care if they choose not to, regardless of whether there is availability to train in the interventionalist medical approach.
I agree Simon.
I think some clinicians may have reservations about the scientific, philosophical, ethical and even legal basis of physical interventions for gender-related distress.
I have in fact attended specific training in this area, but the training did not address any such concerns, and would not have reassured a clinician with such concerns.