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GPs expected to lead in new service for transgender children

GPs expected to lead in new service for transgender children

GPs will be expected to take a lead on referrals to specialist services for transgender children after NHS England slashed the number of potential referrers.

Draft proposals for the redesigned service state that the number of professionals who can refer into the NHS Gender Identity Development Service (GIDS) – which currently includes staff in schools, voluntary organisations and social services – will be cut down to just GPs and NHS professionals.

Currently around 65% of referrals into GIDS are made by GPs.

It will also task GPs or referrers whose patients do not meet the criteria for the new service to develop a ‘local care plan’ to meet the young person’s needs.

It comes after the BMA this year warned that GPs are having to conduct ‘extensive reviews’ for patients referred to the adult services to assist with extraordinary waiting lists.

The new changes form one aspect of the controversial interim service which will see GPs handed greater responsibility in the pathway, amid major criticism from international healthcare professional body.

The draft specification – which is open for consultation until 4 December – comes in the wake of the Cass Review, an ongoing assessment of the current GIDS pathway, run by the Tavistock and Portman NHS Foundation Trust, North London.

Published in the summer, the interim report recommended the Tavistock service – the only one of its kind in England – be discontinued and replaced by several regional hubs.

NHS England’s interim specification is intended to operate until Dr Hilary Cass publishes her final report in 2023.

This spec would also see care move away from a linear pathway, involving just one specialist practitioner, to one with a ‘greater emphasis on formation of joint care plans with local professional networks’, but led overall by a medical doctor.

Dr Sam Hall, a GP partner in Brighton, said the pathway should not be led by a medical doctor at all and should instead follow a biopsychosocial model, with leadership drawn from experience in the community and voluntary sector.

He added that cutting the number of referrers will ‘reinforce a gatekeeping approach to care’, as it assumes GPs and NHS professionals will compassionately understand their role in the pathway.

‘The current statistics suggest that a small percentage are referred by people who are not an NHS professionals or GPs. Presumably this small number represents a cohort for whom the normal referral routes are not open for some reason. This cohort are likely to be disadvantaged in the interim spec,’ he said.

‘It is not acceptable to allow individuals to be denied access to services through lack of engagement with NHS professionals or GPs when the reasons for poor engagement might be the very thing help is being sought for.’

Dr Clare Bannon, BMA England GP committee policy lead for healthcare delivery, said: ‘The BMA is committed to the equitable provision of healthcare to all patients, and recognises that lack of access to appropriate services contributes to health inequality experienced by some trans patients who need access to gender dysphoria services.

‘GPs are expert medical generalists, however, there must be a balance between what can be expected in primary care and the expertise which should rightly remain with specialist gender dysphoria services, especially for children. The BMA will continue to lobby for NHS England and NHS Improvement to commission an appropriate and accessible service for all trans patients who need to access ongoing specialist care and treatments.

‘The BMA will be responding to the consultation on the interim service specification for children with gender dysphoria in due course.’

The specification has also come under fire for suggesting that the GIDS ‘will be unable to provide ongoing clinical supervision for the management of these interventions’ in cases where ‘puberty blocking drugs or hormone drugs are prescribed or accessed outside the service’.

Currently, trans children under 18 in England are able to access treatment via private services or via the NHS service, but some may access them online or from unregulated services.

In latter cases, the interim specification advises GPs to ‘initiate local safeguarding protocols’, which could include child protection services.

The World Professional Association for Transgender Health (WPATH) – an interdisciplinary professional body– said this charge would put GPs who understand the GIDS service has a lengthy waiting time ‘at risk of censure for refusing to make such an inappropriate child protection referral’.

Dr Hall said that setting up a pathway that ‘fails to give care’ then proposing ‘punishment via safeguarding mechanisms’ is discriminatory, and would leave GPs with an ethical dilemma.

He said: ‘It would appear that GPs in particular are being threatened with sanctions (via safeguarding) if they do provide support and monitoring to such patients. This creates an ethical dilemma which pits preserving a licence to practice against proper care for a patient in dire straits.

‘Patients do not seek unregulated care when there is adequate provision in the system. But there isn’t. This would be similar to refusing to provide physiotherapy or other aftercare to a patient who could not wait to have their knee replacement in the NHS so took steps to secure the surgery privately.’

The CQC’s inspection of the GIDS service in October 2020 found that there were 4,600 children and young people on the waiting list, with wait time of over two years to their first appointment.

For more information on providing care for trans patients, visit the Pulse CPD module.


          

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READERS' COMMENTS [7]

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

Dave Haddock 1 December, 2022 6:23 pm

Hopefully the BMA are at this very moment drafting a reply along the lines of “we are advising our GP members that this service is outside their contractual obligations, and that we are advising that they decline all involvement”.

Patrufini Duffy 1 December, 2022 6:40 pm

Dentists are well placed for this.

Anonymous 1 December, 2022 9:10 pm

Leading in what way? Referring to mental health teams? That’s sugarcoating the blatantly obvious drive to curb most referrals.

David Jarvis 2 December, 2022 8:32 am

Yep so not a simple GP 10mins appt. Refer to specialist service and let them get on with it. Done my job after that.

Decorum Est 2 December, 2022 2:30 pm

Left the BMA over thirty years ago. They were useless then and are still useless (or worse).

Cameron Wilson 2 December, 2022 8:24 pm

Expected to Lead! Default position of every nonenity who is given a brief to come up with something that the punters want to hear, without any funding!!

Just Your Average Joe 3 December, 2022 12:13 am

No thank you.

Not contractual requirement.

Not trained to provide this specialist tertiary care service.

Let community services who know and deal with these patients make the referral and let the tertiary service review the referrals and then triage the information and then provide care.

If there is not sufficient capacity to do this, stop promoting demand until NHS England commissions sufficient supply.