GPs urged to refuse gender dysphoria shared care with unregulated providers
GPs must not enter shared care agreements with unregulated providers operating in the field of gender dysphoria for children and young people, NHS England has said in updated guidance.
The guidance said NHSE received requests from GPs and ICBs for advice on how to respond to requests made by unregulated providers for a shared care approach to the prescribing, administration and monitoring of hormone interventions as a treatment option for gender incongruence or gender dysphoria.
An unregulated provider is one that is not registered with, or regulated by, a UK health regulator such as the CQC or Health Inspectorate Wales.
In March this year, the NHS paused the initiation of new prescriptions for exogenous hormones in the NHS Children and Young People’s Gender Services pending the outcome of a public consultation on the evidence base.
Subject to the outcome of this consultation, NHS England has proposed that exogenous hormones should not be prescribed to children under 18 years of age for gender dysphoria because of the ‘limited evidence about safety, risks, benefits and outcomes’.
The guidance said: ‘It is within this context that GPs and other prescribing professionals are cautioned against a shared care approach with unregulated providers who continue to offer access to – or facilitate access to – endocrine intervention to children and young people under 18 years of age as a response to gender dysphoria or gender incongruence.’
Similar advice was issued last year, when GPs were warned against entering agreements with providers that offer services to UK patients but are either registered overseas or operate their clinical team overseas.
It said that GPs must:
- refuse to support the private prescribing or supply of GnRH analogues when used for the purpose of puberty suppression unless the course of treatment concerned began before 3rd June 2024
- refuse to support an unregulated provider in the prescribing or supply of alternative medications that may be used to suppress pubertal development
- refuse to support an unregulated provider in the prescribing of exogenous hormones
- always be prepared to refer their patient for an appropriate non-routine investigation under an NHS contract where there is a concern that the child or young person may come to harm as an outcome of a medication from unregulated sources
If GPs have concerns that declining responsibility would pose a ‘clinical risk’ to the child or young person, the decision to decline a shared care agreement should be weighed against the ongoing risk posed by administration of a medicine from an unregulated source.
In such cases, GPs should consider a referral to ‘appropriate local services’, the guidance added.
In all cases, safeguarding measures should be considered where the administration of a medicine sourced from an unregulated source presents an immediate safety risk, NHS England added.
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READERS' COMMENTS [2]
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It beggars belief that NHSE feel they need to say ‘don’t do shared care with unregulated providers’.
Still, nice to agree with them on something.
It can seem harsh, in view of waiting times of about 3-4 years for NHS services, and the fact there is no ‘local’ NHS provider for us within several hours by train or car, and all referrals to mental health that are not ‘Emergency’ are currently banned/declined, but entering shared care with a private non-NHS service lays the GP open to taking responsibility for all care provided by the Private provider, (who makes aprofit while we do not), and none of it is covered by NHS medical Indemnity arrangements. You need to fully check out and vet the private provider clinician and take responsibility for all decisions made by their staff, including unqualified ones. It is NOT worth the risk. It also transgresses a number of GMC requirements. Also not worth the risk.