ICB agrees to gender incongruence service after pressure from GPs

An ICB is preparing to commission a gender incongruence service for adults following ‘concerted and recurrent’ pressure from local GPs via the LMC.

Kent and Medway ICB has confirmed that it is in an ‘exploration phase’ which will inform a specification and business case for a locally commissioned service, and this will seek to address GPs’ concerns about the ‘adequacy and equity of services’.

Currently, adults presenting to their GP with signs of gender incongruence face long waits for specialist treatment, since national services ‘have been unable to meet demand’ and waiting lists ‘have grown significantly before and during the pandemic’, according to the ICB. 

There are eight NHS gender dysphoria clinics in England which are commissioned nationally and to which a GP can refer patients directly.

Kent LMC executive member Dr Zishan Syed told Pulse that they lobbied the ICB to deliver a safe locally commissioned service to look after this cohort of patients, which would include a psychiatrist, endocrinologist and other specialists. 

He said that often patients on long waiting lists for NHS services will contact private providers who then send the patient back to their GP with letters asking them to arrange blood tests or prescribe.

‘Basically we’ve got lots of private providers who are, in my view, and in the view of other clinicians, exploiting this group of people.’

He added: ‘They charge them huge amounts of money for a “consultation”, and usually the outcome of the consultation ends up with a diagnosis of gender dysphoria. 

‘They don’t do what is actually required, which is actually issuing a prescription or arranging blood tests and following up on the results of that blood test. 

‘What they then end up doing is simply writing a letter saying they’ve diagnosed the patient with whatever the issue is, i.e. gender dysphoria, and then say “prescribe”.’

Without a service that can do full assessments, organise blood tests and prescribe, Dr Syed warned that private practices and NHS secondary care services ‘are trying to offload all the risks medico-legally speaking on to the general practitioner’. 

GPs may not be able to make prescriptions ‘ethically’ because it is outside their ‘areas of expertise’, according to Dr Syed, who also said interactions with patients can become ‘very emotionally charged’ because GPs are seen as the ‘obstructive barrier’.

Kent and Medway ICB told Pulse: ‘In response to the needs of our patients, feedback from Healthwatch and the LMC on behalf of primary care, we are planning a locally-commissioned gender incongruence service for adults. 

‘Primary care colleagues will be fundamental in designing this service once we finish the exploration phase.’

And in its update to local GP practices, the ICB referenced a locally commissioned service in Sussex, which it said was ‘forward thinking’, that will likely ‘inform the service specification in Kent and Medway’.

Kent LMC relayed this news to local GPs in a recent newsletter, saying: ‘After concerted and recurrent pressure from Kent LMC we are pleased to let members know that the ICB has agreed to commission a service to support gender incongruence and practices and the initial work on this has started.’

Earlier this week, the LMC also issued a template letter for GPs to send to patients stating the practice cannot support requests from private providers for prescribing and monitoring of transgender medications. 

The letter said the national gender identity clinics commissioned by NHS England ‘cannot keep pace with the growing demand for these services and the average waiting times are currently more than three years’. 

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 locally commissioned services to maintain prescribing and monitoring.’

Earlier this week, 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.

NHS England published draft proposals last year which suggested that the ability to refer patients to its service for transgender children would be limited to GPs and other healthcare professional – however, it rowed back on these plans in June this year.