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New GPSIs in gender dysphoria could take on prescribing of hormone therapy



New GPs with a special interest in gender dysphoria could take on prescribing responsibilities for hormone therapy under plans proposed by NHS England.

A consultation into changes, sparked by concern that GPs are being forced to make prescribing decisions which are beyond their competence, suggests that GPs with the new qualification could issue prescriptions for all relevant patients in their area.

It comes after a row broke out last year over GPs’ responsiblity for prescribing hormone therapy to patients with gender dysphoria, which saw the BMA’s GP Committee (GPC) issuing advice telling GPs to ignore GMC guidance on the matter.

NHS England’s consultation suggests the option of training GPSIs to manage the care of transgender patients would be ‘convenient for patients as primary care retain responsibility, while also developing local expertise among GPs, both the trained experts and others who will learn experientially’.

But it added that it will ‘cost more’ and could ‘impact on certain patients, such as the disabled, who will have to travel to a different GP practice for their hormone treatments’.

The other options presented in the consultation include keeping the current arrangements, where ‘the patient’s own GP remains responsible for prescribing on the recommendation of the specialist team’, alongside options for specialist teams to either make out the first prescription, or taking on the responsibility for prescribing for the first year, before handing over responsibility to the patient’s GP.

As for keeping the current arrangements, NHS England says that this would be ’convenient for the patients as hormone treatment is managed by their GP alongside their general healthcare needs’ and ‘will require no additional resource’.

It adds that ‘GPs will be supported by the specialist team when this is needed’ but does acknowledge that ‘a small but significant and increasing proportion of GPs do not feel able to accept responsibility for prescribing’ and ‘additional primary care training and service development may be required’.

The consultation says: ‘BMA’s GPC has asked us explore possible alternative models that fulfil the needs of patients as it feels that the current common practice is not clearly defined and does not provide adequate support for prescribing practitioners.’

Dr Andrew Green, clinical and prescribing policy lead at the GPC, said it was now ‘vital’ that ‘all LMCs, and as many GPs as possible, reply to this consultation’.

‘This is the opportunity we have to ensure that this vulnerable group of patients have services commissioned for them for their entire patient journey, not just for the relatively short period they are receiving care from the gender identity clinics.’

The four options consulted on by NHS England

A. The patient’s own general practice remains responsible for prescribing.

B. Specialist team is responsible for issuing the first prescription; the patient’s own general practice will be responsible for issuing subsequent prescriptions.

C. Specialist team is responsible for issuing prescriptions for around one year (or until the patient’s endocrine treatment is stabilised); the patient’s own general practice will be responsible for continuing to issue prescriptions after this time.

D. A new role will be developed called ‘GPs with a Special Interest in Gender Dysphoria’.

NHS England said it also welcomes alternative suggestions.

Source: NHS England