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GPC guidance tells GPs to ignore GMC advice on prescribing for gender dysphoria



The GPC has issued guidance on treating gender dysphoria, which states that GPs should not be obliged to prescribe ‘bridging prescriptions’.

It has issued a new report in response to controversial GMC’s guidance that said GPs should prescribe so-called ‘bridging prescription’ hormones for patients before and after they get specialist care.

The BMA’s new report says that the GMC’s guidance ’fails to address the resulting significant medicolegal implications for GPs, and neglects the non-pharmacological needs of these patients.’

This is the latest in the long running row between the GPC and GMC/NHS England over GPs being told to offer specialist treatment which is in many cases beyond their competence.

The GPC acknowledges that all GPs will provide services to patients with gender identity problems at some stage and wants ‘to ensure high quality service provision is made for this particular group of patients.’

In April, the GPC said there were ‘significant concerns’ about NHS England and GMC guidance on prescribing advice, and discussions over the guidance are still ongoing.

The GPC’s new report advises: ‘While awaiting specialist assessment, GPs should attend to their patients’ general mental and physical health needs in the same way as they would for other patients, but are not obliged to prescribe bridging prescriptions.’

It has called on NHS England to make proper commissioning arrangements to avoid patient self-medicating ‘rather than by GP-prescribing before initial assessment and diagnosis.’

The guidance added that GPs need to understand the issues to ensure they provide quality care and make appropriate referrals to specialist services.

It said: ‘In our view, there is however a need for a balance between what can justifiably be expected of GPs in providing Primary Medical Services to patients with gender incongruence, those enhanced services which can be provided in primary care, and the knowledge and expertise which should rightly remain within the remit of specialist services.’

It also advised GPs to:

  • Refer early and quickly to a reputable gender service;
  • Support recommended treatment;
  • Get pronouns right and ask discreetly if in doubt;
  • Take care over medical confidentiality and never divulge a patient’s gender past without their consent;
  • Avoid misattributing commonplace health problems to gender.

The GPC also called on CCGs to refrain from blocking appropriate direct referrals to the eight gender identity clinics (GIC) in England from GPs.