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New approach needed to improve NHS care for trans patients, says RCGP

The RCGP has called for a whole-system approach to improving NHS care for trans patients. 

The College, which represents 53,000 members, declared that the GMC should provide greater clarity for doctors on the issue, particularly concerning regulation. 

It also emphasised the ‘urgent need’ for increased independent research into the effects and impact of interventions for gender dysphoria, especially regarding children and young people. 

The position statement on the role GPs can play in caring for gender-questioning and trans patients was approved by the governing council on Saturday 22nd June and includes the recommendations that:

  • IT systems are updated to enable GPs to treat trans patients safely and respectfully – and that NHS systems record codes for gender identity and trans status, as well as biological sex;
  • The GP curriculum covers gender dysphoria and trans health issues – and that more training programmes be developed to support GPs and their teams to appropriately advise trans patients;
  • The principles of oversight and regulation applied by the Care Quality Commission in England and equivalent bodies in Scotland, Wales and Northern Ireland should be applied to all providers of gender identity services, not just NHS services;
  • Waiting times for Gender Identity Clinics (GICs) are addressed, and that expanding services are prioritised.

RCGP chair Professor Helen Stokes-Lampard said: ‘GPs and our teams should treat our trans patients on the basis of need and without bias, as we would any patient.

‘This includes being mindful of the terminology and language we use when talking to our trans patients, based on each patient’s individual preference. It sounds simple, but there are barriers to this, not least with our current NHS IT systems that only allow us to record a patient’s gender in a binary way.

‘As well as unintended misunderstandings and the apparent lack of respect that can result from this, it also has serious health implications, for example, around referring trans patients for appropriate screening.’

She added: ‘This is an important area of medicine, and one for which GPs need greater clarity from regulators on where they stand.

‘There is also a distinct lack of high-quality research in the area, and a lack of reputable clinical guidance available – particularly in respect to gender-questioning children – and addressing this must be a priority.’

The position statement recognises that as GPs aren’t trained in treating patients with gender dysphoria and trans health issues, treatment should be initiated in specialist care – but acknowledges that NHS gender identity services are under severe strain.

GICs in England have seen a 240% increase in referrals over five years, and last year the average waiting time for an initial appointment at a GIC was 18 months, although the maximum waiting time for an initial specialist appointment following referral is identified under the NHS Constitution for England as 18 weeks. 

A trans health model is currently being trialled in Manchester, where GPs work with GICs to improve their diagnostic skills.

Additionally, the RCGP is due to launch an e-learning course on gender variance later this year, while the Royal College of Physicians and NHS England are developing a postgraduate diploma in Gender Identity Healthcare Practice. 

However, the RCGP got rid of their online course on gender dysphoria last December, following GPs’ concerns that they are being expected to prescribe outside of their clinical competence.