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Unacceptable waiting list - The Independent

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Unacceptable waiting list - The Independent

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‘Unacceptable’ waiting list of up to eight years for NHS gender care, reveals health secretary

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‘Unacceptable’ waiting list of up to eight years for NHS gender care, reveals health secretary - Exclusive: ‘This breaks my heart,’ says minister Wes Streeting as waiting list tops 42,000

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NHS England guidance for GPs on use of puberty suppressing hormones 

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NHS England guidance for GPs on use of puberty suppressing hormones 

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Cancer care: addressing inequalities for the trans community

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Cancer care: addressing inequalities for the trans community

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Cancer care: addressing inequalities for the trans community | RCN Magazine | Royal College of Nursing

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Senior research nurse Mo Ibrahim reflects on the cancer care barriers trans people are facing and what’s needed to provide truly inclusive care

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Includes information about waiting times for first appointments.

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The Leeds Gender Identity Service offers assessment and support to people aged 17 and above with Gender Dysphoria.

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Leeds GIS Information re bridging prescriptions 

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Leeds GIS Information re bridging prescriptions 

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HWY Magazine Introduction to our gender healthcare project

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HWY Magazine Introduction to our gender healthcare project

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Gendered Intelligence - Maximising trans inclusion after the Supreme Court judgment

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Gendered Intelligence - Maximising trans inclusion after the Supreme Court judgment

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Version 1.1 - 21st May 2025

This guide is for organisations and professionals who wish to know what the impact of the recent Supreme Court Judgment (and any subsequent changes to statutory guidance and regulatory changes) will mean for their trans inclusive practices and their trans employees and service users.

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Maximising trans inclusion after the Supreme Court Judgment

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How to maximise your trans and non-binary inclusion in light of the For Women Scotland v Scottish Government Supreme Court Judgment

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BMA Guidance - Gender incongruence in primary care

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BMA Guidance - Gender incongruence in primary care

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The British Medical Association is the trade union and professional body for doctors in the UK.

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​GPs should understand gender incongruence and the issues involved to ensure quality care is provided. However, we also need to balance what can be expected of GPs and the expertise which should rightly remain with specialist services.

This guidance aims to explain what should be provided in primary care and to highlight some of the underpinning ethical and legal considerations.

It is not exhaustive and we encourage practices to refer to the information referenced throughout. We also recommend to read it in conjunction with our guidance on inclusive care of trans and non-binary patients.

Background and terminology

The prevalence of gender dysphoria (or incongruence) is difficult to determine and is still being underestimated. The Gender Identity Research and Education Society suggest that about 1% of the population may experience some degree of gender incongruence.

Gender dysphoria can lead to mental ill health and can severely affect individuals' quality of life. It is important that assessment and, where necessary, treatment is available.

The terminology used in this area is complex, changing, and can cause distress if not used appropriately:

transgender (or trans) is an umbrella term to describe people whose gender identity is not the same as, or does not sit comfortably with, the sex they were assigned at birth

gender incongruence is defined in ICD-11 (International Statistical Classification of Diseases and Related Health Problems) as being characterised by a marked and persistent incongruence between an individual's experienced gender and the assigned sex

gender dysphoria refers to the psychological and physiological discomfort or distress caused by a discrepancy between a person's gender identity, their sex assigned at birth, and their primary/secondary sex characteristics.

Using pronouns

We all have pronouns. The most common ones are 'she', 'her' and 'hers' or 'he', 'him,' 'his'.

Some people prefer gender-neutral pronouns, like 'they', 'them,' and 'theirs'. Some people will use different pronouns at different times. Changing pronouns can be an important part of transition.

Using the wrong pronoun for someone is known as misgendering. This can make people feel invalidated or disrespected, particularly if it occurs repeatedly.

The most straightforward way to determine pronouns is to ask "what are your preferred pronouns"? If you make a mistake, apologise and carry on.

Tips on managing patients with gender incongruence

1. Be mindful of the sensitivity of their condition and of how difficult it might have been for your patient to seek treatment.

2. Be particularly mindful of medical confidentiality, when addressing your patient in person and in written correspondence.

3. Avoid misattributing commonplace health problems to gender.

4. Assist those patients who wish to change their personal details on their practice medical record.

5. Inform your patient of any gender-specific disease prevention and organ screening programmes, including offering information on how to opt out.

6. Discuss any future family plans and fertility treatments options.

7. Refer early to a reputable NHS GIC (gender identity clinic).

8. Get informed about prescribing medicines that you are not normally familiar with.

Prescribing for the treatment of gender incongruence

We are aware that GPs are sometimes asked to prescribe hormones for patients with gender incongruence both before and after specialist involvement.

NHS England guidance encourages GPs to collaborate with GICs in the initiation and on-going prescribing of hormone therapy.

The BMA continues to engage with the GMC on issues relating to prescribing and ongoing care arrangements to seek clarification on its guidance.

Bridging prescriptions

The Royal College of Psychiatrists suggests that GPs may prescribe a bridging prescription to cover the patient's care until they are able to access specialist services. The GMC advises that GPs should only consider a bridging prescription when:

the patient is already self-prescribing, or seems highly likely to self-prescribe, with hormones obtained from an unregulated source (online or otherwise on the black market)

the bridging prescription is intended to mitigate a risk of self-harm or suicide, and

the doctor has sought the advice of a gender specialist and prescribes the lowest acceptable dose in the circumstances.

Collaboration with gender specialists

The GMC advice states that GPs must co-operate with gender identity clinics and specialists to provide effective and timely treatment for trans and non-binary people.

NHS England's guidance states that when clinical responsibility for prescribing is transferred to general practice, it is important that the GP is confident to prescribe the necessary medicines.

In our view, this advice reaffirms that GPs should approach shared care and collaboration with gender identity specialists in the same way as they would any other specialist.

It is important that GPs feel clinically competent to prescribe the necessary medicines in order to provide the most appropriate level of care to the patient.

NHS England - guidance on responsibility of prescribing between primary and secondary/tertiary care

Commissioning of services

GPC England statement on commissioning of gender identity services in England

Our current position on the commissioning of gender identity services and gender identity clinics in England.

In England, NHS GICs are commissioned by NHS England and NHS Improvement.

These clinics provide patients with access to a multidisciplinary team and will accept referrals from primary or secondary care. There is no need for the patient to be assessed by mental health services prior to referral, and GPs do not need prior approval from their CCG/ICS (Clinical Commissioning Group/Integrated Care System).

We have concerns about the lack of specialist service provision, the impact this has on patients and the pressure it can have on practices.

In our view, patients require a holistic approach; their psychological needs should be treated as well as their physical response to treatment.

Service provision from GIC clinics

There have been reports of some GICs asking GPs to review patients who had already been referred to the GIC, due to long waiting times.

It is the responsibility of GICs to manage their waiting lists - not practices - and they should be approaching patients directly to explore whether they still want access to their services.

Disclosures of information

The Gender Recognition Act 2004 provides safeguards for the privacy of individuals with gender dysphoria and restricts the disclosure of certain information.

The Act makes it an offence to disclose 'protected information' (ie a person's gender history after that person has changed gender under the Act) when that information is acquired in an official capacity.

Primary Care Support England guidance sets out the steps involved in changing the patient's name and gender on the patient record.

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​GPs should understand gender incongruence and the issues involved to ensure quality care is provided. However, we also need to balance what can be expected of GPs and the expertise which should rightly remain with specialist services. This guidance aims to explain what should be provided in primary care and to highlight some of the underpinning ethical and legal considerations.

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Transactual - Information on bridging prescriptions

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Transactual - Information on bridging prescriptions

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A bridging prescription is a temporary prescription of hormone replacement therapy (HRT), typically oestrogen or testosterone, issued by a GP to a patient who is waiting for specialist treatment, usually at a gender dysphoria clinic (GDC, previously called the Gender Identity Clinic or GIC).

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Independent review of data, statistics and research on sex and gender

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Independent review of data, statistics and research on sex and gender

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Department for Science, Innovation and Technology

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Independent review of data, statistics and research on sex and gender

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An independent review by Professor Alice Sullivan that looks at data, statistics and research on sex and gender.

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Failure to accurately record biological sex harms all

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Failure to accurately record biological sex harms all

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The Observer view on gender data: failure to accurately record biological sex harms us all | Observer editorial

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A report lays bare the extent of real-world detriment caused by institutions that have caved in to activist pressures

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Cancer screenings missed because of how data is collected

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Cancer screenings missed because of how data is collected

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Aoife WalshBBC NewsEuan O’Byrne MulliganBBC News

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Public data should not conflate sex and gender, review says

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Author of government-ordered review says biological sex and gender have become distinct and should be recorded separately.

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Gender questioning children: a summary of the legal position for schools

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Gender questioning children: a summary of the legal position for schools

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Gender questioning children: a summary of the legal position for schools

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An outline of legal challenges for schools regarding gender questioning children, recent government guidance, and the Equality Act’s implications.

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Your browser is out of date. Update your browser to view this site properly.Click here for more information

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NHS failure to reliably record sex puts patients at risk

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NHS failure to reliably record sex puts patients at risk

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How to find an NHS gender dysphoria clinic

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How to find an NHS gender dysphoria clinic

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Trans and non-binary people's general health needs are the same as anyone else's. But trans people may have specific health needs in relation to gender dysphoria.
Your particular needs may be best addressed by transgender health services offered by NHS gender dysphoria clinics (GDCs).

All NHS GDCs are commissioned by NHS England, who set the service specifications for how they work.

A GP or another health professional can refer you directly to one of the 8 GDCs. You do not need an assessment by a mental health service first. Neither does the GP need prior approval from their Clinical Commissioning Group (CCG).

The websites of the clinics listed on this page also have useful information for you to think about before you see a GP.

Gender dysphoria clinics in London and the southeast
The Tavistock and Portman NHS Foundation Trust: Gender Dysphoria Clinic for Adults
Lief House
3 Sumpter House
Finchley Road
London
NW3 5HR

Phone: 020 8938 7590

Email: gic@nhs.net

The GDC website has an overview of information useful for anyone with gender identity needs, not just those in the area.
The Tavistock and Portman NHS Foundation Trust Gender Identity Development Service (GIDS) for children and young people
GIDS
The Tavistock Centre
120 Belsize Lane
London
NW3 5BA

Phone: 020 8938 2030

Email: gids@tavi-port.nhs.uk

GIDS also has a clinic in Leeds, which is for people from northern regions of England:

8 Park Square
Leeds
LS1 2LH

Phone: 0113 247 1955

The Gender Identity Development Service website includes information about the services they offer young people (up to the age of 18). They help those who are experiencing difficulties in the development of their gender identity, and their families.

Gender dysphoria clinics in the north
Sheffield Health and Social Care NHS Foundation Trust Gender Dysphoria Service
Porterbrook Clinic
Michael Carlisle Centre
75 Osborne Road
Sheffield
S11 9BF

Phone: 0114 271 6671

Email: porterbrook@shsc.nhs.uk

The Sheffield clinic's website includes information about referrals, clinic opening hours and links to eligibility criteria.
Leeds and York Partnership NHS Foundation Trust Gender Dysphoria Service
Management Suite
1st Floor
The Newsam Centre
Seacroft Hospital
York Road
Leeds
LS14 6WB

Phone: 0113 855 6346

Email: gid.lypft@nhs.net

The Leeds clinic's website covers referrals, commonly used medicines and information on the clinic's Gender Outreach workers.
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust Northern Region Gender Dysphoria Service
Benfield House
Walkergate Park
Benfield Road
Newcastle
NE6 4PF

Phone: 0191 287 6130

Email: NRGDS@cntw.nhs.uk

The Northern Region Gender Dysphoria Service website has a range of leaflets, including information about referral, hormones and support groups.

Gender dysphoria clinics in the Midlands
Northamptonshire Healthcare NHS Foundation Trust Gender Dysphoria Clinic
Danetre Hospital
H Block
London Road
Daventry
Northamptonshire
NN11 4DY

Phone: 01327 708147

Email: genderclinic@nhft.nhs.uk

Visit the Northampton clinic's website for more information about how to get a referral and the role of the GP.
Nottinghamshire Healthcare NHS Foundation Trust The Nottingham Centre for Transgender Health
12 Broad Street
Nottingham
NG1 3AL

Phone: 0115 876 0160

Email: NCTHGeneral@nottshc.nhs.uk

Visit The Nottingham Centre for Transgender Health website for more information about how to get a referral.

Gender dysphoria clinics in the southwest
Devon Partnership NHS Trust West of England Specialist Gender Dysphoria Clinic
The Laurels
11-15 Dix's Field
Exeter
EX1 1QA

Phone: 01392 677 077

Email: dpn-tr.thelaurels@nhs.net

The Laurels' website has information about the types of services on offer and the help available during transition.

New gender dysphoria services in 2020

In 2020 new NHS gender dysphoria services for adults will open in Greater Manchester, London and Merseyside.

These services will be delivered by healthcare professionals with specialist skills and based in local NHS areas, such as sexual health services. Full details will be available once each service is opened.

Initially, access to these services will be available to people who are already on a waiting list to be seen at one of the established gender dysphoria clinics.

NHS England will assess how useful these new pilot services are.

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How to find an NHS gender dysphoria clinic

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Trans and non-binary people's general health needs are the same as anyone else's. But trans people may have specific health needs in relation to gender dysphoria. Your particular needs may be best addressed by transgender health services offered by NHS gender dysphoria clinics (GDCs).

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If you are LGBTQ+, it’s just as important for you as for anyone else to use NHS services to keep yourself healthy.

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MORE INFO?

Whilst our work is continuing in this area, we are keen to promote and share documents and resources that may be of interest.

Do you want to gain a basic understanding of trans people and their needs, then click on the image link below to open up an informative guide.

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Find support and resources for transgender and non-binary individuals at York LGBT Forum. Join our support group and connect with a community dedicated to promoting inclusivity and understanding.

# data[].attributes.body
Generate is a small, grass-roots charity organisation based in York, serving the population of North Yorkshire. We are a peer-led, therapeutic organisation, providing support for all members of the transgender, non-binary, gender questioning, and gender diverse community.

# data[].attributes.attachment_link.description
Generate is a small, grass-roots charity organisation based in York, serving the population of North Yorkshire. We are a peer-led, therapeutic organisation,

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Trans and non-binary mental health support

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Trans and non-binary mental health support

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Trans and non-binary mental health - Mind

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Some things you may go through as a trans or non-binary person can affect your mental health – such as transphobia and exclusion from healthcare. Find out more.

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Legislation is available in different versions:

Latest Available (revised): The latest available updated version of the legislation incorporating changes made by subsequent legislation and applied by our editorial team. Changes we have not yet applied to the text, can be found in the 'Changes to Legislation' area.

Original (As Enacted or Made): The original version of the legislation as it stood when it was enacted or made. No changes have been applied to the text.

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Latest Available (revised): The latest available updated version of the legislation incorporating changes made by subsequent legislation and applied by our editorial team. Changes we have not yet applied to the text, can be found in the 'Changes to Legislation' area.

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NHS England Gender dysphoria service specifications

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NHS England Gender dysphoria service specifications

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Gender Recognition Act Reform: Consultation and Outcome

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Gender Recognition Act Reform: Consultation and Outcome

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Dr Hilary Cass has submitted her final report and recommendations to NHS England in her role as Chair of the Independent Review of gender identity services for children and young people.

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BMA to undertake evidence-led evaluation of the Cass Review

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The BMA believes it is clinicians, patients, and families who should be at the centre of an evidence-based decision-making process about their health, not politicians

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Royal College of Psychiatrists response to Cass Review

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Royal College of Psychiatrists response to Cass Review

# data[].attributes.attachment_link.title
Detailed response to The Cass Review's Final Report

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The College has published a more detailed response to the independent review of gender identity services for children and young people, commissioned by NHS England and chaired by Dr Hilary Cass OBE.

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In response to the National LGBT survey, this LGBT Action Plan outlines firm commitments to tackle some of the biggest issues facing LGBT people.

Documents

Ref: ISBN 978-1-78655-660-8 PDF, 2.06 MB, 32 pages

Details

In July 2017, the Government launched a national survey of LGBT people. The survey was open to anyone who identified as having a minority sexual orientation, gender identity or had variations in sex characteristics. It asked questions about people's experiences of living in the UK and in accessing public services. We asked questions about education, healthcare, personal safety and employment.

The survey received more than 108,000 responses, making it the largest national survey of its kind anywhere in the world. This response was unprecedented, and it was a significant undertaking to analyse the results. We have now published the results from the national LGBT survey in the form of a research report and a summary report, and we hope that the findings will be a valuable resource, not only for government, but also for everyone working to support LGBT people.

The Government is committed to taking bold action on the results of the survey. This 'LGBT Action Plan' explains how we will advance the rights of LGBT people both at home and abroad, and improve the way that public services work for them. Our vision is for everyone, regardless of their sexual orientation, gender identity or sex characteristics, to be able to live safe, happy and healthy lives where they can be themselves without fear of discrimination.

Thank you for your feedback

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LGBT Action Plan 2018: Improving the lives of Lesbian, Gay, Bisexual and Transgender people

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HWE Report: Trans and non binary people face hurdles at every stage of primary care

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HWE Report: Trans and non binary people face hurdles at every stage of primary care

# data[].attributes.body
Published 25th July 2025

# data[].attributes.attachment_link.title
Trans and non-binary people face hurdles at every stage of primary care

# data[].attributes.attachment_link.description
Our self-selecting survey of nearly 1,400 trans and non-binary adults highlights that only 53% rate their GP practice as good for general care.

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Published 11th March 2020

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Story shared with Healthwatch Derbyshire.

# data[].attributes.attachment_link.title
Trans healthcare: What can we learn from people’s experiences?

# data[].attributes.attachment_link.description
We examine what the NHS can do to improve health support for the trans community.

# data[].attributes.attachment_link.provider_name
The British Medical Association is the trade union and professional body for doctors in the UK.

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Introduction

It is important that all groups within the patient population have access to appropriate, timely, high quality healthcare. We acknowledge that many trans and non-binary patients have had negative experiences of accessing healthcare in the past and continue to do so.

The National LGBT survey 2018 captured data about people's experiences of healthcare.

40% of trans respondents who had accessed or tried to access public healthcare services reported having experienced at least one of a range of negative experiences because of their gender identity in the 12 months preceding the survey.

21% of trans respondents reported that their specific needs had been ignored or not taken into account, and

18% had avoided treatment for fear of a negative reaction.

Addressing these concerns is critical to providing high quality care and reducing health inequalities, as well as to ensure an inclusive healthcare system free from discrimination.

Outside of trans-related care such as gender clinics, trans and non-binary patients have the same healthcare needs as other patients. It is therefore likely that all doctors will provide care to someone in this group of patients at some stage. An understanding of the issues involved is necessary to ensure high quality general medical care is provided and, where necessary, appropriate referrals are made to specialist services. We also urge all doctors to take advantage of opportunities for continued professional development to advance their understanding of best practice in working with trans and non-binary patients.

The advice contained here is not intended to be exhaustive. There are a number of complex issues relating to care provision that need to be resolved. The BMA will continue to press for adequately resourced services to support patients seeking treatment for gender dysphoria.

We would encourage doctors and patients to refer to the sources of additional information and guidance that are referenced throughout the full guidance document.

Terminology

The terminology used in this area is complex, changing, and can cause distress if not used appropriately. Doctors and medical students are encouraged to respect and reflect the language choices that an individual patient uses to describe their own identity.

Transgender (trans)

Transgender and trans are umbrella terms to describe people whose gender identity is not the same as, or does not sit comfortably with, the sex they were assigned at birth. Trans people may describe themselves using one or more of a wide variety of terms.

Transsexual

The term 'transsexual' was used in the past as a diagnostic term and in legislation; it is still used by some people to describe themselves, although many people prefer other terms such as trans or transgender.

Non-Binary

The spectrum of gender identities or expressions that fall outside the historically typical gender binary (masculine and feminine). This includes those who do not identify as either a man or a woman and those who are gender-fluid (gender identity/expression changes over time or in different contexts) or agender (do not define themselves as having any particular gender identity).

Gender identity

Every individual's personal, internal sense of their own gender.

Gender expression/presentation

The way in which a person expresses their gender identity, typically through appearance, clothing, and behaviour.

Gender incongruence

Discrepancy between a person's gender identity, their sex assigned at birth, and their primary/secondary sex characteristics. Gender incongruence is now a specific diagnostic term in ICD-11. Further information is available here.

Gender dysphoria

Psychological and physiological discomfort or distress that is caused by a discrepancy between a person's gender identity, their sex assigned at birth, and their primary/secondary sex characteristics. Gender dysphoria is not in and of itself classified as a mental illness. Untreated, gender dysphoria can severely affect the individual's quality of life and potentially lead to mental ill health such as depression or anxiety.

Transition

Many trans people change their gender expression to bring it into alignment with their gender identity (which may include non-binary identities). This process is known as "transition". Transitioning is a process and may include physical, psychological, social, and emotional changes. It may also (but does not necessarily) involve various types of medical treatment, to bring a person's physical characteristics more into conformity with their gender identity and expression. Some transgender and non-binary people have little or no desire to undergo surgery to change their body but will transition in other ways.

Retransitioning/detransitioning

In a small number of cases, people may decide not to continue transition. Detransitioning (or retransitioning, which is increasingly the preferred team) is a process of stopping or reversing the decision to transition. While this may be associated with regret, a person's individual reasons for retransitioning are likely to be more be complex and nuanced.

They may no longer identify as trans or they no longer identify with a gender they previously identified with.

People may also have found the process of transitioning too difficult, or experienced a lack of support or rejection from people close to them.

Some people may have concerns about the long-term impacts of medical interventions that supported their transition.

Some people may choose to pause, rather than reverse, the transition process, and some people who retransition may decide to transition again at a later point.

Some older trans people may retransition because they are concerned that they may not receive appropriate support in care settings or for end of life care.

Providing inclusive support for all trans- and non-binary patients

The BMA affirms the rights of all transgender and non-binary individuals to access healthcare and live their lives with dignity, including having their identity respected. Doctors should work collaboratively with their trans and non-binary patients as they do with any patient: in a respectful, open and sensitive way, free from discrimination or bias.

Doctors should be aware that not all transgender and non-binary patients will experience dysphoria or distress due to their gender identity, and should avoid automatically attributing particular health concerns or conditions to a patient's gender identity. Trans and non-binary people, as a broad group, experience relatively poorer access to health services compared to other groups within the population. Inequitable access can result in trans and non-binary people receiving less care relative to their needs, or sub-optimal care, which can lead to poorer experiences and overall health outcomes.

The following sections cover topics of relevance to the management of all trans and non-binary patients regardless of whether they are seeking treatment for gender dysphoria.

Core principles of supportive care for transgender and non-binary patients

WPATH (The World Professional Association for Transgender Health) sets out broad principles for supportive care of transgender and non-binary patients, including:

exhibit respect for patients with non-conforming gender identities

provide care (or refer to knowledgeable colleagues) that affirms patients' gender identities and reduces the distress of gender dysphoria

become knowledgeable about the possible health care needs of transgender and non-binary people in general, including the potential benefits and risks of treatment options for gender dysphoria

match treatment approaches to the specific needs of patients

facilitate access to appropriate care and offer continuity of care

seek patients' informed consent before providing treatment and involve them in decision-making.

Demonstrating a trans-inclusive approach

Forms of address

It is important that individual preference should be respected. Doctors, medical students and other health care workers, and non-clinical staff, should address transgender and non-binary patients as they would prefer to be addressed. This is not dependent on any official name change. If in doubt, an opportunity should be found to discreetly ask the individual which form of address they prefer, and how they see their own gender identity. One way to do this would be to ask about someone what pronouns they use (see below).

Written correspondence should take into account the fact that others in the household may be unaware of the individual's gender circumstances so preferences for written communication should also be asked about and documented. Doctors may for example wish to address written correspondence using an initial and surname, rather than using gendered titles such as Mr or Mrs.

Training and awareness

All healthcare workers should receive training in trans and non-binary awareness as part of their education and training and should seek awareness raising activities as part of their own professional development. The BMA will continue to lobby the Medical Schools Council and Royal Colleges to ensure that trans awareness is part of both undergraduate and postgraduate training.

In addition, all healthcare organisations should ensure their staff undertake training on trans and non-binary awareness alongside other training on inclusivity and respect. All healthcare workers and staff should respect the dignity of patients with respect to pronouns and gender-markers on any communication with the patient, including face-to-face interactions.

Healthcare workers and staff should be aware that a person's outward appearance may not correspond to their gender identity and will need to be sensitive and interact with patients in a way that demonstrates an understanding that gender identity is not based on appearance. Similarly, when using telemedicine, healthcare workers and staff should avoid making assumptions about a person's gender identity based on their voice, for example assuming that a person with a deep voice identifies as a man.

Changing medical records

Sometimes doctors are asked by transgender patients to change their name and/or gender on the medical record. Patients have the right to change the name and gender on the medical record irrespective of whether they intend to obtain a Gender Recognition Certificate. Healthcare workers should follow the advice outlined in the GMC's advice to ensure patients' rights are respected in this area and that they are properly informed of what documentation, if any, is needed to make changes.

When a patient informs the practice that they wish to change gender, the practice should inform the patient that this will involve a new NHS number being issued for them, which is not reversible. If the patient wanted to change their gender marker back to the gender they were assigned at birth, or to a different gender, patients would receive a third NHS number. All previous medical information relating to the patient needs to be transferred into a new created medical record and the patient registered as a new patient at the practice. How to do this varies slightly between nations in the UK where health is devolved - MDDUS provides additional information.

Propagating changes like this through the NHS records systems across multiple organisations can take a long time and the doctor and the patient will need to be aware that "the system" may still produce documents and letters with their previous name and gender on them for some time. If this happens, staff should apologise to the patient and have records and systems updated again to try to minimise recurrence.

Disclosure of information and medical records

A person's gender history should not be divulged to anyone without their consent. Care needs to be taken around communications such as referrals to ensure that information that is relevant to the patient's ongoing care is retained, but that information that may reveal gender history and which is not of relevance to the current medical situation is not disclosed.

A patient's gender history can be revealed in ways other than explicitly stating that a person is trans or non-binary. For example, listing certain operations they have previously had that doesn't match their current gender might make the patient's gender history clear to the reader; for example, either gender confirming surgery, or sex-specific surgery such as colposcopy or prostate surgery. Care must be taken when processing documentation where computer systems can populate sections of forms with such data automatically.

The Gender Recognition Act 2004 provides safeguards for the privacy of transgender individuals and restricts the disclosure of certain information. The Act makes it an offence to disclose 'protected information' (i.e. a person's gender history after that person has changed gender under the Act) when that information is acquired in an official capacity. Patients who are undergoing the transition process are also entitled to the same protection against disclosure of their gender history.

This means that the 'protected information' can only be disclosed in healthcare settings when:

it is to another health professional; and

it is for a medical purpose; and

there is a reasonable belief that the patient has consented to the disclosure.

Information obtained in the course of providing healthcare would usually be considered as acquired in an official capacity and therefore inappropriate disclosure would be an offence. Best practice would be to discuss with the patient why disclosure is considered necessary in a specific circumstance and to gain written consent from the patient to the disclosure of the information.

Continuity of care

Patients who have transitioned or are transitioning, or who are non-binary, may require or request access to medical services and treatments aligned with their registered sex at birth and/or former gender identity. It is important that doctors are able to provide general advice on these issues while respecting their patient's gender identity and their autonomy to make decisions about their own healthcare.

NHS Screening calls

Trans and non-binary patients may require access to disease prevention and organ specific screening programmes (such as cervical smears, breast screening or prostate examinations) which are habitually offered only to specific groups and which may not align with the patient's own gender identity.

Doctors should work with these patients to ensure that they understand any screening procedures they should continue to have. This may also include providing access to information on how patients may opt out of specific screening calls.

Prescribing

Doctors may be asked by trans and non-binary patients to support them in accessing hormone treatment either before they have received support from a gender specialist or with ongoing prescribing once they have been discharged from a specialist gender service:

Prescribing in this field is not part of the General Medical Services contract for GPs and prescribing in this field may be outside the competency of some GPs. Those GPs with relevant training and knowledge in this field may be able to support prescribing prior to, or in association with, specialist gender services.

Fertility care

Doctors who work with trans and non-binary patients who are considering surgery and/or endocrine treatments should work with those patients to explore whether they may wish to have biological children in the future and options to preserve this capacity, such as whether gamete storage might be considered.

The Human Fertilisation and Embryology Authority (HFEA) has useful information for trans and non-binary patients and their doctors on fertility and fertility treatment issues.

Retransitioning

Healthcare workers should avoid assuming that a decision to restransition/detransition is based on regret or that the person is no longer experiencing gender dysphoria. As with transition, patients who are retransitioning should be treated with empathy and their choices about their care should be respected.

Many of the practical processes involved in retransitioning will involve the same processes that were undertaken for transition; for example, establishing preferred pronouns or amending information on the medical record. Patients who are, or are considering, retransitioning may also benefit from specialist support, particularly if they have undertaken medical treatment as part of their original transition process.

Conclusion

All patients deserve respectful, supportive treatment in the healthcare system, both with their gender-related care and their medical care more generally. Doctors play a key role in demonstrating this and should be mindful of the lifelong need to provide sensitive care that recognises a patient's gender history where medically necessary, but which broadly and consistently treats the patient according to their wishes around their gender identity and expression.

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Inclusive care of trans and non-binary patients

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Introduction It is important that all groups within the patient population have access to appropriate, timely, high quality healthcare. We acknowledge that many trans and non-binary patients have had negative experiences of accessing healthcare in the past and continue to do so. The National LGBT survey 2018 captured data about people's experiences of healthcare.