Gender
Reassignment

A number of queries have been raised with GPC regarding the management of patients who present at their general practice with gender identity problems; including questions relating to patient records and confidentiality and, in particular, regarding prescribing and monitoring responsibilities in relation to the gender reassignment process.

Cambridgeshire LMC has reviewed the GMC Gender Dysphoria Guidance which was developed to assist Gender Identity Clinics and Primary Care Clinicians however we believe it to be inconsistent with other GMC principles in Good Medical Practice.

We support and have found helpful the NHS England Prescribing Guidance and the BMA Gender Incongruence in Primary Care.

 

Prescribing and Referral

Our advice to GPs is that they should only prescribe anything when they are familiar enough with the patient, problem, and medicine to know it is in the patients best interests.

GPs can be guided by advice from others however they must take responsibility for their own decision making regarding prescribing and shouldn’t feel that they have to do as another clinician asks.

It is important that GPs, when reviewing guidance of others should know something about them and only refer to those who are trusted.

Extract below from the BMA guidance which is in the link provided above:

Collaboration with a specialist and ongoing prescribing

The GMC advice states that “You must co-operate with GICs and gender specialists in the same way that you would co-operate with other specialists, collaborating with them to provide effective and timely treatment for trans and non-binary people. This includes prescribing medicines recommended by a gender specialist, following recommendations for safety and treatment monitoring, and making referrals as recommended by a specialist”.

The GPC states, in their 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. The advice should therefore be read in conjunction with the principles which underpin shared care as set out by the GMC in Good practice in prescribing and managing medicines and devices.

Participating in a shared care agreement is voluntary, subject to a self-assessment of personal competence, and requires the agreement of all parties, including the patient. This will necessitate NHS England arranging additional local services to meet the prescribing and related needs for the patients of those GPs not commissioned to provide these services.

 

Extract below from the BMA guidance which is in the link provided above:

Collaboration with a specialist and ongoing prescribing

The GMC advice states that “You must co-operate with GICs and gender specialists in the same way that you would co-operate with other specialists, collaborating with them to provide effective and timely treatment for trans and non-binary people. This includes prescribing medicines recommended by a gender specialist, following recommendations for safety and treatment monitoring, and making referrals as recommended by a specialist”.

The GPC states, in their 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. The advice should therefore be read in conjunction with the principles which underpin shared care as set out by the GMC in Good practice in prescribing and managing medicines and devices.

Participating in a shared care agreement is voluntary, subject to a self-assessment of personal competence, and requires the agreement of all parties, including the patient. This will necessitate NHS England arranging additional local services to meet the prescribing and related needs for the patients of those GPs not commissioned to provide these services.

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