NHS England has been responsible for commissioning of gender identity services in England since 2013.

However, there continues to be a lack of specialist service provision in England for this group of patients, which both impacts on patients and is putting practices under pressure.

Access to these specialist services should be rapid in order to ensure patients receive safe care - and if timely access at a GIC (Gender Identity Clinic) is not possible - additional intermediate capacity has to be commissioned locally to ensure safe and effective care pending specialist involvement.

NHS England has so far neglected to commission comprehensive, local, quality controlled specialist services for the ongoing care of patients once they have been discharged from the GIC, which we believe is vital to ensure patient safety. NHS England, as a public body, should consider its duties under the Equality Act 2010 and provide proper services to patients with gender incongruence.

NHS England’s guidance advises that when clinical responsibility for prescribing is transferred to general practice, it is important that the GP is confident to prescribe the necessary medicines. This should be done under a ‘shared care agreement’, which is voluntary, subject to a self-assessment of personal competence, and requires the agreement of all parties, including the patient. Using share care agreements will also necessitate NHS England in arranging additional local services to meet the prescribing and related needs for the patients of those GPs not commissioned to provide these services.

We have had reports of some GICs asking GPs to do extensive reviews of patients who had already been referred to the GIC, due to long waiting times. This work is not part of GMS services; it is the responsibility of GICs to manage their waiting lists, which should be funded similarly to other local pathways for support. This is another example of the urgent need for commissioning of GID services.

We continue to call for NHS England for the development of national guidelines and properly commissioned services for this particular group.

We have also written to NHSE/I on a number of occasions since 2018, highlighting the urgent need to put arrangements in place for prescribing for patients with gender dysphoria. 

Following our recommendations made in response to the 2018 consultation, we ask that enhanced services for prescribing under shared care arrangements should be put in place, until the service is recommissioned.