GPs taken out of day job to work in ‘gender dysphoria’ clinics
Family doctors are being put in charge of local NHS gender services, as specialist clinics become overwhelmed.
GPs will carry out assessments, recommend hormone treatment and make referrals for gender reassignment surgery - prompting concern that they will be drawn away from where they are most needed.
Health officials have set up new schemes, deploying GPs to take on work previously done by specialist clinics, as they warn that the current system cannot keep up with demand.
Pressure groups raised concern that responsibility for life-changing decisions was being handed to those with inadequate specialist knowledge, with one likening the pilot schemes to “the Wild West”.
In one pilot scheme, which has just been launched across Sussex, family doctors and nurses will be asked to carry out specialist assessments of adults with concerns around “gender dysphoria”.
Under their new roles GPs will take decisions about whether patients should be prescribed hormone therapy, voice coaching to “feminise” or “masculinise” their voices or be referred for gender reassignment surgery.
Those running the service, which has just begun taking patients, said all staff will be given specialist training from a centre for transgender health care in Nottingham, with which it has been paired.
It is one of five pilot schemes commissioned by NHS England which will mean those aged 17 and over who are considering medical treatment to change gender will receive consultations from GPs and staff working in sexual health services.
The moves come despite a national shortage of GPs, with a shortfall of more than 4,000 family doctors.
GP Louise Irvine, from the Clinical Advisory Network on Sex and Gender, said: “This will take GPs away from where they are desperately needed in general practice, which is suffering from a shortage of GPs. It also suggests the GPs who would staff these services would have a shorter training than the gender specialists, in order to have them available as soon as possible.”
She said giving GPs responsibility for assessment, hormone prescribing and referral for surgery was “the wrong approach” to address shortages of specialists.
“This is not part of core GP training and the training to be a gender specialist should be no less stringent and thorough than for specialist consultants,” she said.
‘Experts of their own experience’
The doctor said GPs were being expected to deliver services without a clear evidence base or rationale.
One NHS pilot scheme staffed by GPs describes itself as “trans and non-binary led” describing trans and non-binary people as “the experts of their own experience”.
In documents seen by The Telegraph, health officials suggest that the controversial shift is necessary because existing specialist clinics cannot cope with demand.
In the past decade, the number of referrals to adult gender dysphoria clinics has risen by 280 per cent, the report by NHS England warns, highlighting average waits of three years for a first appointment, and a risk of harm to those facing such delays.
“Based on waiting times and workforce shortages, there are concerns that the historical gender dysphoria clinic model is not sustainable in its current form,” it says.
“NHS England has established five new pilot services, testing how gender dysphoria healthcare delivered by gender dysphoria clinics could be delivered in other settings, such as primary care and sexual health clinics.”
The document, dated March 2023, warned that 28,000 people are waiting for a first appointment at a gender dysphoria clinic, including 1,100 in Sussex.
A report by Sussex Partnership NHS Foundation Trust, presented to council officials in Brighton and Hove, described how its pilot scheme will have GPs from Sussex as “core members of the clinical team” with nurses, speech and language therapists and psychologists also recruited and trained.
Surgical interventions
“The pilot will provide onward care as appropriate, including making referrals for surgical interventions,” it says, while the service will directly deliver “specialist endocrinology [hormone] services, speech and language/voice coaching and gender-specific psychological support.”
GPs working for the gender service will be asked to provide specialist assessments, and to make recommendations so patients seeking to change gender can be prescribed hormone treatment, such as testosterone or oestrogen.
While each of the five pilot schemes is different, most rely heavily on GPs.
The East of England has created a “GP-led” pilot, while Indigo Gender Service in Greater Manchester is based in primary care, and staffed by GPs, while describing itself as “trans and non-binary led”.
“We know that trans and non-binary people are the experts of their own experience, and that is why this service has been developed by and for trans communities. Our services are trans and non-binary led, with trans and non-binary people guiding and feeding into them at all levels,” the service states. The Cheshire and Merseyside Adult Gender Identity Collaborative is run by primary care and sexual health services. Another scheme, TransPlus, the first integrated Gender, Sexual, Health and HIV service, has been commissioned on a long-term basis, following a pilot phase.
NHS England has said the models may be rolled out more widely, depending on the success of the two-year pilots, which may be extended.
Complex area of healthcare
A spokesman from Sussex Partnership NHS Foundation Trust said: “We are continuing to develop the Sussex Gender Service, which is a pilot service, and are working to ensure the service is staffed by professionals who are highly skilled in this complex area of healthcare.
“All vacant posts at the service are now recruited to, and most staff have received initial training. Staff who will form the pilot service continue to receive specialist training and supervision in gender healthcare from the Nottingham Centre for Transgender Healthcare - our link gender identity clinic. Our clinicians will also complete the Royal College of Physicians Gender Identity Healthcare Credentials course.”
Stephanie Davies Arai, founder and director of Transgender Trend, an organisation calling for evidence-based health care, said: “We have great concerns about these pilot clinics - they’re like the Wild West.”
“My concern is that these people are not really clinically qualified to make these diagnoses,” she said, warning of a lack of scrutiny of adult services which take cases from the age of 17.
She raised concerns that some of the schemes gave too much authority to those from the trans community, rather than to those taking an independent view.
“Where you’re getting people with so called ‘lived experience’ running the clinics or being heavily involved in these clinics, and nobody dare say anything against that, that deeply concerns me,” she said.
It comes after the NHS announced that it will no longer prescribe puberty blockers to children, outside of clinical trials, in a landmark decision.
It follows a decision last year to close the Tavistock child gender identity clinic, after a review found that it was “not safe”.
Guidance issued by the British Medical Association in October says that GPs should “understand gender incongruence and the issues involved to ensure quality care is provided”.
However, it says: “We need to balance what can be expected of GPs and the expertise which should rightly remain with specialist services”.
Earlier guidance from the Royal College of GPs stresses that “gender dysphoria and gender identity issues are not part of the GP curriculum or GP speciality training.
“GPs are currently required to refer patients experiencing gender dysphoria to gender identity specialists for further assessment and treatment advice.”
An NHS spokesman said: “While GPs will continue to focus on delivering a record number of routine appointments, a small number of primary care services alongside sexual health clinics will run gender dysphoria clinics, with staff in those services receiving specialist training from the Royal College of Physicians.”
