GPs will be paid for trans hormone prescriptions - Sussex

@Faffertea
I'm sure you will continue to practice safely, but you say 'I’m aware of several colleagues who have had patients who’ve seen GenderGP have letters about prescribing hormones reminding them they can fall foul of GMC guidance on this in an attempt to coerce prescribing.' That's a pretty scary threat for a GP, isn't it?

As an aside I tried to refer this young person to CAMHS for psychological support and to explore things as they are very clearly questioning their whole identity and struggling with a lot of issues. CAMHD are swamped so the referral was rejected and I was directed to GIDS.

And from what we/tribunals have been told GIDS work on the assumption they have been seen and assessed by camhs before they see them so no point GIDS going over 'old ground' when they see them...

OFFS
I asked GP for HRT, told no then went private for first prescription, and got it, now waiting to see if GP will pick up the prescription request.

Why do women have to beg and fight for HRT, and these people get hormones with hardly a whimper from GP's

@Outofexcuses
I don’t actually know because no one has actually said what’s expected and the first I had heard about this new interim service was when I received the letter from GIDS. But that’s nothing new. I’ve got used to finding out what I’m supposed to be doing my reading it in the press. It’s par for the course for this government and their puppets in NHSE.
As for the GMC I can only assume they are captured given their previous guidance on this which is direct contradiction of their guidance in Good Medical Practice and against the usual practice for other drugs that need specialist initiation. I don’t start patients on other drugs that are beyond my competency to initiate just because the waiting lists are very long and despite the fact that the patient is suffering due to the waiting time.
I will continue to practice safely and hold the position that a failure to properly commission and fund a service does not make it a GP role to fill the gap. Patients deserve better.

@OldCrone

I agree and can only hope that the faith I have in my colleagues and what I’ve seen to date is correct and this will not be accepted.
As an aside I tried to refer this young person to CAMHS for psychological support and to explore things as they are very clearly questioning their whole identity and struggling with a lot of issues. CAMHD are swamped so the referral was rejected and I was directed to GIDS.

This person from Stonewall thinks that 2 1/2 hours is enough ‘training’ to make these GPs specialists?

Isn't that the type of course that Helen Webberley did to make her a specialist?

They plan to pay doctors for prescribing cross sex hormones while patients are still on the gender clinic waiting list, but say that this is not promoting the initiation of hormonal treatment. If they are still on the waiting list they have not started treatment, so they will be initiating the treatment, and surely a payment for doing so is promoting the treatment.

And interim care for those on the waiting list should be psychological support not irreversible physical treatment.

validate 1 to validate them

I forsee a new banner 'Validate 1 - Validate all'.

In baby blue and pretty pink of course. Because we are all toddlers.

Repeat after me...'Validate 1 - Validate all'.

[But not you trouble making witches.]

This man went through a lot of body modification procedures. How successful would you say his transition to become a cat was? Sadly it didn't seem to help his mental health either.

en.m.wikipedia.org/wiki/Stalking_Cat

@Faffertea
So from what you say, you are likely to see this 16 year old again and you will be expected to prescribe - what? Puberty blockers? Cross sex hormones? With only 2.5 hours specialist training?
This is unbelievably shocking - surely the GMC must see that?

Surely we want them to transition properly

What does 'transition properly' mean? A man will no more be a woman if he takes drugs and has extreme cosmetic surgery than if he simply puts on a gender-nonconforming item of clothing. You cannot change sex.

A few things to unpick here…

This is part of a move to try and set up services that are acting like satellite services for patients on GIDS waiting list.
Currently there is a referral form to complete for GIDS which asks questions about how and why someone wants to transition/identifies as transgender, what their mental health is like etc. It’s a pain in the arse to complete but is not (in my opinion) designed to be a thorough exploration of the patient’s situation and to be fair that’s not the point of a referral, that’s what GIDS should be doing.
Having recently (and unhappily because I have concerns about GIDS but can’t refuse because that’s the NHS pathway and a fear of being labelled transphobic if I speak up) referred a 16 year old teenager. I have had a reply telling me that there is a plan to set up this service starting in Spring 2022 because of how long the wait is and I may be asked to issue prescriptions. Ironically though they make it very clear that the patient will not be under GIDS clinical responsibility until physically seen.
To add some context to this a few years ago the GMC issued guidance to GPs about providing ‘bridging’ prescriptions for hormones to patients on GIDS waiting list which contradicts its own guidance about prescribing only within our own competence and many GPs were and are very unhappy about it. I’m aware of several colleagues who have had patients who’ve seen GenderGP have letters about prescribing hormones reminding them they can fall foul of GMC guidance on this in an attempt to coerce prescribing.

The funding thing is actually pretty standard. Funding for practices is really quite complicated. GP practices are paid a basic amount of money (around £99) per patient per year to provide all Primary Care services such as medication, appointments with doctors, nurses etc and to pay all the staff costs, utilities etc. Clearly that is not enough money so there is additional funding for non core services. For example, childhood vaccinations are non core, so if you do them you get paid etc. Lots of routine work is funded in this way. In addition to this there are other schemes that practices in some parts of the country are offered because there is a local need for it and practices sign up to offer this work for additional funding but have to demonstrate they have done the work in the contract.
The vast majority of GPs will not do something they think is not good for their patient just because they’ll get paid for it. The biggest worry here for me is that there will be those who will do it because they think they’re doing the right thing or because GIDS tells them it’s the right thing without being aware of the full issue.

I guess this is what happens when a religion decides their sacrement is a medication rather than a food.

If you want wine or little biccies, you can just get them from the supermarket, then do whatever you do to bless them, but hormones are a little trickier to source.

Although, got to be careful about for religious bits, as Glinner noted.

Sasha Misra, an associate director at Stonewall, said: “With enough capacity and training, schemes like this could ensure trans people can access the specialist care they need in their local community and without the lengthy wait.”

Truly, has this quote been taken out of context? This person from Stonewall thinks that 2 1/2 hours is enough ‘training’ to make these GPs specialists?

I am very concerned for GPs in this. I suspect they are going to get a raw deal. Just as the patient is.

‘Interim support’ with a financial incentive to prescribe hormones, and a yearly check up. Maybe who ever has felt this was a good idea could tell us what is reversible in females with testosterone treatment?

How can prescribing testosterone to females be consider ‘interim’!!!

I am continually astounded by the lack of awareness of just how the treatments are so much more harmful to females. But that is never publicised and never discussed and when directly asked of extreme trans activists, ignored everytime.

Even here on this thread we have some plop something down about men in dresses. Perish the thought they ever think about female transitioners at all!

"They will also be able to claim an extra £91 a year for providing an annual health check to a transgender, non-binary or intersex (TNBI) patient."

The inclusion of 'intersex' patients suggests ideological capture not clinical thinking. Patients with VSD would not be seen by gender clinics anyway they must be treated by specialists - I'm guessing genital-urinary medicine and endocrinologists. And given the complexity of conditions in VSD how would a 2 1/2 hour online course cover it?

And non-binary? What is that these days?

And why is the " treatment " exactly the same for a teenage female (18 is still a teen) and a middle aged male.

If 3 people had the exact same cancer, 1 may opt for surgery, one may opt for chemo and the other may choose to max put a credit card and take a trip around Europe instead of taking treatment. And none of the choices reflect on anyones different choice.

But here treatment is seen as validate 1 to validate them all despite being from different stages of their life and different sexes and different circumstances. Uts seen as a personal.atgack on all trans people of one person is denied or decides not to take medication.

but they are experimental with no long term study they are already linked to retardation of brain development and crumbling bones and teeth.

what happened to ethics?

I fee sorry for the GPs, instead of investing in more specialised help, the government have pushed it all onto the GP, who will have a 10 minute consultation to deal with the patient.

I can forsee absolutely nothing going wrong here, whatsoever.

It also sounds a bit like a "oh god we need to do something" panic - from central government? because of the upcoming conference? - and this is being abseiled in without keeping up to date with the tribunal and so on.

The GP rep sounds unconvinced/worried about it. If it's just one location (or a few GPs), probably they'll be worried about going first and being overwhelmed.

And if you think regulars on this board think there is a problem with a man in a dress, you are also showing your ignorance about what the majority on this board care about. Men can wear anything they want. They are still men though. And why should they need medical treatment to wear that dress?

Surely Minty, you can do better.

This sounds a bit like they're endorsing Dr Michael Webberley's "shopping list" approach, and not really on board with the concerns of the endocrinologist witness there.

When here talk about many facets of the while 'becoming Trans' journey. We talk about the realities of the medication, the real effects, or lack thereof, on gender dysphoria; the very real long term health issues medication does cause, the realities of the varying surgeries, the cost financial, physical and emotional; we discuss the differences between varying impetuses to become trans, what being trans actually means, what a "full transition" would actually be. And that is entirely separate from the issues around women's rights.

And yet still we get trite little pops like this. A quick admonishment for not being nice enough, for not caring enough.

Pshaw!

There's this:

A document, seen by The Times, says that the Sussex scheme is “not designed to promote the initiation of hormonal treatment in general practice”.

And then this:

It says that it aims to provide “interim support” to patients on the gender clinic waiting list and “improve access” to hormone therapy.

It's hard to tell if that means interim, or start of process.

Debbie Hayton thinks it's sub-standard, saying it's nothing like the processes she went through. Which she says are the right ones (longer, more checks).

So they're incentivising GPs to prescribe opposite sex hormones?