Sorry, some more thoughts. I have FAR too many on this. (Don't encourage me with your kind feedback!)
I think that given the muddle already in the public about sex and gender, the fact that medical services are adding to this by seemingly not making a conceptual distinction in their records is very worrying. I strongly suspect from Barracker's comments that the system is built in such a way that the NHS COULD record sex/gender ID separately, if they wanted to.
I actually wouldn't have a hard time imagining a case where someone who is biologically male (or biologically female) was unsure as to whether they have a cervix or not. Or really, anything about anatomy/physiology getting confused. Because it seems to me that we have grown adults saying male-bodied individuals can have menstrual periods now... They CANNOT.
In my view, we should just move to a place where you can record sex, record gender id, and if a patient is trans then so what? That should mean as much as their occupation, weight, if they are a Jehova's Witness or whether they have asthma. Just an additional descriptor that gives you some information about their potential risk factors for certain conditions, how they wish to be addressed, and their beliefs. Nothing more. No big deal.
But sex is just NOT an optional extra, or something that can be ignored. We can't change sex. I cannot get my head around the fact that anyone thinks that, in essence, HCPs should be encouraged to record what are actually medical falsehoods in their documentation.
Additionally, patients usually have to explain their medical histories multiple times when they are treated for a condition. Each time a new HCP comes along, they'll tend to ask more questions (sometimes very detailed, sometimes to get new info, sometimes to confirm what's written down, etc). This can get tedious, even when the information isn't too sensitive to talk about. I could imagine that being reminded of your sex if you have dysphoria would be exceptionally troublesome in such a process. However, my question is: if you are trans, would it not be preferable to somehow just record sex and gender identity somewhere safe in your record ONCE (and you could maybe make the "sex" part only for HCPs with verified access to the notes or something, and theoretically have gender id as fluid as you like) instead of potentially having to keep explaining the situation whenever someone gets confused because they don't know about a sex/gender ID mismatch? I don't know.
As for your question about bloods Badstyley - it's an excellent one. The normal (reference) ranges for test results can vary depending on the lab, and are usually programmed into the systems themselves. We've said already that these can be different for males/females. The system is helpful as abnormal results tend to be automatically highlighted by the software when the HCP is reviewing them. If someone's blood test is outside the reference range, it might show up as red, for example, to draw the HCPs attention. In the case you mention, I would suspect that the HCP would need to manually check results against the reference ranges for the opposite sex. This is sub-optimal, because it relies on the HCP remembering to do it, could lead to mistakes (if they're reading the result/reference range wrong for some reason), is more time-consuming, and if there is an on-call HCP they might not know that this is the protocol for this person's results. In my opinion, it's definitely a risk in terms of patient safety because it introduces a potential error in interpretation. An option to mitigate this might be to make an alert/note in the system to remind HCPs to manually review sex-specific results using the normal ranges of the opposite sex. BUT this would "out" the trans patient to anyone using that system to check those results, so you'd need to get explicit patient permission beforehand...