@Faffertea
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.
Thank you, that is very interesting, especially about the patient not being seen as the responsibility of GIDS until after initial consultation, on the surface this seems reasonable , if I thought I had cancer, I would want a proper diagnosis using diagnostic tools my GP does not possess, and prior to diagnosis I would
not be my oncologists responsibility . However , neither would I expect or want my GP to prescribe interim chemotherapy for me based on an online course lasting a couple of hours without reference to the support services and monitoring care that a specialist oncology department offers.
It does seem as though the responsibility for any adverse outcome is being firmly glued onto GPs shoulders. What happens when a patient takes gp prescribed hormones and bumps them up a bit with stuff bought online , who monitors the patients wellbeing, both physical and psychological over what could be several years before GIDS appointments are available, who makes sure that this doesn’t turn into a free for all market place where hormone medication becomes another commodity on the black market . Who is ultimately responsible when a patient decides not to continue with their treatment and finds they are permanently damaged?
At a time when GPs are under huge stress and pressure I hope you all have the energy to band together and fight this. It is not about patient care, it is about an ill advised knee jerk reaction to social craziness.