GPs will be paid for trans hormone prescriptions - Sussex

[Igneococcus]

I don't quite get it, supposedly it is “not designed to promote the initiation of hormonal treatment in general practice" but also "The document adds that any decision to start hormone therapy is “at the discretion of the individual GP”.
Also it seems non-binary people also need hormones.

www.thetimes.co.uk/article/eb0eb198-b1f3-11ec-8570-b43daaf58ea1?shareToken=bda8d448f411c2d44f782d823721d844

So what happens if GPs declines to get involved in the scheme? The patient complains about transphobia, and the GP get disciplined by NHSE and potentially struck off by the GMC.

But this scheme seems to be very similar to what the Webberleys have been doing at Gender GP. Self-diagnosis by the patient who then chooses their own drugs. The Webberleys are both currently under investigation by the GMC.

Or are GPs somehow going to be equipped to diagnose gender dysphoria in patients following their 2 1/2 hour online course? Doesn't this require some sort of psychological assessment which wouldn't really fit in to a short appointment with a GP?

Most GPs are not going to be happy about this. With a few notable exceptions!

@ResisterRex

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).

Poor wording, but I suspect they're using "interim" to mean "while waiting for assessment at Gender Clinic". So it would actually be initiation.

Rather than finding out why there are so many thousands of young women being referred that W/L are so long.

So the quarterly battle to get hold of Oestrogel if you're on HRT will be even worse.

Surely we want them to transition properly, isn’t hormones the start?

You cannot change the sex of a human. No hormones, clothes, surgery or makeup can alter the XX or XY chromosomes which are determined at conception. An adult who has particular body parts removed is still exactly the same sex they were before. Being born male or female is a fact of life, it is not an error on nature's part and it is definitely not a medical complaint.

@MissLucyEyelesbarrow

At the moment GPs are not initiating cross sex hormones at all, let alone "without a whimper", and I suspect most won't do so despite this misguided initiative

The trouble is, NHS England, the GMC and BMA are all Stonewalled.

So what happens if GPs declines to get involved in the scheme? The patient complains about transphobia, and the GP get disciplined by NHSE and potentially struck off by the GMC. Most GPs are not going to risk their livelihoods by taking a stand, and I don't mean that as a criticism. Why should they face the sack, or at least months of public shaming and stress, because of NHS England's cowardice? NHSE is passing the buck.

I agree that GPs should not be being put in the position of having to worry that if they decline to become involved in any part of this scheme for any reason (and the likeliest reason is lack of expertise in what is a very specialised area of health care) they will be at risk of a complaint. I'm not sure that even taking on the additional workload of annual health checks for trans and NB people is a good use of GPs' time at present, let alone training to a point at which someone like me could convince a fitness to practice hearing that I was suitably qualified to initiate puberty blockers or cross sex hormones if a patient had complications or changed their mind about transitioning.

@OldCrone

So what happens if GPs declines to get involved in the scheme? The patient complains about transphobia, and the GP get disciplined by NHSE and potentially struck off by the GMC.

But this scheme seems to be very similar to what the Webberleys have been doing at Gender GP. Self-diagnosis by the patient who then chooses their own drugs. The Webberleys are both currently under investigation by the GMC.

Or are GPs somehow going to be equipped to diagnose gender dysphoria in patients following their 2 1/2 hour online course? Doesn't this require some sort of psychological assessment which wouldn't really fit in to a short appointment with a GP?

No, it's different because it's an NHS scheme. There are similar arrangements for various specialist drugs: a specialist initiates them, but GPs prescribe follow up prescriptions and do any monitoring required. In most cases, it's good, because it saves patients schlepping up to see their specialist, just to get a repeat prescription, while also ensuring that GPs aren't prescribing drugs we aren't familiar with. But the other drugs aren't anything controversial - they are only part of the scheme because they require specialist knowledge to initiate.

As it's an NHS scheme, there shouldn't be any risk of GPs getting into trouble for participating in it. The risk will be all on the other side - even though it's theoretically optional, who is going to risk being accused of transphobia by refusing to participate?

PS I agree that 2 hours of online training are ridiculous, and will leave GPs open to litigation and to inadvertently harming patients.

It's different from the other schemes, because they involve medical conditions we already know about - it's just the drugs that are specialist. So, for example, there is one in my area for a drug for Rheumatoid Arthritis. Well, I studied RA at medical school, and have treated people with RA for 20 years, so I know a fair amount about it. So I feel fairly confident about prescribing a drug for it, once a specialist has confirmed that the drug is right for the patient.

This is totally different from gender dysphoria, which is an idea in someone's head, and a subject about which I have had zero training.

@Igneococcus

It says intersex patients as well, why are people with a DSD included in this?

Some DSDs have physical health issues. This is about the only sensible part!

And (I'm on a roll, now 😉), if i said I didn't feel I could safely prescribe the RA drug, the patient might complain, but i would be supported by the BMA and the GMC, as long as I had reasonable grounds for saying so.

But the BMA, NHSE and GMC are 100% Stonewalled. I would have no confidence at all that they would back me up if I objected to prescribing for a trans patient on safety grounds. On the contrary, I would expect to have disciplinary action taken against me.

@Whatiswrongwithmyknee

Message deleted by MNHQ. Here's a link to our Talk guidelines.

Yes, I'd be asking "suggested by who?". I bet it's not GPs who suggested it.

I don't know why the post I replied to was deleted. It was a quote from the article
"Setting out its reasons for launching the scheme, Sussex Clinical Commissioning Groups said that research showed “the most frequently suggested action for improving healthcare for trans people was an increase in awareness training within primary care”.

I was commenting on that in asking who was this 'most commonly suggested' by? I'd be very very surprised if it was the GPs that suggested it . . .

Pisses me off that the taxpayer pays millions for controversial treatments of unproven benefit to treat the self-diagnosed neuroses of confused people but I have to pay privately to fund IVF that I only need because the NHS damaged my womb 😡

@VelvetChairGirl

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?

That's puberty blockers - cross sex hormones damage fertility and sexual response, and cause pain and heart problems, and often lead to the need for a hysterectomy.

No, it's different because it's an NHS scheme. There are similar arrangements for various specialist drugs: a specialist initiates them, but GPs prescribe follow up prescriptions and do any monitoring required.

But that doesn't seem to be what's being proposed here. It's not doctors being asked to prescribe hormones and do blood tests etc for a patient who has been diagnosed by a specialist clinic which has recommended a particular course of treatment.

What is being proposed here is that the doctors will prescribe the hormones while the patient is on the waiting list for the specialist clinic. Such a patient will not already have a diagnosis and appropriate treatment will not have been recommended by the specialist.

@MissLucyEyelesbarrow is correct. There are procedures set up for GPs to monitor and prescribe drugs initiated by specialists under what are called Shared Care Agreements. The crucial point though is that this is an agreement- GPs can decline if they feel they cannot do it safely and while that can be frustrating for patients it’s not something the GMC would concern themselves with. The difficulty with GPs prescribing for people, and especially children, who are waiting to see GIDS is that there is no equivalent in which GPs prescribe. The treatments are not evidence based, there’s concerns about ethics and even with additional training this is beyond the scope of GPs unless it’s going to be run by GPs with special interest in the way GPs do other roles e.g prescribing in drug addiction. But that usually requires postgraduate training, exams, assessments and so on not 2.5 hours online learning.

The fact that it’s GPs being put in this position is reflective of a couple of things. Firstly that whenever there is a gap in NHS provision of services the assumption is GPs will plug the gap. I am expected to do all manner of inappropriate tasks or have things passed to me with the expectation I will do it because unlike other departments our contract is essentially open ended and vague so people assume if it’s not their job it must be mine. In addition to this NHSE, governments of any colour and in fact a fair amount of non Primary Care managers, doctors, nurses etc don’t actually know what we do.

Add to the mix that these official bodies have been Stonewalled and it’s not hard to see how this has come about.

In terms of responsibility and what happens if someone changes their mind, detransitions and decides to sue it would be whoever prescribed the drugs, whether under specialist direction or not, who is held responsible. As for whether GPs will do it out of fear of a GMC referral or fear of being called transphobic I don’t know but I don’t think so. The principles of ‘first do no harm’ and not prescribing outwith your competence is so ingrained that I think there may be resistance to taking this on and there are many of us following the GMC’s previous directive on this who are unhappy at being put in the position of working outside our competence and being asked to make a ‘special exception’ for prescribing hormones although as with so many groups there are GPs who’ve already drunk the Kool Aid.

Just seen in the article there is a new acronym. TNBI. does this mean we will now have LGB and TNBI. This would definitely work better on separating the two groups which have nothing on common and often conflicting interests.

"A spokeswoman for Sussex Commissioners said: “Transgender, non-binary and intersex (TNBI) people experience significant health inequalities — something we are committed to tackling.”"

"Hayton questioned the level of psychological support in the scheme. “When I transitioned I had an hour with a therapist every week for months,” she said. “That’s what I needed to understand myself. An annual review is a pale shadow of that.” Doctors will also have to monitor patients and carry out blood tests to ensure they are taking treatments safely."

Those two statements seem to contradict. Do they really experience health inequality?

Mental health services generally are really underfunded. It's very difficult to access appropriate treatment and timescales of any treatment are often limited to short periods such as 6 weeks if/when you do get it. I have a serious mental health condition and often have periods when I am suicidal and I get no support at all. When I do get any support tbh it's pretty useless ime (eg a monthly call from a mental health nurse was the most recent offering - I stopped those as they were completely ineffectual). If you can access a weekly appointment "for months" I would say that's fucking amazing in comparison to support in offer for many other conditions.

I also have ADHD. Untreated ADHD has extremely poor physical and mental health outcomes including limited life expectancy. Yet in many areas there is no diagnostic service at all and where there is a service the waiting times are years long, 4-5 years in some areas. Then when you get an assessment it's sometimes inadequately carried out. So the long wait time for trans people send to pretty on a par with or better than what's being offered to everyone else - it's pretty shit for everyone ime!

Ideally mental health services would be improved across the board including for trans people, but tbh if it was a choice my vote would be to improve the services for children and young people first as CAMHS is particularly dire. Even referrals for suicidal children are declined by the service as they are so underfunded, it's appalling.

So I don't think there are "health inequalities" for trans people. NHS Mental health services are shit for everyone. It's all pretty equal.

@OldCrone

No, it's different because it's an NHS scheme. There are similar arrangements for various specialist drugs: a specialist initiates them, but GPs prescribe follow up prescriptions and do any monitoring required.

But that doesn't seem to be what's being proposed here. It's not doctors being asked to prescribe hormones and do blood tests etc for a patient who has been diagnosed by a specialist clinic which has recommended a particular course of treatment.

What is being proposed here is that the doctors will prescribe the hormones while the patient is on the waiting list for the specialist clinic. Such a patient will not already have a diagnosis and appropriate treatment will not have been recommended by the specialist.

I agree that this is one of the many dodgy aspects but I think what will happen is that a specialist will triage some patients on the list as appropriate for the drugs. So there will be some vague specialist oversight.

I'm 100% agreeing with you about how worrying this is though, I'm just trying to explain how this scheme will be positioned as 'business as usual' by NHS England.

Some DSDs have physical health issues. This is about the only sensible part!

This is absolutely not a sensible part. This needs specialist investigation and care.

Just seen in the article there is a new acronym. TNBI. does this mean we will now have LGB and TNBI. This would definitely work better on separating the two groups which have nothing on common and often conflicting interests.

Hear, hear!

I wouldn’t be too concerned about this
It’s largely irrelevant as in most areas of sussex it will take years for them to actually obtain a gp appointment to get the prescription.

At least the 2 1/2 hours online training requirement provides a get out for more ethical GPs. They can simply not do the training.

The Government guideline states that the maximum time anyone should wait for treatment is 18 weeks. Yet I have been told that the wait time for my treatment is 4 years. This will hopefully speed it up and make it comply with government guidelines.

This is where it becomes transparent about the big money Pharma behind this this drive to push transgenderism.

I read a document today that said adults and young people would be included in this.

Also don't forget if the new conversation therapy law went through it would mean that GP would not be able to challenge these people/young people as in ... in fact it would be illegal.

'Why do you feel you are in the wrong body? Can we have a look at any other underlying issues?'

Which could be -
A self disgust at being homosexual
Hatred of body due to sexual abuse
Mental health issues such as bi polar ect
Autistic and feels like not fitting in to society.

We have to really really look at why way more young girls are transitioning than young boys.

And lets not forget these 'hormones' cause so mach damage to the body over time. Kidney failure, osteoporosis amongst many.

So whilst grown adult men are free to take the hormones - although I'd put money on they don't take them as they lose their erections and as we know the vast vast majority of adult men like to keep there penis when they transition.

I am not arsed about adults doing this ( they can pill pop what they want) - its the kids that are following suit we really needed to be alarmed with.