Pharmacy First Scheme Nonsense

[ChestInflection]

There was a discussion on a local Facebook group about who could attend a pharmacy for antibiotics for a UTI without having to see the GP.

There were a lot of anecdotal stories about who had been seen before but lots of confusion so someone linked to the actual NHS paperwork showing the inclusion/ exclusion criteria and I was pretty shocked by some of the language:

Non pregnant cisgender women, non-binary people assigned
female at birth, transgender men (with no structural alteration to
their urethra)
• Individuals aged 16 years to 64 y

Individuals aged 15 years or under or 65 years of age and over
• Cisgender men, non-binary people assigned male at birth,
transgender women (including those who have had structural
alteration to their urethra)

I get that the clarifications about urethral surgical alterations may be useful and necessary (what a tangled web we weave) but I really feel uncomfortable about the use of 'cisgender' as an objective term for decision making around the supply of medicines. Surely this is somewhere where the term 'biological female' is really appropriate? Or even the 'female sex at birth' terms?

Does the use of these (I think contested and to me at least, offensive) terms in an NHS document mean that all pharmacy staff participating in this scheme have had training which explains these terms to them? Not sure if there's a training document somewhere that defines what their understanding of cisgender is? Is that now a universally accepted and settled term?

These documents are dated from the beginning of this month, so any hope this stuff was fading seems misplaced unfortunately.

Actually reading that back I think they've muddled up TW and Transgender Women and TM and Trangender Men?

So none of it is actually that definitive?

I don’t think they have muddled anything up but they have not put transgender men who have had structural alterations to their urethra in either list, nor other women who have had structural alterations to their urethra for other reasons.

But I do agree this will be confusing for lots of people.

Having followed the link, I can see this is a document aimed at medical professionals and as well as that they have defined their terms at the beginning of the document. So hopefully nobody will be confused. Also, the exclusion criteria as much longer than you have written so would exclude other women who had some reason to have their urethra structurally altered after all.

I would assume that a transgender man was a male who was transgender as opposed to a transman, hence the potential muddle.

I am disappointed that they have noted the recent changes to language as to me the original was far more factual and clear and less captured:

Inclusion criterion amended from “females” to “cisgender women, non-
binary people assigned female at birth, transgender men (with no
structural alteration to their urethra)”
• Exclusion criterion amended from “males” to “cisgender men, non-binary
people assigned male at birth, transgender women (including those who
have had structural alteration to their urethra)”

No ABs allowed for me then, as a female/woman I'm not on that list. The words cisgender and non binary should have no place in any medical algorithm, they are subjective and mean nothing in that context.

I can't believe that our health service is using "assigned at birth" nonsense as objective criteria.

I know I should be over it by now but the way this language has been uncritically adopted into official documents by really, really educated and qualified professionals distresses me.

It also clearly demonstrates that sex is immutable, important and has real significance in certain medical situations.

Even those obfuscating and waffling and using stupid terms are essentially getting at the point we all know which is that there are only 2 sexes and at times you need to be really clear about which you are.

I can't believe that our health service is using "assigned at birth" nonsense as objective criteria.
I know I should be over it by now but the way this language has been uncritically adopted into official documents by really, really educated and qualified professionals distresses me.

I saw Professor Simon Baron Cohen being interviewed by Andrew Gold. All good, until Trans came up. SBC asked autistic people if they felt they were the same gender as assigned to them at birth! I was so upset I could not watch any more.

I think the erosion of trust and respect that we feel in professionals that use this language is rarely considered.

Transgender men are women.
Transgender women are men.
So that's ok as far as it goes.
Cis-gender man/woman is offensive, making men and women subsets of their own sex. Also completely incomprehensible to someone whose first langauge is not English, as well as to anyone who isn't up on this jargon or has any special needs e.g. autism.
No mention of surgical alteration for non-trans reasons which could mean men or women who should see their GP won't. Confusing.

There may well be more - it's a longer document with more detail further down

I think of a transgender man as a man who is transgender ie male

On the NHS website it simply says for pharmacy first, "women 16 to 64 years" can get treatment for UTIs.

https://www.nhs.uk/nhs-services/pharmacies/how-pharmacies-can-help/

Copied from that link:

Most pharmacies can also offer prescription medicine for some conditions, without you needing to see a GP or make an appointment. This is called Pharmacy First.
Conditions they can offer prescription medicine for are:

• impetigo (aged 1 year and over)
• infected insect bites (aged 1 year and over)
• earache (aged 1 to 17 years)
• sore throat (aged 5 years and over)
• sinusitis (aged 12 years and over)
• urinary tract infections (UTIs) (women aged 16 to 64 years)
• shingles (aged 18 years and over)

Well handily what you think is pretty irrelevant, and to avoid this issue of different perceptions - they’ve defined the terms.

As you say, aimed at competent professionals who can read guidance properly. Rather than a lay reader. With an agenda.

yes, the public messaging is perfectly clear and unambiguous, which is what matters

I'm a service user of the NHS.

I am concerned by the health professionals that I seek advice from being informed by documents that use captured and offensive language.

Just insisting the valid concerns of women are irrelevant is how we got into this mess in the first place.

It is good and clear. Begs the questions for the need for the word salad in the longer document really.

Although the whole reason this document was shared in a FB group is because people were giving confusing advice based on anecdotal experience.

This document is accessible to the public and causes concerns such as mine.

I think they produce those documents for professionals to make it clear that, come the inevitable day when a TIM turns up demanding a pharmacist prescribe ABs for his UTI, the pharmacist can say
'excuse me a moment while I just check our exclusion criteria....ah yes, I'm afraid it does say here that we can't help you through this scheme, you will have to see your GP, or I can recommend some self help measures'

If people are confused, the best place to go is the ordinary NHS website, imo. It is deliberately concise and clear, for everyone to understand. I think it is a really decent website and I've used it loads since becoming a mum

A transgender man is a woman who thinks she is a man.

A transgender woman is a man who thinks he is a woman.
I think the obsfucation is deliberate to hide what is in plain sight - that men are cosplaying as women.

Beginning to think OP is confused as to terms 'transgender woman' (man) and 'transgender man' (woman). OP has just replied to me saying they think that 'transgender man' refers to a man who is trans. This may be the root of confusion for many!

I'm not clear on what people with no gender identity are supposed to do?

I am confused. That's why I posted! I am a literate and qualified professional but don't think I'd be alone in not being categorical abit what means who in the way o would be if 'Male' and 'Female' were used.

Neither is cisgender which is an offensive term to many.

I don't think controversial, contested or confusing terms (without fixed or defined meanings) should be in official guidance or nhs documents.

It undermines my trust in the professionals we seek help from at our most vulnerable.

I think even if a HCP (and in this case it would be a pharmacist with advanced knowledge of anatomy, physiology, drugs and their actions)- IF they were genuinely unclear what was meant by transwoman/transman/cisgender- it would probably be obvious from the context or they could simply look it up.
The message to the public is unambiguous as we always are demanding. The detailed instructions for HCPs are to cover any outliers (AKA awkward buggers)

Are you ok with the uncritical adoption of the term cisgender into NHS documents?

It means that all staff involved in Pharmacy First are receiving training with cisgender presented as a factual and uncontested term. Makes me really uncomfortable.

For those of us without a gender identity and who don't like the creeping assumption that we all have one, nevermind that we identify as a woman, it is discomforting.