Landmark trans care review recommends GP referral as sole pathway to gender services

[IwantToRetire]

David Levy, investigated the safety and effectiveness of nine gender dysphoria clinic (GDC) services in England.

Commissioned by NHS England in June 2024, the review has now identified ‘exceptionally long waiting times’ for gender services reported, a lack of knowledge-sharing between GDCs, and absence of patients waiting lists or outcomes data.

It said NHS England should ‘standardise and streamline’ referrals by working with GDCs to ‘establish GP referral as the only pathway to adult gender services, with an end to self-referrals’, as well as ‘support more informed GP referrals and GDC triage processes by developing a standardised patient form for GDC referrals’.

article continues at https://www.pulsetoday.co.uk/news/clinical-areas/mental-health-pain-and-addiction/landmark-trans-care-review-recommends-gp-referral-as-sole-pathway-to-gender-services

See also

Operational and delivery review of NHS adult gender dysphoria clinics in England
https://www.england.nhs.uk/long-read/operational-and-delivery-review-of-nhs-adult-gender-dysphoria-clinics-in-england/#what-good-looks-like

https://www.mumsnet.com/talk/womens_rights/5141807-nhs-review-of-adult-gender-services

Yes, but this is the outcome.

Had hoped by posting as a new thread would get more attention.

https://podcasts.apple.com/gb/podcast/inciteful-sisters/id1802508941?i=1000738016606

I think this is a good podcast to realise the huge responsibility GPs have and how some do not want to deal with prescribing to people who need other kinds of support

I didn't see how it was or is realistic to expect GPs alone to be the gate keepers.

Let alone if this was something they wanted to do and / or had the time and expertise.

Or is it going to come down to some sort of agreed check list, and if the patient scores more than 50% then they start down the path way.

This is technical but as I understand it, no more self referrals. GP refers to Gender Clinic, clinic prescribes or doesn't hormones, GP is responsible for monitoring. Some GPs are struggling with the monitoring. This is similar to a lot of medications started under secondary care

Edit - that's probably good as self referral means the clinic may not have all the relevant medical history, such as prior mental illness.

Some trans rights activists argue GPs should he allowed to prescribe transgender hormones. One tried to tell me was "segregation" as "cis" people get hormones from their GP. Obviously to the rest of us menopausal women getting HRT is not the same as cross sex hormones...

The NHS should not fund an ideology.

I agree. It would be analogous to a GP agreeing to arrange FGM for a child, because her family really really believed in it.

It's less than ideal as the desire to transition usually shows up with other problens such as depression or autism, and it's a massive tangle to unpick. I don't think it's fair to push that onto a GP who usually has less than 15 minutes per patient. However it is a standard referral pathway for other complex conditions, so my focus would be on the quality of care further up the line. Will the person in question get decent counselling and consideration or would they be nodded through for cross-sex hormones?

It still blows my mind that these drugs are given out so freely for a self-described mental health condition.

they suggested that GPs are directly liable when prescribing. Someone else will know for sure but I think they are private practices and sit alongside the NHS and therefore can be directly liable and hold their own insurance

I saw this yesterday, and my first thought was, this looks like pretty cynical buck-passing, let's load it onto already busy GPs, they'll take the flak, and the 'treatment' will continue. I can't imagine GPs are pleased about this.

My understanding is that the recommendation isn't that GPs take on more responsibility for ongoing care, but that they become the only route for referral to the specialist service. I think that's far better than allowing self-referrals or in some cases for support charities to be able to refer directly. It has benefits for patients and for efficient management of the specialist service.

GPs should have a fuller picture of someone's medical history and any co- morbidities. A system where someone can self-diagnose is unsustainable and potentially dangerous. Looking at posts by many trans identified young people and adults it's clear that some view NHS gender identity service as a free sweetie shop where they can get whatever medication or treatment they want. If being transgender is a health condition (I don't agree that it is) the service needs to be properly organised with safeguards in place. Nobody gets to identify as having any other health condition and have it automatically affirmed and 'treated' at public expense.

I'm utterly baffled by the TRAs' determination for trans people to receive abysmally subpar medical care. It's already bad enough that trans people and their families don't seem to realise that at this point, anyone who is receiving "gender-affirming" medical treatment is still in effect a guinea pig being experimented on, since there are no long-term studies on the consequences of those treatments. But to actively refuse to be handled by the proper medical professionals in the first place? That's just insane!

Would they entrust their car to anyone claiming to "know a bit about mechanics"? Would they agree to receive their surgeries from vets who never studied the human body, "but they studied animal bodies, close enough" ? Then why are they refusing to entrust their endocrine systems and their minds to people who have the exact proper training in dealing with them??

GPs should not be burdened with the follow-up of hormonal prescriptions; endocrinologists are the only ones who can do that in full knowledge and understanding. TRAs should be asking for the best possible care, which means working with the right professionals, instead of looking for doctor-shaped pill dispensers.

If being transgender is a health condition (I don't agree that it is)

Oh, they agree with you that it's not! They need medical treatments, but it's not a medical condition - literally what they argue. They want those medical treatments to be paid for entirely by the NHS, but don't you dare imply that they are in any way sick in the first place.

Personally, I do think that in some rare cases, it's indeed a health condition: a psychological or maybe neurological one. In the vast majority of cases these days, however, it's social contagion or dramatic misattribution of the root cause of mental distress.

You may find this interesting, Seethlaw.

https://www.tumblr.com/edinburghath/163521055802/trans-health-manifesto

There is a recent free HRT scheme in Ireland - guess who are making a fuss about it?
Yes the TRAs, who say they should be getting free HRT too.

In Ireland the gate-keeping buck seems to have been passed to pharmacists, who say that a prescription is a prescription is a prescription, so they can't decide who is entitled and who is not.
I can see their point, it comes back to prescribing hormone replacement therapy for someone who never had those hormones in the first place, and it's at that stage that medical and ethical questions need to be asked.
'I'm not looking up someone's skirt': Pharmacists reject deciding who's eligible for free HRT

In fact, I'm wondering what 'transgender medicine' actually means. All transpeople are either male or female, and there is an established healthcare system for men and for women, which is available to all.

If a young person who is thinking of 'transitioning' is not aware that they are going to remain susceptible to conditions such as cervical or prostate cancers, and should engage with screening etc, in their new 'gender presentation', which may be awkward, they clearly have not thought things through properly.

Hormones for people who do not medically need them? Questionable.
Double mastectomies of healthy breasts? Indefensible.
'Bottom surgery' which produces non-functioning imitations of real organs?
Mis-selling.

And all the ongoing consequences of these dodgy practices fall on an already overworked GP system.

I can't decide whether to laugh, cry, or facepalm really really hard.

Perfect representation of the TRA mindset indeed: "We waaaaaannaaaaaa!!!" In line with what I've experienced: "We want everything and its opposite, and we want it for free!"

Adults behaving like toddlers is not cute, and judging by the abysmal number of likes and reblogs, this attitude did not endear them to anyone. I note also that the only few comments left are still negative ones.

I'm wondering: has anyone sent this manifesto to politicians and other decision-makers? To show them where the TRAs' arguments, no matter how reasonable they may seem at first, eventually lead? I mean, I doubt politicians would be happy to learn that they are expected to "pay reparations" for how trans people have been dealt with in the past. Or that medical professionals would be enthused to read about how TRAs want to effectively tear down the medical establishment (while still fully using it freely, mind you). Operation Let Them Speak indeed...

In fact, I'm wondering what 'transgender medicine' actually means. All transpeople are either male or female, and there is an established healthcare system for men and for women, which is available to all.

The way I see it, "transgender medicine" includes, in no particular order:

• the surgeries and their follow-up,
• the administration of hormones and its followup,
• the psychological support.

This medicine is indeed entirely dependent on the sex of the patients involved, from the first appointment up till death, throughout every medical test and interaction. "Transgender medicine" for a female trans person is in no way similar to that for a male trans person.

If a young person who is thinking of 'transitioning' is not aware that they are going to remain susceptible to conditions such as cervical or prostate cancers, and should engage with screening etc, in their new 'gender presentation', which may be awkward, they clearly have not thought things through properly.

"They clearly have not thought things through properly" could apply to so much of trans people's decisions, in every area of their lives...

There's also the many trans people who don't want to consider that they still need to be screened for their sex's conditions. The classic example is that of trans women who want "gynaecological" care, but don't want to hear about prostate cancer screening because it's "dysphoria-inducing". They celebrate receiving an invitation to a breast cancer screening, but a doctor reminding them that they still need to be screened for prostate cancer is transphobia... sigh

'GP's should have a fuller picture of co-morbidities'. They should indeed, however, I can't be the only person who's sat uneasily in a GP's office and realised that they a) haven't looked at my file and b) don't understand the condition that's treated by a specialist.

We get told regularly that we mustn't pressurise GP's to prescribe antibiotics because the poor fragile dears give in. Imagine how much more pressure an obsessed person who believes their a different sex will put them under.

What I imagine would (should) happen is that the adult gender clinic sets out advice for GPs on who they will and will not see. This is standard stuff and exists for most services.

For example haematology list what/ who to refer urgently, routinely or not at all. Weight loss, drenching night sweats & lumpy glands = urgent suspicion of cancer. Older adult with mildly low white cells - don't refer unless white cells drop further to dangerously low level.

Adult gender clinic - don't refer people with new onset/transient dysphoria, people with active alcohol or substance dependency, people with active eating disorders etc etc

It's tricky.

From what I've read of what you've written, it seems that your treatments have helped with dysphoria, and I think I have a rough idea of how that had manifested.

If there ever was a case for the medical pathway as posited by the NHS for gender incongruence, your history would seem to illustrate it perfectly.

But how would/can doctors/the NHS discern the difference between that history, and that of a confused young autistic lesbian who needs time to reconcile her changing body and a sexist world? Or a fifty year old male who feels that breasts and a penidectomy would 'fulfil his true self'?

I'm not trying to set up a gotcha, by any means. I just wonder how it's possible to assess where medicalisation pathway may actually help and resolve dysphoria, and where it is likely to end up doing more harm than good.

But how would/can doctors/the NHS discern the difference between that history, and that of a confused young autistic lesbian who needs time to reconcile her changing body and a sexist world? Or a fifty year old male who feels that breasts and a penidectomy would 'fulfil his true self'?

Honestly? I don't even think it matters, simply because people who seek a transition know how to lie to get exactly what they want. If, say, research determined that there are "true" trans and people who are not "really" trans, the word would go around real quick as to how to present as a true trans. So I don't think making a distinction between the various types of trans people would lead anywhere useful.

I think a better avenue would be for the NHS to put strong limits on what they will and won't do. For example, they could declare that in the absence of proper research, they won't give surgery or hormones to minors. Or they could go the whole way, and outright refuse to do any surgery or hormonal treatment anymore, on anyone, either because by definition it means harming a healthy body and that's unethical, and/or because they accept what TRAs say, that trans people are not ill (and so they don't need treatment), or because being trans is all in the head and you don't treat mental issues with surgeries and hormones, or whatever.

Basically, I think the NHS (and the local equivalent in my country, mind you!) need to stop letting themselves be pulled and pushed around by the TRAs, and to re-take control of the narrative. They are the ones providing the service; they should be the ones setting the conditions. Listening to experts is one thing; blindly accepting a shopping list is another entirely.

We do not consider that our work will ever be complete, there will always be greater things on the horizon. As such, this manifesto is not final, but an open draft which will evolve as we do. This is our call to action. We will fight anyone who stands in the way of universal liberation. This is war, and we will win.

Sometimes wonder whether all those politicians and media pundits who spread they message that all this is about is allowing a few people to be their "true selves", how they reconcile that position with this statement.

If any of these allies just for once spoke out against those who do see it as war they are going to win and at any cost (ie women) that they dont say we dont support the extremists, and those threatening violence.