Shared Care Prescribing For Gender Incongruence

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Introduction

A number of queries have been raised nationally regarding the management of patients who present at their general practice with gender identity problems, including questions relating to patient records and confidentiality.

There is a need for a balance between what can justifiably be expected of GPs in providing Primary Medical Services to patients with gender incongruence, the enhanced services which can be provided in primary care, and the knowledge and expertise which should rightly remain within the remit of specialist services.

This policy aims to explain what will be provided in the Practice with regard to prescribing and monitoring in relation to the gender reassignment process.

Our aim is to ensure high quality service provision for all patients.

Background

Patients with gender incongruence require a holistic approach, addressing their mental health and psychological needs, in addition to their physical response to treatment. The practice has significant concerns about prescribing and the potential for this to have broader implications beyond the scope of the treatment of transgender patients and the lack of specialist knowledge with the GP team with regard to ongoing prescribing.

Confidentiality and Medical Records

All practice staff receive training in trans-awareness as part of their equality and diversity education, and will respect the dignity of patients with respect to pronouns and gender-markers on communications. A person’s gender past will not be divulged to anyone without the patient’s consent, and particular care will be taken over electronic forms of communication, such as e-referrals, which might make reference to past medical history which is of no relevance to the current medical situation.

Prescribing, monitoring and follow-up after gender reassignment treatment

GPs nationally are being asked to prescribe hormones for patients with gender incongruence both before and after specialist involvement.

The two circumstances in which GPs may be asked to prescribe for patients with gender incongruence are “bridging prescriptions” and “ongoing care following consultation at a Gender Identity Clinic” In both cases GPs will be responsible for any prescription they sign.

Participating in a shared care agreement is voluntary, subject to a GP’s self-assessment of personal competence, and requires the agreement of all parties.

Following review of all the available guidance the Practice has agreed on a policy to support patients presenting with gender identity issues by working closely with registered specialist clinics commissioned by NHS England. This includes the monitoring of physical health and providing results of investigations or other medical records as required, but does not extend to shared care prescribing of medications including the ongoing prescribing of puberty blockers for children under 16.