GPs and Pharmacists

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How can I make my practice more trans-friendly?

Physicians can be supportive by ensuring that their paperwork or electronic medical systems are sensitive to the needs of the transgender community. People may identify as male, female, trans woman, trans man, genderfluid, non-binary, agender, neutrois, pangender, two-spirit, or other options not listed here. Ensure that you have your trans patient's chosen name up to date, regardless of gender identity, and remember that not everyone uses their legal name in everyday conversation. Paperwork a...

My patient says they're trans. What's next?

Start by hearing, believing, and listening to your patient. Trans people are no different from cis people in their medical needs, they just need their hormone profile bringing into line with their correct gender identity. First, make sure that you are respectful with your terminology. Ask the patient for their name, pronouns, and gender identity. Each person may have terminology that is specific to their own experience, so allowing them to use their own language is the most respectful method. ...

What terms should I use around sensitive body parts?

Some trans people may experience gender dysphoria relating to parts of their anatomy that are not congruous with their gender identity, particularly genitals and (in transmasculine people) breasts. You can help avoid triggering this gender dysphoria by asking your patients what their preferred terminology is. Some people may prefer anatomical terms, or may have no preferences at all, but it doesn't hurt to check.

What has changed in primary care since the 2016 Women and Equalities Report?

Since the 2016 report, it seems that many GPs have undertaken personal and professional education to increase their knowledge and skills in this area of healthcare. At GenderGP we have seen a steady increase in GPs willing to prescribe and monitor under our guidance. This makes healthcare for trans people much more affordable and accessible, while they wait for their appointments via the specialist clinics.

Why is it said that GPs lack understanding of trans healthcare?

In 2016 the Women and Equalities Commission (https://www.parliament.uk/business/committees/committees-a-z/commons-select/women-and-equalities-committee/news-parliament-2015/transgender-inquiry-report-published-15-16/) found that ‘The NHS is failing in its legal duty under the Equality Act 2010. Trans people have significant problems in using general NHS services – often because of lack of knowledge and understanding by staff. GPs in particular often lack an understanding of trans identities, the...

I am a GP or healthcare provider and I feel unsure about collaborating in regards to trans patient care. Can I be assured that this is the best plan for care for these patients?

Please refer to Specialised Services Circular 1620 (https://gendergp.com/wp-content/uploads/2018/02/Primary-Care-Responsibilities-in-Prescribing-and-Monitoring-Hormone-Therapy-for-Transgender-and-Non-Binary-Adults.pdf), which can be found here: ‘GPs are usually at the centre of treatment for trans people, often in a shared care arrangement with other clinicians. GPs may prescribe hormones and make referrals to other clinicians or services, depending on the needs of the particular service user.’ ...

I am concerned about the off license prescription issued for my patient. How can I be sure the medicines indicated for this patient are safe to use in this manner?

It is well known that many medications that are prescribed are unlicensed for use in trans healthcare. Our Risk Assessment Management (https://www.gendergp.com/pharmacy-hub/risk-assessment-management/) page, available via our Pharmacy Hub contains all the information you need. You can access GMC guidance on prescribing for trans healthcare directly here (https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare#prescribing).

Can GPs prescribe and carry out blood tests for private patients?

In January 2018, NHS England published advice to GPs on Primary Care Responsibilities In Regard To Requests by Private On-Line Medical Service Providers to Prescribe Hormone Treatments for Transgender People (https://www.gendergp.com/wp-content/uploads/2018/02/GMC-advice-to-GPs-on-online-specialists.pdf): ‘A number of trans and non-binary individuals access private on-line medical services, often because of long waiting lists into an NHS-commissioned Gender Identity Clinic. The online provide...

Should GPs collaborate with gender specialists if they lack knowledge in this area?

The NHS constitution (https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england) gives patients the right to access certain services delivered through the NHS within maximum waiting times, or for the NHS to take all reasonable steps to offer a range of suitable alternative providers if this is not possible. The Specialised Services Circular 1620 (https://gendergp.com/wp-content/uploads/2018/02/Primary-Care-Responsibilities-in-Prescribing-and-Mo...

Why don’t GPs treat trans patients?

There are many reasons why GPs do not feel able to treat trans patients. These can vary from reasons related to prejudice or religion, to a general belief that they lack the knowledge to do so, and a lack of training resources available. Prejudice or personal belief should never be accepted as a valid reason not to treat a patient, whatever their medical needs. Lack of specialist knowledge is also becoming less accepted as an argument against helping trans patients. We are seeing more GPs learni...

I am a GP and I am responsible for the care of one of your patients. I would like to discuss their care with you. How do I go about this?

We are more than happy to liaise with GPs. Please submit your query using this form. (https://www.gendergp.com/ask-gendergp-healthcare-professionals/)

I am a pharmacist and have some more specific questions, where shall I go?

If you are a pharmacist, please visit our (https://www.gendergp.com/pharmacy-hub/)Pharmacy Hub (https://www.gendergp.com/pharmacy-hub/) where you will find all the information you need about how to work with GenderGP as well as our pharmacy related FAQ.

How do I raise concerns?

If you have any concerns please complete this form (https://www.gendergp.com/ask-gendergp-healthcare-professionals/) and a member of the team will contact you.

Who is your prescribing lead?

All decisions are made by a multidisciplinary team which includes several doctors. If you would like details of the specific doctor related to a specific patient then you can request that information (https://www.gendergp.com/request-prescriber-information/)here (https://www.gendergp.com/request-prescriber-information/).

Why have there been issues around chemists prescribing for trans patients?

A lack of education and awareness around trans issues has led to a culture of fear. This hampers safe and effective provision of care for this patient group. Active anti-trans lobbyists have raised unnecessary and unfounded concerns, particularly in relation to trans youth, and this has made regulators very concerned. Although this concern appears in other countries, it seems that the UK is falling behind in understanding the need for equality in healthcare for trans patients.

Can I set up a SLA with you?

Yes you can. Please click on (https://www.gendergp.com/service-level-agreement/)this link (https://www.gendergp.com/service-level-agreement/) to view our template SLA.

Do I need special training to dispense to this patient group?

There is currently no specific training available which relates to this group of patients. The medication used and the monitoring required within this patient group, is no different to those who are being treated for menopause, endometriosis, prostate cancer, precocious puberty, constitutional delay in puberty. Gender dysphoria is not a highly specialised field that involves dangerous medication requiring comprehensive monitoring. The benefits of having access to care far outweigh the risks a...

I am a pharmacist, and would like to know who at GenderGP is responsible for any prescriptions issued to my patient(s).

As each clinical decision is made by a multidisciplinary team (including doctors, therapists, and other medical professionals who may be involved in patient care), there is no single clinician responsible. Clinical decisions are made jointly. You can find more information at our Pharmacy Hub (https://www.gendergp.com/pharmacy-hub/).