The Royal College of GP’s has put out a new position statement on trans healthcare so we asked our Policy and Engagement Officer, Natasha Handley to take a look at it. 

Hello everyone. Natasha here, the Policy and Engagement Officer for Mermaids!

Today a really important document was published by the Royal College of General Practitioners (RCGP) regarding the role of GPs and how they care for gender-questioning and transgender patients.

The first half of this new document is a relatively in-depth summary of the difficulties transgender people face in accessing medical care, and it reflects what many of our service users have been telling us for years: things really need to change and fast.

The statement highlights just how long the waiting lists are at the moment. It states an average of 18 months from GP referral to a first GIC appointment but I know many wait much longer. Compare that to a transgender person’s constitutional right to an initial appointment within 18 weeks and it looks just as awful as it is. That’s not including the average 18 months again until a second assessment.

The statement also talks about how little the situation is changing and how inconsistent (or non-existent) the guidance for primary care providers often is.

In the meantime, trans people have little support except from their GPs and third sector organisations like the team here at Mermaids and a small but amazing group of others which you can find here.

In 2016, the Women and Equalities Committee found “serious deficiencies in the quality and capacity of NHS gender identity services” and expressed concern about “the apparent lack of any concrete plans to address the lack of specialist clinicians in this field.”

At the time, NHS England pledged to reduce the wait to below 18 weeks by 2018.  This hasn’t happened, and right now there are around 7,500 adults still waiting for their first assessment.

Any young people waiting for an appointment at GIDS will know how desperate the demand for more services is. We can all agree with this document’s conclusion that ‘there is an urgent need to increase the capacity of gender identity specialists and clinics and expand the understanding of gender variance issues across the entire health system.’

Whilst the waiting lists are so long, a supportive GP can be crucial to the health and wellbeing of trans people of all ages. However, as this document states: “the UK lacks a nationally recognised training programme for gender identity health care” and “GPs often lack a deeper understanding of trans identities, gender dysphoria, referral pathways into gender identity services, and their own role in prescribing hormone treatment.”

This has led to cases where appropriate care has not been provided. We know from our service users that one of the biggest barriers to accessing care is the lack of knowledge and awareness in GP surgeries

The RCGP also talks here about the specific issues surrounding trans young people:

“GPs face even greater challenges in addressing the needs of children and young people under the age of 16 who are experiencing gender dysphoria or are in the process of transitioning to another gender. These challenges include the vulnerabilities of young people at this time and the heightened risk of self-harm and attempted suicide, the concerns of parents who may not be accepting of what is happening to their child and the lack of a robust evidence base for interventions. Parental and carer involvement in the care of these patients is crucial and adds another layer complexity to the GPs role.”

In response to all these points, the RCGP make some excellent UK-wide policy recommendations and initiatives, which are urgently needed. Let’s take a look:

    iv.         We strongly encourage the NHS to consider the expansion of gender identity services in the Devolved Nations and for gender-questioning children as well, to address the increasing demand and pressure on the Tavistock and Portman clinic which is currently the only GIC treating children and young people in England, Scotland and Wales.

     v.         The NHS should urgently address the extensive waiting lists for GICs across the country and ensure the commissioning of gender identity services is sufficient to support the level and spread demand for specialist advice from patients and GPs.

    vi.         Up-to-date IT systems and associated IT training is needed to enable GPs and other healthcare professionals to treat trans patients and patients with gender dysphoria in a safe and respectful manner (for example, documenting generalist and specialist advice in writing as part of the patient record, maintaining safe access to screening programmes such as smears after a patient’s gender has been changed on records). NHS systems should record codes for biological sex as well as gender identity, while ensuring all patients are afforded the right to express their preferences for how they wish to be named and referred to by their GP and other healthcare professionals.

So what can we make of these recommendations? The issues with the waiting lists were planned to be fixed by 2018. In 2019, they are not getting any shorter and demand is only increasing, leaving thousands of trans people without the support they desperately need. Tackling these waiting lists needs to be a priority, as well as ensuring that GPs have adequate tools and training to care for their trans and gender-nonconforming patients.

RCGP is also leading the way by developing an e-Learning module to help GPs understand the needs of their trans and non-binary patients which will cover a huge range of topics; everything from ways to make their patients more comfortable with them to the risks and benefits of prescribing.

Other educational and training bodies are encouraged to provide their own training programmes and materials to support GPs and their team is engaging with trans people and this is definitely something Mermaids will be working on in the near future. We will fully support any other organisation who would like to do the same.

I ought to say here that TransLeeds has a guide for GPs already and It’s pretty good in my opinion. I wrote it!

This document from the RCGP is warmly welcomed. It expresses the concerns of trans people and their families who are currently navigating the system and sends a clear message to policy makers that these issues need to be addressed. However, I think it really needs to be emphasised just how important a supportive GP is.

When I was first referred to the Gender Identity Service, the waiting list for initial assessment was four years long. Imagine struggling with your gender identity for so long before finally having the courage to go to your GP to ask for help, only to find out it will be another 4 or 5 years before you will have access to treatment. I was incredibly lucky to have a supportive GP who helped me access an HRT bridging prescription three years before I received my diagnosis of Gender Dysphoria. I cannot tell you how important that prescription was to me. I could finally go out and live my life and have been doing everything I can to support my peers since then. Without it, I might still be a recluse and wouldn’t have met or worked with all the amazing people I call my friends.

Having a supportive GP shouldn’t be a lottery, and hopefully with the Royal College of General Practitioner’s help everyone will have access to care they need.