Please note we are responding to feedback on this document. We have temporarily removed some sections and are doing further engagement on the content.
When assessing GP practices, we will look at how a service cares for:
- people with variations of sex characteristics (VSC)
- trans people aged 17 and older and transitioning their gender
- non-binary people aged 17 and older and transitioning their gender.
The General Medical Council (GMC) has produced guidance on trans care. The guidance advises that if a health problem is unrelated to gender dysphoria or its treatment, GPs and practice staff must assess, provide treatment for and refer trans and non-binary patients in the same way as other patients.
GP practices have a responsibility to trans and non-binary people under their care. This is regardless of their personal beliefs.
By looking at the care of trans and non-binary people, we can check how GP practices provide personalised care for people in smaller minority or population groups. This can also show us how the practice ensures effective services for people with less common healthcare needs.
The role of a GP practice in the trans care pathway
The Royal College of General Practitioners (RCGP) has produced a policy and position statement on transgender care. This states:
- GPs are most often the first point of health care contact for people questioning their gender. General practice plays a vital role in making sure these patients receive the care they need.
- GPs are expected to approach the holistic care of gender-questioning and trans patients as they do with every patient. This means openly, respectfully, sensitively and without bias.
The Royal College of Nursing (RCN) recognises that trans and non-binary people often experience prejudice and discrimination. RCN has published a resource for staff to respond to their needs.
Assessing care for trans and non-binary people in GP practices
To inform our assessments, we engaged with the LGBT Foundation to ask trans people what makes a good service. We will use this feedback when looking at the key questions and our local teams will talk with staff and ask questions about specific areas, or observe the environment if we visit a practice.
Effective
Caring
- People are able to see the same GP consistently where possible.
- Practices communicate well.
- Practices have links with local trans and non-binary care support groups and provide information on them.
- Staff react positively to people with VSC, trans and non-binary people, so they can use the service with confidence.
- Staff address people by their preferred name, title and pronoun.
- Staff are aware that the person’s voice on the phone may not match their preconceptions about the person’s gender.
Patients should have a substantial role in deciding the types of treatments that are appropriate for them. This may include choices about the pace and sequence of treatment and who provides the service. An appropriate specialist should support the patient in making those decisions. It is best to have a flexible approach to care that meets a person’s needs. In cases of disagreement between clinician and patient, there is a right to an independent second opinion by another specialist working in the field.
Peer support can reduce social isolation and distress. It plays an important role in providing support and encouraging people to use organisations and resources. Clinicians should provide information on local and national resources. This includes those supporting trans and non-binary people in different ethnic groups.
GPs and practice staff should be aware of local specialist support services that they can refer to. For example:
- endocrinology clinics
- screening services
- prostate cancer diagnostic services
- hair removal services
- gynaecological issues
- sexual health, fertility services and reproductive health services
- mental health services.
GP practices should be aware that there is no reliable way to know if a patient is trans or non-binary, unless the patient tells them this. It is good practice to record on the patient record what pronoun a person wishes to be referred to and important to use gender-neutral language. Avoid assuming gender as misgendering someone can heighten gender dysphoria. When interacting with a trans or non-binary person, it is best to learn how they wish to be addressed and how they understand themselves, on a case-by-case basis. If in doubt, ask. The ‘correct’ terminology or pronoun is whatever the trans or non-binary person uses to describes themselves.
A trans or non-binary patient does not need to seek or have accessed medical transition for their name to be changed on their patient record. There is no legal process that must be followed to start using a new name.
To help gather evidence, we will check monitoring data or speak with staff and ask questions for example, relating to:
- The number of trans and non-binary people using the service.
- Ensuring continuity of care in the practice for people on the trans care pathway.
- The approach to caring for a trans or non-binary patient, including tailoring communication. For example, use of pronouns.
- How trans and non-binary people are helped to engage with national initiatives to improve population health. For example, trans and non-binary people are thought to have a negative experience when engaging in physical activity due to specific barriers relating to gender identity, transphobic experiences, lack of awareness about trans people, and discriminatory sport policies. Awareness of any trans-inclusive sport and exercise initiatives for example, trans cycling or trans swimming groups.
- Training for staff (including reception staff) in equality that covers care of trans and non-binary patients and meeting their needs. This includes trans and non-binary people from different ethnic groups.
- The process for identifying safeguarding concerns for a person because of their gender expression/identity. This includes discrimination and/or violence.
Responsive
- Posters in waiting rooms are inclusive of trans and non-binary issues.
- Patient appointment screens do not give a person’s title, for example ‘Mr’ for trans women.
- Patient records are updated to show the person’s new title and gender.
- Self-log-in systems do not ask a person their sex as an identifier (ideally, although practice may not have full control over this).
Trans people may choose to change their name. If a patient asks for their name and gender to be changed in their medical records, a signed and dated request is all that is needed. A Gender Recognition Certificate (GRC) is no longer needed. The patient should be made aware that changing gender on their records may mean that clinical systems no longer generate invitations to gender-specific screening appointments and should be given details about how they will be able to access screening. GP practices may have to create a local plan to ensure these patients are still able to access appropriate screening.
A trans person’s ‘deadname’ is the term used for the name given to them at birth. Hearing their deadname can be distressing. This can potentially trigger gender dysphoria, especially if the deadname does not match gender presentation.
GP practices should consider:
- Where possible, providing gender-neutral toilets or supporting people to use a toilet that best matches their gender identity. Where issues with estates make this challenging, practices should consider how best to support trans patients in this area.
- Giving disabled patients who attend with a carer the opportunity to discuss their gender identity for themselves.
- Ensuring staff are aware that it may be unlawful to disclose a patient’s trans identity without their consent under the Gender Recognition Act 2004.
- Including trans status monitoring on patient questionnaires.
GP practices could consider having a flexible catchment area for trans and non-binary people to enable more patients to access their services. They may also consider providing specific patient information packs for trans or non-binary patients.
To help gather evidence, we will check monitoring data or speak with staff and ask questions for example, relating to:
- Responding to changes in people’s preferred gender, name and title. For example, Mr, Ms, Mx. This includes in patient records, letters and appointment check-in systems and screens.
- Responding to positive feedback or complaints/suggestions for change from trans and non-binary people who have used the service.
- Specific guidance or policies on record keeping for trans patients. For example, updating to show the person’s new title and gender.
Further information
- GP mythbuster 61: Patient registration
- Support for GPs and trans patients (LGBT Foundation/NHS in Greater Manchester)
- The role of the GP in caring for gender-questioning and transgender patients (Royal College of General Practitioners)