GPs taken out of day jobs to deal with gender services
Extra roles prompt fears medics will be drawn away from general practices
FAMILY doctors are being put in charge of local NHS gender services, as specialist clinics become overwhelmed.
GPs will carry out assessments, recommend hormone treatment and make referrals for gender reassignment surgery – prompting concern that they will be drawn away from where they are most needed. Health officials have set up new schemes, deploying GPs to take on work previously done by specialist clinics, as they warn that the current system cannot keep up with demand.
Pressure groups raised concern that responsibility for life-changing decisions was being handed to those with inadequate specialist knowledge.
In one pilot scheme which has just been launched across Sussex, family doctors and nurses will be asked to carry out specialist assessments of adults with concerns around “gender dysphoria”. The roles will see GPs taking decisions about whether patients should be prescribed hormone therapy, voice coaching to “feminise” or “masculinise” their voices or referred for gender reassignment surgery.
Those running the service, which has just begun taking patients, said all staff will be given specialist training from a centre for transgender health care in Nottingham with which it has been paired. It is one of five pilot schemes commissioned by NHS England which will mean those aged 17 and over who are considering medical treatment to change gender will receive consultations from GPs and staff working in sexual health services.
The moves come despite a national shortage of GPs, with a shortfall of more than 4,000 family doctors.
GP Louise Irvine, from the Clinical Advisory Network on Sex and Gender, said: “This will take GPs away from where they are desperately needed in general practice, which is suffering from a shortage of GPs.”
The doctor said GPs were being expected to deliver services without a clear evidence base or rationale.
One NHS pilot scheme staffed by GPs describes itself as “trans and non-binary-led”, describing trans and non-binary people as “the experts of their own experience”.
In documents seen by this newspaper, health officials suggest that the controversial shift is necessary because existing specialist clinics cannot cope with demand.
In the past decade, the number of referrals to adult gender dysphoria clinics has risen by 280 per cent, the NHS England report warns, highlighting average waits of three years for a first appointment, and a risk of harm to those facing such delays.
“Based on waiting times and workforce shortages, there are concerns that the historical Gender Dysphoria Clinic model is not sustainable in its current form,” it says.
The document, dated March 2023, warned that 28,000 people are waiting for a first appointment at a gender dysphoria clinic, including 1,100 in Sussex.
Stephanie Davies Arai, the founder and director of Transgender Trend, an organisation calling for evidence-based health care, raised concerns that some of the schemes gave too much authority to those from the trans community, rather than to those taking an independent view.
Guidance issued by the British Medical Association in October says that GPs should “understand gender incongruence and the issues involved to ensure quality care is provided”. However, it says: “We need to balance what can be expected of GPs and the expertise which should rightly remain with specialist services.”
An NHS spokesman said: “While GPs will continue to focus on delivering a record number of routine appointments, a small number of primary care services alongside sexual health clinics will run gender dysphoria clinics, with staff in those services receiving specialist training from the Royal College of Physicians.”
‘This will take GPs away from where they are needed in general practice’