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NHS England is the responsible commissioner for the specialised element of the gender dysphoria pathway, which in England is delivered through seven specialist Gender Identity Clinics.
The Laurels Clinic for Gender and Sexual Medicine is an NHS specialist Gender Identity Clinic in Exeter. It is operated by Devon Partnership NHS Trust and is one of the seven national centres offering services for the management of gender dysphoria.
Specialist Gender Identity Clinics provide assessment, care and treatment for people affected by concerns regarding gender identity, role and/or expression that differs from the cultural norms for their birth-assigned sex; such concerns may result in gender dysphoria.
Specialist Gender Identity Clinics offer or facilitate a variety of therapeutic practical, physical, medical and surgical interventions for people affected by gender dysphoria.
Clinical guidance for GPs will be provided by the gender specialist physician, and is supported by the Devon Partnership Trust prescribing guideline for gender dysphoria.
NHS England guidance (Specialised Services Circular 1620, April 2016) states that:
More detailed advice is available from the NHS England Specialised Services Circular 1620 (April 2016).
Refer also to the Devon Partnership Trust prescribing guideline for gender dysphoria.
The following advice is taken from the NHS England Specialised Services Circular 1826 (January 2018):
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 provider may make a diagnosis of gender dysphoria through remote contact with the patient and in such cases a private prescription may be issued, or the patient's GP will be asked to issue a NHS prescription. Either way, it is likely that the patient's GP will be asked by the online provider to assume responsibility for monitoring and testing and for passing the results of the monitoring and testing to the private on-line service.
Regulatory guidance and NHS England's current commissioning protocol supports a decision by a GP to accept a request made by a private on-line medical service to assume responsibility for prescribing, and for monitoring and testing, in cases where the GP is assured that the recommendation is made by an expert gender specialist working for a provider that offers a safe and effective service.
Where this is the case, GPs should also refer to "responsibilities in prescribing and monitoring hormone therapy for transgender and non-binary adults" above.
A GP may reasonably decline to accept responsibility for prescribing, monitoring and testing if the GP is not assured that the recommendation for prescribing has been made by an expert gender specialist, as long as the GP is also satisfied that declining responsibility would not pose a significant clinical risk to the individual. It is reasonable for the GP to ask the provider to demonstrate that it has the necessary expertise before responding to the provider's request.
All requests should be considered on a case-by-case basis.
More detailed advice is available from the NHS England Specialised Services Circular 1826 (January 2018).
For further guidance and information: