Focus On Gender Incongruence in Primary Care
A number of queries have been raised with GPC regarding the management of patients who present at their general practice with gender identity problems; including questions relating to patient records and confidentiality and, in particular, regarding prescribing and monitoring responsibilities in relation to the gender reassignment process.
In response, the GPC have produced new guidance, which:
- Aims to explain what should be provided in primary care
- Signposts to further sources of guidance
- Highlights some of the underpinning ethical and legal considerations..
Legal recognition will only follow after the issue of a full Gender Recognition Certificate by a Gender Recognition Panel. The panel must be satisfied that the applicant:
- has, or has had, gender dysphoria
- lived in the acquired gender throughout the preceding two years.
- intends to continue to live in the acquired gender until death.
In this case, the patient must be supplied with a new identity and the old identity revoked, including transferring all medical records.
Generally, patients will have lived as the alternative administrative gender prior to clinical reassignment.
A patient may request to be known by a different administrative gender without a full Gender Recognition Certificate.
This may be as a result of a clinical intervention or simply a desire to be known by a different gender.
In such cases the patient must be cautioned about the consequences of changing administrative gender, for example, in connection with cancer screening programmes. Both types of request are currently treated identically.
GPs and staff should also be careful that whatever stage of transition the person is at, this information should only be passed on when it is relevent to patient care. With the use of IT systems to help produce referral letters etc it is easy for irrelevent personal information to be included in, for example, an ENT referral, where there can be no clinical reason for sharing those details.
What happens now?
When a patient requests a gender reassignment of either type, the patient's GP or Primary Care Trust must write to the Personal Demographics Service (PDS) National Back Office. The case will then be managed by them.
The National Back Office creates a new identity with a new NHS Number and requests the records held by the patient's GP. These records are then transferred to the new identity and forwarded to the new GP.
The old NHS Number is withdrawn so that it can no longer be used. Questions on the process should be referred to the patient's Primary Care Trust.
The Department for Constitutional Affairs (DCA), which has overall responsibility for the Gender Recognition Act, is working with NHS Connecting for Health to incorporate the new legislation into the NHS Care Records Service.
The advent of the NHS Care Records Service means that there is greater opportunity to extend the policy to the patient's entire clinical record, rather than that just held by their GP.
Please refer to Chapter 7 of the procedures guide for further guidance and informaiton.