Transgender Patients/Gender Reassignment
Gender Identity toolkit: The toolkit has been produced in collaboration between the Institute of General Practice Management, Indigo Gender Service, Practice Index and Pride in Practice.
It is designed to support the knowledge and confidence of general practice teams providing inclusive and equitable care to trans and non-binary patients. The barriers trans and non-binary patients face range from direct discrimination to supportive healthcare professionals lacking the knowledge or confidence to provide appropriate care. Concurrently, the number of openly trans and non-binary patients seeking gender-affirming care from their GP and other healthcare professionals is increasing. The Gender Identity Toolkit is a practicable resource to improve the availability of inclusive and equitable care for trans and non-binary patients at a crucial moment.
A patient may request to be known by a different gender with or without the legal recognition which will only follow after the issue of a full Gender Recognition Certificate by the Gender Recognition Panel under provisions contained in the Gender Recognition Act 2004 (1). In this case, the patient must by law be supplied with a new identity and the old identity revoked, including transferring all medical records.
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 are obliged to make arrangements for patients to continue to have appropriate screening tests without need to reference the previous gender to the agency providing the service.
What happens now?
When a patient requests a gender reassignment the patient's GP or CCG must write to the Personal Demographics Service (PDS) National Back Office which creates a new identity with a new NHS Number (the old one is withdrawn and not re-used) and requests the records (or envelope) held by the patient's GP. These records are then transferred to the new identity and sent back to the practice. Written records should then be altered to remove any reference to the previous name, gender and NHS number but no changes should be made to conceal or alter the patient’s clinical history. GP clinical computer systems providers can give advice on merging clinical records.
GPs and staff should be careful that, whatever the stage of gender transition, information should only be passed on when it is relevant to patient care. For example, with the use of IT systems to help produce referral letters, it is easy for irrelevant personal information to be included in, say, an ENT referral where there can be no clinical reason for mentioning it. Furthermore, the Gender Recognition Act provides transsexual people with special protection of their privacy and so it is an offence to disclose the transsexual history of a patient with a Gender Recognition Certificate without their explicit consent. It is recommended that a warning be placed on the record stating “Confidential Patient Data – take care on disclosure of information” and that this should not be immediately visible to the patient.
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.
(1) The panel will have been satisfied that the applicant: has gender dysphoria; has lived congruent to the acquired gender throughout the preceding two years (generally this is before surgical intervention and is often referred to as “real life experience.”) and intends to continue to live in the acquired gender until death.
The role of the GP in caring for gender-questioning and transgender patients - RCGP Position Statement