The Blog

Time For A Different Approach

Clearly, the specialist provision available via the NHS is insufficient, and patients, many of whom are desperate for help, support and treatment, are stuck between a rock and a hard place - it seems to be a case of put up or shut up.

Shockwaves ran through the transgender community last week when West London Mental Health Trust (WLMHT), which houses the UK's leading transgender clinic in Charing Cross, announced that it was to terminate its contract with the NHS to treat patients with gender variance, focusing instead on its mental health services provision. A full copy of the statement can be found below.

The news that the busiest Gender Identity Clinic (GIC) in the country is shutting up shop, has since been refuted, with those in charge attempting to reassure patients that there will still be specialist provision made for them under a different guise - the specific details of the restructure are unavailable at this time.

So where does that leave the clinic's current patients, those on the bulging waiting list (the combined waiting list for the United Kingdom's 11 NHS gender identity clinics is believed to be in the region of 5,000 patients) and the increasing number of people who are seeking treatment on a day-to-day basis? Charing Cross referrals have almost quadrupled in the last 10 years.

Clearly, the specialist provision available via the NHS is insufficient, and patients, many of whom are desperate for help, support and treatment, are stuck between a rock and a hard place - it seems to be a case of put up or shut up.

So what can be done to address the issue?

Anyone familiar with my blog will know that my fundamental belief is that a large proportion of these patients should be able to receive treatment from their GP. The treatment, in the most straightforward cases, requires the prescribing of hormones to assist the patient with their feelings of gender incongruence, prescribing testosterone for female to male patients and oestrogen for male to female patients.

These are hormones which GPs are entirely familiar with and which are routinely used to treat patients presenting with hormone related health issues. The reality is that not all transgender patients want full gender reassignment surgery and not all of them need extensive mental health assessments.

The majority of patients are self-diagnosed and in the absence of suitable, timely care, alarming numbers are self-medicating with unregulated hormones sourced online while other, more tragic cases, are self-harming and even committing suicide out of desperation. In clear-cut cases of gender variance their GP could help.

Since 1966, Charing Cross claims to have supported 7,500 patients. A simple calculation shows that is two patients per week. It is believed that there are as many as 650,000 people in the UK are "gender incongruent to some degree" and as awareness of gender variance grows this number will increase.

There is no doubt that Charing Cross and the UK's 10 other GICs have a vital role to play in treating specialist cases but for the more 'straightforward' patients, adults who have known their entire lives that they are living as the 'wrong' gender and who simply need the right medical prescription to ease their feelings of dysphoria - GPs have a vital role to play.

Of course it will require some education. Research has shown that GPs often feel that they lack the specialist knowledge to treat transgender patients and the patients themselves have reported that they feel unable to approach their GP for help, due to the perception that their needs will not be addressed.

In the statement put out by WLMHT, some reassurance is offered to patients that their treatment will not be affected, I find it hard to believe that such major change will go unnoticed but hope for the sake of the already desperate patients - many of whom have already waited in excess of 12 months to be seen - that they are right.

The fact remains that there is an alternative solution which could be implemented and which would make a world of difference - all that's required is a bit of lateral thinking, acceptance and willingness to learn on the part of the UK's GPs.

The future of the Charing Cross Gender Identity Clinic

The Gender Identity Clinic at Charing Cross plays a leading role nationally and internationally in helping people experiencing gender dysphoria to feel more comfortable in their own bodies.

West London Mental Health Trust (WLMHT) is incredibly proud to have been at the forefront of developing gender identity services during a period in which societal attitudes and understanding of this issue has improved so vastly, and that the Charing Cross GIC and its staff have, since 1966, helped nearly 7500 people to lead happier, healthier lives.

Demand for gender identity services has risen sharply in recent years as society has grown more understanding and awareness of NHS services has developed. This has been challenging for the clinic and resulted in waiting times that are longer than we would like. However, the clinic's staff have continued to invest huge amounts of energy and, working with NHS England, have made great strides in bringing these waiting times down while still providing a service which is rated highly by patients.

However, as WLMHT moves forward it is necessary to refocus the services that we provide. The Board has made a decision that the medium-term strategic focus for the Trust will be to develop mental health services, physical care and integration between the two.

As a result, the Trust has come to the conclusion that patients requiring gender identity services would be better served in the long term by another provider, and has therefore served notice on our contract to NHS England.

We know that many of the patients we see at the GIC are at difficult times in their lives and that this announcement may cause alarm; we would therefore like to offer the following reassurances:

This does not mean services are stopping now - we will continue to provide services as normal until such time as a new provider is able to take over; this is likely to be at least six months.

Patients from London and the South East will not be left without services or have to travel much further - NHS England as the commissioner for gender identity services will find a suitable alternative provider as quickly as possible.

Patients will not have to start their treatment all over again - continuity of care for our patients is the number one priority for clinic staff. GIC staff will work closely with NHS England and a new provider to ensure disruption to treatment is kept to an absolute minimum.

This does not mean we will let services deteriorate - WLMHT and the GIC will continue to deliver on plans we have developed with NHS England to improve access to and quality of services while it continues as the provider.

We will not reduce staffing levels - while we remain the provider of this service we have an obligation to ensure there are sufficient qualified staff to maintain and continue improvements in access and quality.

We will ensure a smooth handover to the new provider, working closely with our colleagues at the GIC and NHS England.

We will keep patients and staff informed about progress on the handover to a new provider and what this means for them as our work with NHS England develops over the coming months.