This report has just been published on the Press for Change Facebook page about a consultative meeting with the Department of Health and interested parties that was held in London yesterday

Dear Colleagues,

You may find it helpful to have this update.

The Department of Health conducted a consultation event in London yesterday, which a number of you attended.

National Commissioning
Much of yesterday's discussion focused on the new arrangements for commissioning the specialist services currently provided by the gender identity clinics. In April 2013, their contracts with the local Primary Care Trusts and regional Specialised Commissioning Groups will be transferred to the National Commissioning Board (NCB). This should eliminate the post-code lottery, under which access to care depends on where a trans person lives.

The NCB will not increase the current total amount of money paid to the clinics. GIRES estimates that the number of gender variant people seeking medical care is continuing to grow at 11% per annum. Hence, unless the clinics change their approach to treatment, this will inevitably lead to ever lengthening waiting times.

The NCB has established a Clinical Reference Group (CRG) that is currently preparing the specification of the services to be provided by the clinics. There will be 4 representatives from the trans community on the CRG, in addition to 2 NHS officials and 13 clinicians, of whom 3 work at the London clinic and 2 at Nottingham. If the CRG attempts to improve the quality and range of services to be purchased from the clinics, it appears that this would have to be achieved with no increase in cost.

The CRG intends to invite a number of trans organisations to comment on the specifications and also attend a consultation event on 17 July.

Human rights and equality law, as well as the new Standards of Care published by the World Professional Association for Transgender Health are relevant to the CRG's work. Under the above arrangements, the individual community representatives and the trans organisations will have an opportunity to ensure that they are properly considered.

Although many trans people receive good care in the NHS, the community may also need reassurance about the way the NCB will monitor the quality of care actually provided by some of the clinics when an individual is finally able to attend for gender identity treatment. The Trans Community Statement of Need, to which the GEO's representative referred during her presentation, raises a number of concerns, which included: equality and human rights issues; the misuse of the Real Life Experience (which no longer features in the WPATH Standards); inappropriate name change requirements; and negative attitudes.

Local Care
The provision of other gender identity treatments, including counselling, hormones and hair removal would be the responsibility of the GPs within the local Clinical Commissioning Groups (CCGs). Here the post code lottery will persist. At present, at least one GP offers a package, that includes counselling, specialist endocrinology and prescription of hormones, in accordance with the WPATH Standards. However, others refuse to treat (6%) or do not wish to do so (21%). Among doctors generally, 84% think that NHS money should not be spent on a treating gender dysphoria, which they consider to be a "lifestyle choice".

It would save the NHS money if more GPs offered the above care package. Referrals to a gender identity clinic would only be necessary if the GP needed a second opinion before prescribing hormones or the service user was considering surgery. Then, the GP should be able to refer directly to the clinic, without having first to obtain an opinion from a local non-specialised psychiatrist.

British Standards of Care
The Intercollegiate Committee, which the Royal College of Psychiatrists established 9 years ago to prepare British Standards of Care for treating gender dysphoria in adults, met again on 29 May 2012. It considered the latest draft (version 12.4) of the proposed British Standards. Representatives from GIRES and Press for Change attended the meeting. In the afternoon, a number of additional clinicians joined the meeting. There is continuing resistance among some of the clinicians to accept the implications of the law or the new WPATH Standards. The meeting was again inconclusive and the Committee will reconvene on 2 and 3 October 2012.

Guidance for GPs
The London clinicians, to whom the Department of Health (DH) has assigned the task of writing the guidance, have already drafted the document without engaging the trans community. The DH intends to conduct a consultation about the document by means of an online survey. However, the authors would then be in a position to accept or reject the community's responses. This is not a proper engagement process, which should commence in the formative stage of any initiative.

Warmest regards, Bernard

Bernard Reed OBE, MA, MBA
Trustee
Gender Identity Research and Education Society (GIRES)
Melverley
The Warren
Ashtead
Surrey, KT21 2SP
01372 801554
[email protected]
www.gires.org.uk