I was sent a link by GIRES this morning to the new draft GIC draft guide on transgender pathways and consultation. You can access it at:
http://gires.org.uk/tranzwiki/index.php/Main_Page#Draft_Guide_on_Transgender_Pathways_in_England
I had a quick look at it this lunchtime and the main idea seems to be harmonising best practice across the NHS. In tune with the changes that are coming with NHS reforms a much bigger role for GPs is proposed with what looked to me like a proposal that they be allowed to prescribe hormones before attendance at a GIC. To me that all sounds great and has the potential to speed things up but I am also aware that some GPs are as trans aware as an old copy of the Daily Mail. There is a process by which we can make helpful suggestions for the draft but I'd ask everyone to not raise any personal experiences but instead be constructive in any criticism. If anyone wants me to collect and collate suggestions for a general response I'd be happy to do this.
Thanks
Here are the documents that the GICRG (Gender Identity Clinical Reference Group) have published for consideration when the NHS is re-organised next year
1. http://www.crazy-girl.webspace.virginmedia.com/GICRG/2012-07-24/Collated_feedback_NHS_South_of_England_held_a_Round_table_event_on_17th_July_2012.pdf
2. http://www.crazy-girl.webspace.virginmedia.com/GICRG/2012-07-24/Confirmed_GICRG_Associates_(Organisation_list_at_24-07-12)_(2).pdf
3. http://www.crazy-girl.webspace.virginmedia.com/GICRG/2012-07-24/Gender_dysphoria_(adult)_(EM)_Nov-2009.pdf
4. http://www.crazy-girl.webspace.virginmedia.com/GICRG/2012-07-24/Gender_identity_Risk_Log_East_Mids_policy_final_draft_June_12_submission.pdf
5. http://www.crazy-girl.webspace.virginmedia.com/GICRG/2012-07-24/Sch_E_Sec_19_Equity_Equality_&_No_Discrimination_2012_13_NHS_Std_Contract.pdf
6. http://www.crazy-girl.webspace.virginmedia.com/GICRG/2012-07-24/Service_Specific_Template_GIC_Draft_v3_05.07.12.doc
7. http://www.crazy-girl.webspace.virginmedia.com/GICRG/2012-07-24/Service_Specific_Template_SRS_Draft_v2_05.07.12.doc
All feedback is gratefully received - remember that these draft protocols will affect how funding will be arranged for all treatments of transgender people - so it is important that your voice is heard
Hi again, I was in discussions today with a colleague and she sent me an email from Bernard at GIRES which she received back at the end of May. In it, under the section 'Local Care', he seems to say what I thought was inferred in the report. See what you think: 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
I was astounded by some of the facts revealed there - 84% of the GP's consulted consider being trans a lifestyle choice - when around 50% of us have considered or attempted suicide on one or more occasions. Absolutely staggering that so many GP's appear to be completely unsympathetic or even antagonistic.
It was also noted that there is predicted to be a 10% increase in the number of trans people accessing the NHS for treatments year on year, but that the overall funding will remain the same i.e. quality of care will be reduced, appointment times will become longer and it will become increasingly difficult to obtain surgery after the 2 year RLE test. We will soon be back to the waiting times/RLE times will be the same as they were back in the 1980's when the RLE was a minimum of 3 years and then a minimum of 1 year after being referred to the surgeon waiting for the operation.
http://www.gires.org.uk/assets/DOH-Assets/pdf/doh-guidelines-for-clinicians.pdf
Thanks for all the posts on this. My recent experience shows (see my recent thread 'I get a nasty shock') bears out what is actually happening. What I can't understand is this: if we don't get the treatment we should be then it isn't just a case that we shrug our shoulders and say OK I'll have to just grin and bear this. For many there are consequences in terms of breakdowns and subsequent medication, hospitalisation, follow - up counselling, etc, suicide and attempted suicide (what is the cost of a coroner's court and all the police investigation), consequences for employers, the need for local authority mental health teams to support people - the list is endless. All of this costs money and lots of it usually. And it changes nothing - the trans person involved will still be wanting treatment - unless of course they have been successful in their suicide. Well I've got the name and phone number of the person who makes the commissioning decisions for the NHS and we will be having a 'full and frank discussion' on Monday morning. I'll keep you posted.
x
I'm posting again in response to your comment Carol about 'lifestyle choice', perhaps because my wife used the term 'choice' with me this morning about transitioning. To me a 'lifestyle choice' is something you do when you have a viable alternative. Choices I can think of are: gambling, eating until one becomes obese, binge drinking, spending beyond one's means to repay, and starting to take drugs. All of these have an alternative. Being trans on the other hand does not have an alternative choice but repression and anguish - day in, day out, week in, week out - until we crack up or attempt suicide. If my experience is typical the need to transition to another gender never eases. It is there constantly - a pain with nothing to give comfort or ease it; an itch that can never be scratched. So choice - what choice? Nell xxx
DH INFORMATION
Document Purpose For Information
ROCR ref: Gateway ref: 9507
Title Guidance for GPs and other clinicians on the
treatment of gender variant people
Author GIRES
Publication date 10 March 2008
Target audience Allied Health Professionals,
GPs Circulation list
Description This booklet is for information only, no
feedback is being sought.
Cross reference We have produced several documents on the
treatment of gender variant people aimed at
the general public
Superseded documents N/A
Action required N/A
Timing N/A
Contact details Monique Akosa
Equality and Human Rights group
693D Skipton House
80 London Road, Elephant and Castle,
London SE1 6LH
0207 972 5936
For recipient’s use
Policy Estates
HR/Workforce Performance
Management IM & T
Planning Finance
Clinical Social Care/Partnership Working
© Crown copyright 2008
First published January 2008
Produced by COI for the Department of Health
The text of this document may be reproduced without formal permission
or charge for personal or in-house use.
www.dh.gov.uk/publications
This is a sample of similar documents that have been sent out to clinicians and General Practitioners by various organisations PFC, GIRES, DOH. Other Gov departments, in various form since the ratification of the GRA in 2005.
To say such a large proportion of GP's are in total ignorance of Transgender matters is being rather obtuse.
The only problem I ever had with the medical proffession was trying to convince the first shrink I was refered to that my condition was not related to other issues I had at the time, who was reluctant to refer me on to a specialist in gender related issues.
Hi Cristine, Lucy and Carol, Thanks for your posts. The points you make are all highly valid. This was never better illustrated than what happened to me today. I related last week how I was told that the Porterbrook's waiting times had grown to the point where they were indefinite. Well I think I'd read so many negative pieces of information that I was getting to the point where I was feeling quite down about it all. Anyway this morning I emailed a colleague who is also trans and who works in a different department. My email was about the support group I'm trying to set up in Chesterfield but I mentioned the problems I was having at the Porterbrook. Her response was that she'd had a similar experience and after going back to her GP her referral was switched from the Porterbrook to Nottingham where she was seen inside a couple of months. She gave me the number and so I phoned up. I spoke to a receptionist but learned that the secretarial staff were all on holiday. I gave my contact details for them to get in touch tomorrow. Within an hour I took a phone call from a doctor at the GIC who told me that their waiting time was 8 - 10 weeks and they had been urging Porterbrook to send down patients if they were having to wait too long.
The moral of this is tale for me is to check local sources and take a balanced view. The internet is a great place to get information - both good and bad, balanced and unbalanced.
Best wishes,
Nell x
The right to respect, privacy and appropriate care.
Whatever their medical needs, trans people (trans men, female to male/FtM; and
trans women, male to female/MtF) should be addressed and accommodated
according to the gender in which they present, unless they specify otherwise. This
applies, as far as possible, to any correspondence. If medical and administrative
staff are unsure about whether to address an individual as Mr, Miss, Ms or Mrs, it is
better to ask, discreetly.
Confidentiality is required for all service users, but this is a particularly sensitive
issue for trans people. Reception staff and practice nurses, as well as doctors, need
to be aware that unnecessary and unwanted disclosure of the transsexual status of
service users is bad practice and, in respect of those who are covered by the
privacy provisions of the Gender Recognition Act, could amount to a criminal
offence. Furthermore, this information may be irrelevant to their reasons for
attending the surgery, since people experiencing gender variance may seek medical
treatment for conditions that are totally unrelated to transsexualism.
** People are entitled to treatment for transsexualism by law as stated in the case of
North West Lancashire Health Authority v A, D & G, Court of Appeal, 1999 (see
the forthcoming NHS publication A guide to trans service users’ rights). This is not
a condition that clinicians may decline to treat. When trans service users present
for the first time for help with their gender discomfort, it is important that they are
treated non-judgementally and sympathetically. Doctors who feel unable to do this,
should refer them to a colleague who can. **
GPs may also consider that:
“Private services may be appropriate in individual circumstances and are not
necessarily more expensive than National Health services in this field. Services from
within the private sector which meet contemporaneous standards of care can also
be commissioned” (Parliamentary Forum Commissioning Guidelines).6
This is in accordance with the British Medical Association policy that states:
“Patients who are entitled to NHS funded treatment may opt into or out of NHS
care at any stage. Patients who have had private consultation for investigations and
diagnosis may transfer to the NHS for any subsequent treatment. They should be
placed directly on the waiting list at the same position as if their original
consultation had been within the NHS.” 7,8
GUIDANCE FOR GPs, OTHER CLINICIANS AND HEALTH PROFESSIONALS ON THE CARE OF GENDER VARIANT PEOPLE
This is the base for the National LGB&T partnership initial response to the service spec dated 24th July 2012. This is a very good read and may be used as a template for feedback, if you are registered to be on the panel.
The Gender Society is on the list of bodies representing trans people so you may do so I believe.