General practice is underpinned by the GMS contract which specifies addressing healthcare inequalities. https://www.england.nhs.uk/wp-content/uploads/2023/08/PR00497-standard-general-medical-services-contract-august-2023.pdf
In combination with the ethical principles of Good Medical Practice https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-medical-practice and supported by the Locally Commissioned Service by NHS Sussex https://int.sussex.ics.nhs.uk/wp-content/uploads/2022/03/SSX-LCS021-Management-of-Transgender-Non-binary-and-Intersex-TNBI-Adult-Patients-in-Primary-Care.pdf , we have an informed consent model of care in place for trans, non-binary and intersex people needing hormone treatment to facilitate wellbeing.
In 2016 the deputy chief executive of the GMC wrote to the BMA regarding hormone prescribing in primary care…. https://www.gponline.com/gmc-stands-guidance-urging-gps-prescribe-hormones-trans-patients/endocrine/article/1396868
“She added she did not believe providing care for patients with gender dysphoria was a highly specialist treatment area requiring specific expertise. The same hormone treatments are “commonly used in general practice for treating patients with prostate cancer or endometriosis”, she said.
“While [Good Medical Practice (GMP) guidance] states “you must recognise and work within the limits of your competence”, this principle cannot be a bar to doctors taking on new responsibilities or treating unfamiliar conditions,” she warned.
“We would expect GPs to acquire the knowledge and skills to be able to deliver a good service to their patient population. For some unfamiliar conditions or medicines, this may mean undertaking training or working with support or supervision for a period, in order to ensure that patients receive safe, effective care while a GP is extending or updating their knowledge and skills.”
At WellBN, among other GP practices, we believe this is correct and since 2016 have prescribed hormones to people as indicated by their presentation and using an informed consent model of care which underpins all of primary care. We have established robust pathways, a multidisciplinary team and built up expertise amongst our clinicians in the prescription of hormones to thousands of patients over the past 8 years and have access to specialist advice when needed.
We use the well-established principle of Gillick competence to assess capacity to consent in young peoples, as per NHS guidance.
All patients accessing gender affirming care at WellBN are referred via the nationally specified pathways as instructed by NHSE during an inspection in 2021. We take great care to ensure patients are aware of the long waiting times and that they can access appropriate monitoring and care with us whilst waiting.
We welcome registrations from people living outside our geographical boundaries. This allows them to continue to access care remotely in the event they move away (eg for university studies), or cannot access the care they need locally.