PRACTICE MATTERS TRANSGENDER PATIENTS
Liz Price offers advice on ensuring that transgender patients are treated sensitively and in compliance with current legislation
SUPPORTING TRANSITIONS I
T IS now estimated that around one per cent of patients are transgender, or more appropriately have ‘gender
incongruence’ – a belief that true gender is different from how an individual physically appears or was assigned at birth. Our own experience at MDDUS is that most practices are aware of at least one or two patients who are transgender, and almost all can describe awkward or difficult encounters that with better preparation could have been avoided. Patients can find it difficult to disclose
feelings of gender incongruence to GPs and it is important to recognise that the risk of self-harm and suicide for transgender (trans) patients is significantly higher than that of the general population. With this in mind, it is essential for your patients to feel supported and not uncomfortable when accessing GP services and whilst awaiting a specialist referral. As the regulatory guidance for supporting
and treating trans patients evolves, it is important that practice managers review the ways their team cares for this cohort of patients – or might breach any legislation designed to protect them. Consideration of the following aspects of
the care and treatment will help you assess how well your team are providing services.
ASSESSMENT AND TREATMENT The Royal College of Psychiatrists1
provides
guidance on the assessment and treatment of patients with gender dysphoria and you should ensure that all GPs in the practice are aware of what to do following diagnosis. The GMC has also issued specific guidance for doctors which includes directions on referral without delay, and steps to take whilst a patient is awaiting specialist review2
. The GMC provides clear guidance
on the responsibilities of GPs in tackling the risk of harm in relation to ‘bridging prescriptions’ by use of a clear set of criteria. This is where medication may be necessary before specialist input has been received and in particular where the patient is known to already be self-medicating from an unregulated source. GPs can feel out of their depth in this
area and may have concerns that they risk acting outside their level of competence and expertise. With this in mind, the Royal College of GPs has created an online CPD
12 . It is important to note that a
module to help GPs respond to the needs of adults and young people experiencing gender dysphoria3
doctor cannot refuse to see or treat a patient because of their trans status as the Equality Act (2010) has clearly established this as a ‘protected characteristic’.
MEDICAL RECORDS There is no actual legal requirement for a patient to obtain a Gender Recognition Certificate in order to ask for their personal details to be changed by the practice. Neither are they required to provide evidence of an updated birth certificate for this. A signed request from the patient is sufficient to make such changes and the reception team must be prepared to deal with requests of this nature in a sensitive way and not appear to be obstructive. The perception that a practice is being obstructive is most often the case when there is a lack of training in place, or staff are unaware of the patients’ rights or the necessary actions. In addition, we have assisted practices where the patient’s gender has been changed to ‘indeterminate’ (which is an available option within some clinical systems) in the absence of documentary evidence of a complete transition process rather than to the preferred gender stated by the patient. This could amount to indirect discrimination and the practice should always seek to accommodate patient preference. Clear guidance is available online from
the different NHS bodies on the process for changing name and NHS number, and links to these can be found within the new GMC guidance.
CONFIDENTIALITY The Gender Recognition Act (2004) provides safeguards for transgender patients, and practices should note that this legislation makes it an offence to disclose protected information acquired in an official capacity. Protected information here can be that the person has changed from one gender to the other or is undergoing a transition process. Receptionists must be careful to address
patients with their preferred name and title, and if they are uncertain it is appropriate to discreetly enquire how the patient would like to be addressed. If this preference can be
clarified within the bounds of a consultation by the patient’s GP, the records can then be clearly amended to state these preferences. This is less intrusive and allows all staff to access the same information.
REFERRAL Any clinical referral made by a GP must not include reference to the patient’s gender transition/previous gender, unless: • this has been discussed with the patient • •
the information is necessary for medical purposes.
Legal requirements around this are set out specifically within the Gender Recognition Act. This is reinforced in the GMC guidance which states that seeking patient consent
SPRING 2017 ISSUE 16
they have given consent to the disclosure
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