More about our service
More about our service
We provide a service for people seeking support around their gender diversity, we are commissioned to:
- Undertake diagnostic assessments for Gender Dysphoria
- Offer advice on hormone treatments to GPs with whom clinical responsibility is shared
- Provide specialist interpretation of blood test results that are undertaken by the GP
- Undertake physical examinations to ensure any risks are minimised and controlled
- Provide second opinion assessments for other Gender Identity Clinics
- Undertake assessments and make recommendations for gender reassignment surgeries
- Provide on-going support and monitoring throughout treatment, transition and gender reassignment.
The clinical team aim to provide a high quality gender identity service that:
- Follows NHS England Protocols on gender dysphoria to provide the framework for the clinical pathway through the service
- Is patient centred
- Promotes multidisciplinary working
- Advocates patient and health professional collaboration in formulating individualised care plans
- Supports and advises our primary care colleagues in the safe and effective delivery, monitoring and treatment of patients with gender identity needs
- Offers fair and equal access to the service;
- Signposts patients and other health professionals to appropriate information and support resources;
- Promotes positive awareness of gender issues and the legal rights of people who are transgender, in line with the Equality Act 2010.
Contact with the clinic
Contact with the clinic
Appointments
It is very important that you attend your appointments at the scheduled time, we ask that you present to Reception within the Mental Health Resource Centre so that you can be booked in. If you are not able to attend an appointment please let us know at the earliest opportunity so that we can rearrange your appointment, also your cancelled appointment can be offered to someone else who is waiting to be seen. One further appointment will be offered by the clinic following a DNA (did not attend), but if that second appointment is not attended then you will be discharged from the service and referred back to your GP. Where appointments are cancelled without notice, contact via the telephone will be made. If you are travelling a long distance to your appointment we recommend that you contact us prior to setting off to ensure your appointment has not been cancelled.
Clinic Letters
Northamptonshire GIC copy all correspondence sent to primary care (GP) colleagues to the service user at their home address, unless requested not to do so. Please let the GIC know how you would like your letter addressed; for instance gender, name, title, address. You can discuss this with your clinician at your appointment. We can also arrange for shortened versions containing just your treatment plan to be sent out if you should wish.
Prior to your first assessment with the GIC it may be that appointment letters or similar are addressed using the details we have on record, which may differ to someone’s preference. This will be due to what is recorded on our system but can be amended following your first contact.
We recognise that postal services can be unpredictable and clients who fail to attend appointments sometimes have informed us they had not received their appointment letter. We are aware that clinic letters following appointments are not always received as quickly as would be preferred. Unfortunately the length of time can vary due to staff capacity and number of appointments within a given period.
If you are expecting a clinic letter and have not received this within the expected time frame, please contact us via email/telephone.
GIC Emails/Telephone
The GIC can also be contact by email genderclinic@nhft.nhs.uk. This way of communicating with the clinic can be used for queries such as appointments, letters, emailing blood results, GP queries, etc. Emails sent to the GIC will be responded to as quickly as feasible, but due to limited administrative support, the complexity of a matter, or advice required, this may take some time.
We would ask if the matter is urgent that you communicate by telephone on 03000 272858, and follow up with an email. If the matter is more urgent, typically this will concern prescriptions of hormones or blood results etc., it is likely that one of staff in the clinic will ring you directly and we would be grateful if you would keep the clinic informed of your current mobile number. This also speeds up communication about appointments, which unfortunately from time to time might need to be changed.
The role of the GP
The role of the GP
Your GP is pivotal in the provision of your treatment pathway, hormone treatment and referral to other services, including secondary care services when there are co-morbid health concerns. Typically this might include unstable diabetes or hypertension, mental health and communication difficulties.
We recognise however that GPs from the wider referral base may have no knowledge of the field and from time to time GPs are reluctant to initiate treatment as they are unfamiliar with the use of this drug in particular outside of its licensed indications. GPs can seek guidance on our website with the information and links provided or contact us by phone/email found in the Contact Us section.
We will provide individual support to GPs by phone if required, particularly in the use of gonadorelin analogues such as Prostap. We would ask that any GPs with concerns get in touch directly with the clinic, by phone or email and we are able to provide copies of the National Standards of Care and reference to relevant commissioning documents.
GPs should ensure they are involved in the referral process, particularly if another clinician or healthcare provider is referring (e.g. Tavistock GIDS, CMHT). In particular, it should be checked that the GIC’s referral form has been completed for agreement to collaborate on prescribing and monitoring.
In the case of self referral – we will advise in writing that a service user has self-referred to make the GP aware and request support and collaboration.
Why we require GP involvement
NHS England commissioned Specialist Gender Services are only commissioned and resourced to provide specialist assessment of gender related distress, some specific interventions and advice or onward referral for medical treatment of Gender Dysphoria. These services and responsibilities are detailed in the NHS Interim Gender Dysphoria Protocol and Service Guideline 2013/2014.
Nationally, Gender Services successfully rely on cooperation with GP colleagues to provide prescribing and phlebotomy services as advised by the Gender Service – which is the case for all patients under our care. This arrangement benefits the patient as it is convenient and maintains continuity of care with their local GP. NHS England have made clear that GP or local CCG have the responsibility to ensure that patients have access to the treatments and monitoring that are advised by the Gender Service. The prescription and phlebotomy advised can usually be undertaken by the GP, but otherwise they can be arranged by the local CCG to be provided between a local hospital and endocrinology service. The Gender Service do not initiate nor co-ordinate these arrangements and they need to be arranged and managed locally.
The treatments advised are usually familiar to primary care practice, and specific prescribing and monitoring advice is available for the treatment of Transgender patients. The prescription of medications ‘off licence’, particularly where there are no other suitable medications available for treatment, is common to other areas of medicine. These roles and expectations are detailed in the Advice to Doctors Treating Transgender Patients. Where colleagues are concerned about their knowledge and experience in prescribing and monitoring hormone interventions for Transgender patents, we are able to advise on each case individually and we are accessible Monday-Friday by phone and email. CPD resources related to Transgender Care specifically for GP and primary care colleagues can be accessed here.
As we are unable to prescribe hormone treatments and provide phlebotomy services, we seek agreement with GP colleagues that they will do this prior to accepting the referral. Given that a high proportion of patients who are assessed seek and are advised hormone therapy as an effective way to address Gender Dysphoria, a diagnosis without treatment is unhelpful and damaging. Failure to provide the necessary treatment is the responsibility of the GP and local CCG, and if not provided may be discriminatory under the Equalities Act 2010 and will increase distress and harm to the patient.
Therefore we will not be able to progress treatment if there is no agreement in principal regarding the provision of advised treatment and phlebotomy services, or a detailed account of why it is in the best interest of the patient to be seen for assessment only.
Terminology
Terminology
Diagnosis
Northamptonshire Gender Clinic uses the ICD-10 classification system and you may see the term "Transsexual F64.0 - male to female" or "Transsexual F64.0 - “female to male” in the diagnosis section of clinic letters.
We recognise that terminology changes and classifications often lag considerably behind and that many service users object to the term "transsexualism" or "gender identity disorder". We are however obligated to use these terms until there is an official change in the classification system. Clinicians will be happy to discuss any particular wish you may have regarding how your condition is referred to in formal correspondence and wherever possible we will attempt to correspond with you in accordance with those wishes. From Jan 2022 the ICD 11 term will be “Gender Incongruence of adolescence or adulthood” (HA60). When ICD 11 is incorporated into the NHS, this will be reflected in the team’s terminology
This service recognises that people undergoing treatment may not wish to be referred to as "patients" or "clients" and may have already had experience elsewhere in the UK or overseas and may have strong views, for example, of the role of professionals as gatekeepers of service and the relevance of counselling or psychological interventions and what they regard as a normal emotional state. We welcome your views and will seek to reflect that in your individual treatment plan.
Confirming and expressing gender identity should be a positive and empowering experience for everyone.
Gender Dysphoria
In recent years the needs of individuals identifying as transgender and experiencing gender dysphoria has become increasingly highlighted, raising their profile both within the NHS and in wider society through the media. For transgender people, the sex they were assigned at birth and their own internal gender identity do not match.
This incongruence can be a source of significant distress. Indeed, the DSM-5 identifies this distress as ‘gender dysphoria’, where up to 1% of the population reportedly experience ‘Gender Variance’ (WPATH 2011). This highlights an increasing demand for support for individuals experiencing gender dysphoria.
For some individuals who experience gender dysphoria, medical interventions alone, such as hormone therapy and gender reassignment surgery, can alleviate associated distress. Others may need more in depth support around their psychological wellbeing and mental health.
Non-Binary
We recognise that there are identities other than the traditional binary identities. People who identify as non-binary may think of themselves as both man and woman (bigender, pangender, androgyne); neither man nor woman (genderless, gender neutral, neutrois, agender); moving between genders (genderfluid); or embodying a third gender.
The Northamptonshire GIC accepts referrals for people who identify as non-binary and this is in line with the guidance given to us by NHS East Midlands, who commission our service.
Non-binary individuals may have different goals to binary transgender individuals. This can lead to challenges regarding the treatments offered. Medical treatments and surgical procedures can create physiological changes that are not yet sophisticated enough to tailor to individual desires. The GIC always aims to explore, and cater to, someone’s goals and aspirations as fully as possible.