Care of Transgender and Non-Binary Patients in Primary Care
Page Contents
Prescribing and collaboration with gender specialists
Government ban on puberty suppressing hormones made indefinite
Referral Pathway into Children and Young People’s Gender Services
Changing medical records (gender and/or name)
Requests to change medical records (Gender and /or name) for young people under the age of 18
Screening for trans people at a glance
Supporting Trans Patients: A Guide for Staff at the GP Surgery
A number of queries have been raised with the LMC regarding the management of patients who present at their general practice with gender identity issues; including questions relating to patient records and confidentiality and, in particular, regarding prescribing and monitoring responsibilities in relation to the gender reassignment process.
The BMA affirms the rights of all transgender and non-binary individuals to access healthcare and live their lives with dignity, including having their identity respected. Doctors should work collaboratively with their trans and non-binary patients as they do with any patient: in a respectful, open and sensitive way, free from discrimination or bias.
GPs should understand gender incongruence and the issues involved to ensure quality care is provided. However, we also need to balance what can be expected of GPs and the expertise which should rightly remain with specialist services
The BMA has produced guidance, which:
- Aims to explain what should be provided in primary care
- Signposts to further sources of guidance
- Highlights some of the underpinning ethical and legal considerations.
A copy of the guidance can be found on the BMA website .
CQC have also published The Adult Trans Care Pathway.
The GMC has published Advice on Treating Transgender Patients
Prescribing and Collaboration with Gender Specialists
The BMA suggests that GMC advice and NHS Guidance reaffirms that GPs should approach shared care and collaboration with gender identity specialists in the same way they would with any other specialist.
When patients are seen in an NHS Gender clinic, GPs may be asked to prescribe and monitor for these patients, but this is done so under formal shared care arrangements, which are voluntary on the part of the GP
GMC ‘Good Medical Practice’ emphasises the need for doctors to ‘Recognise and work within the limits of your competence.’
You may justifiably consider prescribing and monitoring of puberty blockers/ hormones to be outside of your competence. According to the GMS contract regulations, the GMC’s Good Medical Practice, and an RCGP position statement The role of the GP in caring for gender-questioning and transgender patients
A health care professional may not perform any clinical services under the contract unless that person has such clinical experience and training as are necessary to enable the person to properly perform such services.
Doctors must provide a good standard of practice and care; recognise and work within the limits of your competence.
It is common for GPs to work under Shared Care Agreements (SCAs) set up between GICs and practices to provide joint care for patients. It is important that SCAs are agreed upon by all parties involved, ensuring the appropriate levels of resource, competence and expertise are established, as informed by the patient’s level of medical risk. NHS bodies need to ensure that local shared care arrangements are adequately funded to support the ongoing care and treatment of patients.
The Royal College of GPs recognises that GPs are not experienced in treating and managing patients with gender dysphoria and trans health issues. Gender dysphoria and gender identity issues are not part of the GP curriculum or GP Specialty Training, and GPs are currently required to refer patients experiencing gender dysphoria to gender identity specialists for further assessment and treatment advice. GPs face difficulties in accessing gender identity specialists in a timely way which often has severe implications for the mental and physical health of their patients. As such, GPs are under increasing pressure to provide services which are usually provided in specialist clinics, as they lie outside the remit of a GPs generalist expertise, with limited access to specialist support.
The BMA Medical ethics department produced a useful guidance document titled ‘The Interface between NHS and private treatment : a practical guide for doctors in England, Wales and Northern Island’, May 2009
Patients who are entitled to NHS-funded treatment may opt into or out of NHS care at any stage.
When patients seek specialist treatment privately, the private consultant may prescribe any necessary medication. Often, however, consultants recommend a particular medication and patients ask their GP to issue a NHS prescription rather than paying for it privately. Even though individuals opt for private treatment or assessment, they are still entitled to NHS services.
Where the GP considers that the medication recommended is clinically necessary:
- he or she would be required under the NHS terms of service to prescribe that medication within the NHS, even if the assessment from which the need was identified was undertaken in the private sector; however
- if the medication is specialised in nature and is not something GPs would generally prescribe, it is for the individual GP to decide whether to accept clinical responsibility for the prescribing decision recommended by another doctor. (The same principles apply to requests to undertake diagnostic tests or other procedures within the NHS.
Given the long wait for NHS specialist services, it is understandable that some patients will choose to approach private providers for support.
If you do accept any shared care with a private provider, you would need to satisfy yourself that the provider is appropriately accredited and practising in line with UK best practice. We are aware of some private providers where concerns have been raised about their credibility and practices. You may wish to review the GMC registration of the provider via the GMC website.
Guidance on shared care agreements with unregulated providers for children and young people with gender incongruence
NHS England has cascaded new guidance that advises general practitioners against shared care agreements with unregulated providers in relation to hormone medication to children and young people under 18 as a response to gender incongruence / gender dysphoria.
The guidance outlines that:
A GP must refuse to support the private prescribing or supply of GnRH analogues.
A GP should refuse to support an unregulated provider in the prescribing or supply of alternative medications that may be used to suppress pubertal development.
A GP should refuse to support an unregulated provider in the prescribing of exogenous hormones.
- The cascaded letter states an unregulated provider is one that is not registered with, or regulated by, a UK health regulator such as the Care Quality Commissionor Health Inspectorate Wales. More information is available in the letter.
- In all cases, safeguarding measures should be considered where the administration of a medicine from an unregulated source presents an immediate safety risk.
Cervical screening opt-in process for transgender and non-binary people
The new opt-in process for transgender and non-binary people to receive automatic routine invitations is now live. GP practice managers and screening providers, including sexual health clinics and transgender services, should now begin to identify and invite eligible participants for a consultation to discuss the opt-in.
A flowchart of the process to be followed can be found here , and the slides from an NHS England webinar which describes the opt-in can be accessed here.
Government ban on puberty suppressing hormones made indefinite – December 2024
The Government has announced that the existing emergency measures banning the sale and supply of puberty suppressing hormones for the treatment of gender dysphoria or incongruence in under-18s have been made indefinite. Further information can be found here.
NHS patients who are already receiving these medicines for gender dysphoria or incongruence can continue to access them, as can patients receiving the medicines for other uses.
For children and young people whose access to puberty suppressing hormones have been discontinued (for example, prescriptions from non-UK prescribers) and are not on the waiting list of children’s gender services, NHS England will offer a targeted support from local NHS mental health services in England. Children, young people and their families can access this service, which is being coordinated through NHS Arden and GEM Commissioning Support Unit, by contacting agem.cyp-gnrss@nhs.net or calling 03001316775 and selecting option 3.
PATHWAYS clinical trial paused following new MHRA advice – GOV.UK
Referral Pathway into Children and Young People’s Gender Services – September 2024
In keeping with advice from the Cass Review, from 1st September 2024, new referrals into Children and Young people’s Gender Services must be first directed to either Children and Young people’s Mental Health services or to Community or Hospital Paediatric services. Although GPs cannot refer directly into the gender service, it is likely that primary care service providers will be first point of contact for children, young people and their families, and so need to be aware of this new referral pathway. The Gender Experience Summary form available on the national referral support service website can be helpful to guide initial assessments with young people and their parents, and improve the information provided to secondary care services. Further information can be found in the Primary Care section of the Referral Pathway for Specialist Service for Children and Young People with Gender Incongruence. The LMC will be clarifying local referral pathways with our ICBs.
ICBs should clarify local referral pathways for their area. In the absence of a local pathway, the LMC would advise practices that they may choose to refer to either option.
Referring and prescribing guidance for children and young people’s gender care – June 2026
New guidance has been published that describes the current referral and prescribing arrangements for gender care for children and young people (CYP) and clarifies the role of primary care within the specialist pathway. Read it on the NHS CYP Gender Referral Support Service website.
Waiting Lists
You have a duty to try to support the needs of the patient within the constraints of the NHS offer with appropriate referral to the NHS GIC. The fact that there is a long wait for this service on the NHS is out with your control and is very much an issue for the Commissioners and in no means obliges you as an individual GP to find/provide an alternative service.
Its is the responsibility of specialist Gender Identity clinics to manage their waiting lists-not practices-and if there is the necessity to explore whether a patient still requires access to their service after a long wait then they should be approaching the patient directly.
Changing Medical Records (Gender and / or Name)
Sometimes doctors are asked by transgender patients to change their name and/or gender on the medical record. Patients may request to change gender on their patient record at any time and do not need to have undergone any form of gender reassignment treatment in order to do so. Patients have the right to change the name and gender on the medical record irrespective of whether they intend to obtain a Gender Recognition Certificate
Those undergoing gender reassignment can request a change to their gender marker without changing the NHS number. This needs to be discussed with the patients, and preferably a form signed by the patient and included in their medical records.
Alternatively, the practice can submit a gender reassignment request, and the patient will usually be given a new NHS number and would be registered as a new patient at the practice. The practice must inform the patient that this will involve a new NHS number being issued for them, which is not reversible. To revert back to their original gender, they would receive a third NHS number. The practice also needs to ensure the patient is aware of the implications in issuing a new NHS Number, including potential loss of old medical record, potential screening concerns, and potential loss of place on NHS waiting lists. The practice should confirm this has been discussed with the patient when notifying PCSE. Full details of the PCSE process for a gender reassignment request can be found here.
The LMC view is that in practice it is likely to prove to be very difficult to transfer all medical information to the new record. Transgender patients often will have extensive medical records covering their transition, mental health and physical health. To remove all references to gender may be almost impossible and will render the notes incomplete or incomprehensible.
However, it is obviously important to preserve the medical record as much as possible for the ongoing safe care of the patient and for the handover of care to other clinicians in the future.
Our advice is as follows
- Engage with the patient and explain fully the importance of maintaining the clinical record.
- Some patients may be happy for their old records to be kept under the new identity. If this is the case then we suggest that you keep a record of the conversation with the patient and obtain their consent to keep the old records with the new identity.
- If not, then offer to redact Name and Gender but not remove clinical information that reveals a previous gender identity (e.g. prescriptions for contraceptive pill, previous breast conditions, previous gynaecological history etc.)
- If the patient insists that all references to previous gender are removed and this is practically impossible then we suggest that the important clinical information should be summarised in a way that is gender neutral.
- For example, a pulmonary embolus following breast surgery as part of gender re- assignment might be coded as “Post-operative Pulmonary Embolus” and in free text a note to ask patient for further details.
- If the entire record is not kept, then the patient should be asked to consent to this and a record kept of the discussion and consent.
- Old records should not be kept in a separate file
- Always involve the patient in the decision and ensure that a full discussion takes place.
Name Change on GP Record
A patient can be known as the title they wish while remaining with their current gender. For example, a gender listed as male with a title of “Miss”. You can also state in the free text why the change is occurring so the registration team do not mistake the change as an administrative error.
If a transgender patient would like to change their registered name, there is no legal requirement for the practice to request evidence, although it is considered best practice to do so.
This change can be made for both adults and young people under the age of 18.
Requests to change medical records (Gender and /or name) for young people under the age of 18
An independent review published by Professor Alice Sullivan that looked at data, statistics and research on sex and gender (published on 19.3.2025) has identified a serious safeguarding risk in the current process of re-assigning gender and sex identity in medical records for children and young people.
In response, the Secretary of State for Health and Social Care has directed that the process for changing NHS numbers and gender markers for children and young people under 18 is stopped with immediate effect. General practice teams can continue to change the name / title and put a reminder note on the home screen of the GP record and will no longer need to apply for a new NHS number.
Options for how a child and young person under 18 may record their gender in medical records are being considered, with further advice and information for general practice teams to follow in due course
NHS Screening
It is important that practices and patients understand the implications of gender change in relation to the NHS screening programs
This information is for transgender and non-binary people in England and provides information about the adult NHS screening programmes that are available in England. – https://www.gov.uk/government/publications/nhs-population-screening-information-for-transgender-people/nhs-population-screening-information-for-trans-people#cervical-screening
Screening for Trans People at a Glance
Trans women and non-binary people assigned male at birth who are registered with a GP as female:
- are invited for breast screening
- are invited for bowel cancer screening
- do not need cervical screening as they do not have a cervix
- are not routinely invited for abdominal aortic aneurysm (AAA) screening but can request screening
Trans women and non-binary people assigned male at birth who are registered with a GP as male:
- are not routinely invited for breast screening but can request screening
- are invited for bowel cancer screening
- do not need cervical screening as they do not have a cervix
- are invited for AAA screening
Trans men and non-binary people assigned female at birth who are registered with a GP as female:
- are invited for breast screening
- are invited for bowel cancer screening
- are invited for cervical screening
- are not invited for AAA screening
Trans men and non-binary people assigned female at birth who are registered with a GP as male:
- are not routinely invited for breast screening but can request screening
- are invited for bowel cancer screening
- are not routinely invited for cervical screening but can request screening
- are invited for AAA screening but do not have a high risk of AAA
Trans men who are pregnant should be offered the same antenatal and newborn screening tests as all other pregnant individuals.
Advice on managing cervical screening in a transgender male who has not undergone surgery to remove female reproductive organs
- If the gender is being re-assigned from female to male, screening will become the responsibility of the practice.
It is possible via Open Exeter to download and complete a blank cervical screening form. If this is completed in male identity with the appropriate clinical history, then the lab will process the sample with a male identity.
The responsibility for cervical screening in this situation passes from the national programme to the GP practice.
Our advice is:
- Engage with the patient and agree how call and recall will be organised and how it is recorded on the record
- Stress the importance of accurate and complete medical records and encourage the patient to have the information recorded on their medical record.
- If the patient does not want it recorded in the medical record then consider giving the patient the results and putting a non-specific recall on the notes for the appropriate time interval. The patient should be informed of when the next smear is due and advised to make arrangements with the practice at that time
Coding on Patients Medical Records
We have sought further advice and the Snomed browser has the following:
1108101000000105 – Provision of information about NHS screening programmes available to transgender and non-binary people – this would suggest that the trans or non-binary patient is fully informed about the screening programmes and could be used to identify them.
Perhaps also adding one of the following screening codes:
715011000000109 – Breast screening administration – free text could be added to indicate whether screening is due or not.
512501000000109 – Breast Screening Offered
811481000000106 – Breast screening disclaimer received. – to indicate that the patient has opted out of breast screening.
1104621000000103 – Cervical cancer screening offered
112241000119107 – Cervical Cancer screening declined.
1104671000000104 – Cervical cancer screening not offered.
171169001 – No smear – no cervix
There are few codes which would apply, without adding something to indicate that the patient is either transgender or non-binary, so we would suggest that the practices search for the main code initially, then link it to one of the other codes – as any of the screening codes could be used for any patient.
Disclosing Gender History
It is unlawful to disclose a patient’s gender history without their consent.
When communicating with other health professionals, gender history doesn’t need to be revealed unless it is directly relevant to the condition or its likely treatment.
The gender status or history of trans and non-binary people should be treated with the same level of confidentiality as any other sensitive personal information.
However, there will be circumstances where it is appropriate to disclose this information – with your patient’s consent – so that the service you are referring to is aware that your patient may have specific needs.
For example, if you are referring a trans man for treatment to a gynaecology service, letting the clinic know in advance should allow them to make sure that clinical, administrative and support staff respond appropriately to your patient and care for them in a manner that respects their dignity.
The BMA guidance states the following:
The Gender Recognition Act 2004 provides safeguards for the privacy of individuals with gender incongruence and restricts the disclosure of certain information. The Act makes it an offence to disclose ‘protected information’ (i.e. a person’s gender history after that person has changed gender under the Act) when that information is acquired in an official capacity.
This means that the ‘protected information’ can only be disclosed when:
- it is to another health professional; and
- it is for a medical purpose; and
- there is a reasonable belief that the patient has consented to the disclosure.
The LMC advice, based on this is:
- Involve the patient in the decision on what information to disclose
- Only disclose information that is clinically relevant to the condition that the patient is being referred for and that the patient has agreed to share.
- Offer to copy the patient into the correspondence including the referral letter
Talking Transgender Podcast
Dr Cora Sargent, Educational Psychologist and a Senior Training Fellow at the University of Southampton, joins us to discuss the work she carries out as part of the gender research group. Cora draws on her own experiences of being transgender to explain her journey with trans services and her GP. She also highlights the societal barriers that non-binary and transgender people face.
Listen to the podcast here: Talking Transgender