This site is intended for health professionals only

Transgender people “let down” by discrimination in the NHS

Steps must be taken to improve care in the NHS for transgender people, the first report on the issue produced by a UK parliamentary committee has announced.

“We have found that the NHS is letting down trans people, with too much evidence of an approach that can be said to be discriminatory and in breach of the Equality Act,” it read.

The report said that practice staff, as gatekeepers, are vital and need a better understanding of: trans identities; the diagnosis of gender dysphoria; referral pathways into Gender Identity Services; and their own role in prescribing hormone treatment.

The trans community organisation the Beaumont Society told us the inquiry about the “astonishingly negative reaction by a few GPs” when a trans person appears for the first appointment to ask for an assessment to begin. “You'll be taking money away from more deserving cancer patients” is one quote in the report.

The inquiry found that “matter of serious day-to-day importance at a primary care level is the persistent refusal of some General Practitioners to even make referrals to gender identity clinics (GICs)”.

The clinicsare provided as part of mental-health services, which is “concerning” as “this is a relic of the days when trans identity in itself was regarded as a disease or disorder of the mind,” the inquiry stated.

NHS England, also admitted in the inquiry that that there was an “unwillingness by some general practitioners to prescribe and monitor hormone therapy”, and the report added.

The inquiry is also calling on a “root-and-branch review” of this matter to also be conducted, completed and published within the next six months. 

What practice staff must do - from RCGP guidelines

1. Be understanding. A negative reaction can do serious harm.

2. Get names and pronouns correct (ask discreetly if necessary).

3. Be aware of the importance of medical confidentiality.

4. Be conscious that co-existing health issues may not be linked to gender issues.

6. Support the treatment set out by gender service.

7. Consider signposting to sources of support within the community and voluntary sectors.

8. Understand and use appropriate terminology. Transgender is an umbrella term for people whose gender identity and/or gender expression differs from the sex assigned to them at birth, they may or may not decide to alter their bodies hormonally and/or surgically. Transsexual equals a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex. In the trans community cross-dressing is seen as a pejorative term and is not used.