The General Medical Council (GMC) has responded to British Medical Association’s (BMA) concerns regarding proposals for GPs to undertake specialist prescribing for patients with gender dysphoria.
Susan Goldsmith, deputy chief executive of the GMC, wrote in a letter to Dr Chaand Nagpaul, the chair of the BMA General Practitioners Committee, that guidelines were in place to help GPs treat transgender patients.
The GMC advises that doctors should only prescribe hormones if the patient is already self-prescribing with hormones from an unregulated source, the prescription would mitigate the risk of self-harm and suicide and the doctor has sought advice from a gender specialist.
However Goldsmith said that following Nagpaul’s concerns, the GMC would revise the wording to make these exceptional circumstances clearer.
Goldsmith adds: “Having said that, we don’t believe that providing care for patients with gender dysphoria is a highly specialist treatment area requiring specific expertise.”
“Our understanding is that the same, or similar, hormone medications are commonly used in general practice for treating patients with prostate cancer or endometriosis,” she says.
Goldsmith also recognises in her letter the “push to manage various long term conditions in primary rather than secondary care” is putting increased pressure on GPs’ resources.
Goldsmith’s letter was a response to an earlier letter from Dr Chaand Nagpaul, which raised concerns about GPs carrying out specialist prescriptions.
Nagpaul’s letter outlined two concerns: the GMC’s recommendations for prescribing hormone treatments to those with gender dysphoria and continued prescriptions under shared care arrangements.
He said: “Our key concern is to ensure that GPs can prescribe safely within their limits of competence, and this includes the ability to decline to prescribe, where appropriate.
“Feedback we have received from a large number of practices is that the GMC guidance places inappropriate expectations on GPs, and undermines the GMC’s own Good Medical Practice (GMP).”
However, Nagpaul acknowledges a “legitimate moral need to ensure that patients with gender dysphoria receive prompt and timely care”, especially as they are at higher risk of psychological morbidity through delays in treatment.
Goldsmith directs concerned doctors to the GMC’s online advice on how GMP applies when treating transgender patients.