Working with doctors Working for patients

Prescribing

From Good practice in prescribing and managing medicines and devices
  1.  

  2. 67. The term ‘unlicensed medicine’ is used to describe medicines that are used outside the terms of their UK licence or which have no licence for use in the UK.25 Unlicensed medicines are commonly used in some areas of medicine such as in paediatrics, psychiatry and palliative care. They are also used, less frequently, in other areas of medicine.
  3. 68. You should usually prescribe licensed medicines in accordance with the terms of their licence. However, you may prescribe unlicensed medicines where, on the basis of an assessment of the individual patient, you conclude, for medical reasons, that it is necessary to do so to meet the specific needs of the patient.
  4. 69. Prescribing unlicensed medicines may be necessary where…There is no suitably licensed medicine that will meet the patient’s need.
  5. 70. When prescribing an unlicensed medicine you must: 

     

    1. a. be satisfied that there is sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy
    2. b. take responsibility for prescribing the medicine and for overseeing the patient’s care, monitoring, and any follow up treatment, or ensure that arrangements are made for another suitable doctor to do so
    3. c. make a clear, accurate and legible record of all medicines prescribed and, where you are not following common practice, your reasons for prescribing an unlicensed medicine.

Most of the medications used for the treatment of gender dysphoria are not licensed for this specific indication, although GPs will be familiar with their use in primary care for other purposes. Our guidance (see text box) clearly allows for prescribing outside the terms of the licence (‘off-licence’) where this is necessary to meet the specific needs of the patient, and where there is no suitably licensed medicine that will meet the patient’s needs.

Hormone therapy may have an irreversible effect on your patient’s reproductive capacity. When speaking with them about the risks and benefits of treatment options, you may want to suggest that your patient consider storing gamete before starting any treatment.

Work collaboratively with colleagues to maintain and improve patient care 

From The duties of a doctor

 

"You must work with colleagues in the ways that best serve patients’ interests"

You must co-operate with GICs and gender specialists in the same way that you would co-operate with other specialists, collaborating with them to provide effective and timely treatment for trans and non-binary people. This includes:

  • prescribing medicines recommended by a gender specialist for the treatment of gender dysphoria
  • following recommendations for safety and treatment monitoring
  • making referrals to NHS services that have been recommended by a specialist.

We set out some general principles for managing shared care in our guidance Good practice in prescribing and managing medicines and devices (see paragraph 35-43). Please note that “shared care” here refers to collaboration between gender specialists and other doctors to provide care; it does not refer to specific contractual arrangements between providers and commissioners known as “shared care agreements”.

Once the patient has been discharged by a GIC or gender specialist, the prescribing and monitoring of hormone therapy can be carried out successfully in primary care without further specialist input. From the patient’s perspective, management in primary care is far easier, and there is no specific expertise necessary to prescribe for and monitor patients on hormone therapy.

It is not necessary to refer trans people back to their gender specialist before referring them to other secondary or tertiary providers, for matters unrelated to their gender history.

If you feel you lack knowledge about the healthcare needs of trans people, you should, in the short term, ask for advice from a gender specialist. In the longer term, you should address your learning need as a part of your continuing professional development (CPD – see next page) which will enable you to provide treatment to meet your patients’ needs. E-learning is freely available on the RCGP website and carries CPD points:

Gender Identity Clinics (GICs) in the UK

England

  • Gender identity clinics in London and the southeast
    West London Mental Health NHS Trust Gender Identity Clinic
    179-183 Fulham Palace Road, London, W6 8QZ
    Telephone: 020 8483 2801

The West London clinic's website has an overview of information useful for anyone with gender identity needs, not just those in the area.

  • Gender identity clinics in the north
    Sheffield Health and Social Care NHS Foundation Trust Sexual and Relationship, Sexual Medicine and Transgender Services
    Porterbrook Clinic, Michael Carlisle Centre, Nether Edge Hospital,
    75 Osborne Road, Sheffield, S11 9BF
    Telephone: 0114 271 6671

The Sheffield Gender Identity Services website includes information about referrals, clinic opening hours, and links to eligibility criteria and the Porterbrook Clinic.

  • Leeds Gender Identity Clinic
    Management Suite, 1st floor, Newsam Centre, Seacroft Hospital, York Road, Leeds, LS14 6WB
    Telephone: 0113 855 6346

The Leeds clinic's website covers referrals and commonly used medications.

  • Northumberland Gender Dysphoria Service
    Benfield House, Walkergate Park, Benfield Road, Newcastle, NE6 4QD
    Telephone: 0191 287 6130

The Northumberland Gender Dysphoria Service website has a leaflet outlining eligibility and how to access services.

  • Gender identity clinics in the Midlands
    Northampton Gender Clinic
    Danetre Hospital, London Rd, Daventry, Northamptonshire NN11 4DY
    Telephone: 01327 707200
    Email: genderclinic@nhft.nhs.uk

Visit the Northampton Gender Clinic's website for more information.

  • Nottingham Centre for Gender Dysphoria
    3 Oxford Street, Nottingham, NG1 5BH
    Telephone: 0115 876 0160

Visit the Nottingham Centre for Gender Dysphoria website for more information.

  • Gender identity clinics in the southwest
    The Laurels Gender Identity and Sexual Medicine service (Devon Partnership NHS Trust)
    The Laurels, 11-15 Dix's Field, Exeter, EX1 1QA
    Telephone: 01392 677077

The Laurels' website has information about the types of services on offer and the help available during transition.

Northern Ireland

Opening Hours for Telephone Contact
9.00am – 5.00pm Monday – Friday.

Scotland

There are 4 gender specialist clinics in NHS Scotland and referrals can be made to these clinics to explore with the patient the options available to them.

  • The main NHS Scotland Gender Identity Clinic is based at the Sandyford in Glasgow and accepts referrals from across Scotland. It is also possible to self-refer to the Sandyford clinic www.sandyford.org or 0141 211 8130.
  • The Sexual Problems Clinic within the Royal Infirmary of Edinburgh accepts patients from NHS Lothian Health Board area and also NHS Fife, NHS Borders, NHS Forth Valley, NHS Tayside and the North of England. The clinic can be contacted on 0131 242 2515.
  • NHS Grampian. Referrals are accepted from general practitioners of patients residing in Grampian, Orkney and Shetland. All referrals should be made to Dr John Callender, Royal Cornhill Hospital, Aberdeen AB25 7ZH.
  • NHS Highland Sexual Health Clinic based at Raigmore Hospital, Inverness accepts selfreferrals. The clinic can be contacted on 01463 704202. The clinic does not accept out of area referrals.

Wales

Wales does not currently have a gender identity clinic but in April 2015 Welsh Assembly members voted for an independent study to be carried out into the feasibility of opening a gender identity clinic in Wales.