1) Are there transgender Shared Care Agreement and Bridging Prescription policy/guidance documents in use at your practice? 

As a practice we use the BNSSG recommended sources available on remedy, such as:

• https://remedy.bnssg.icb.nhs.uk/formulary-adult/chapters/6-endocrine-system/68-sex-hormone-responsive-conditions/

• https://remedy.bnssg.icb.nhs.uk/adults/gender-identity/

Including the guidance on Transgender Prescribing Information for GPs in BNSSG: Transgender Prescribing Information for GPs

As well as advice from other sources including "Primary care Responsibilities in Prescribing and Monitoring Hormone Therapy for Transgender and Non-Binary Adults" supplied by Gender Identity Clinic Devon Partnership and GMC and BMA guidelines: Primary care Responsibilities in Prescribing and Monitoring Hormone Therapy for Transgender and Non-Binary Adults

2) How many transgender Shared Care Agreements do you currently have in place? 

We can confirm we support a number of Transgender patients including with prescribing. However, we are unable to release the detail or number of these under Section 40 (2) of the Freedom of Information Act. Section 40 (2) pertains to the exemption of third-party personal data from disclosure. Disclosure of this data would risk identification by inference, and risk contravening the principles of data protection and confidentiality of the Data Protection Act 2018.

3) When presented with a transgender patient that is self-medicating, does your service offer to monitor bloods without a Shared Care Agreement or Bridging Prescription in place? If so, what blood tests are included for those taking feminising HRT and those taking masculinising HRT?

We do not have a specific practice policy on this point but clinicians would assess and manage each case in line with the aforementioned guidelines and bearing in mind GMC and BMA professional standards. See:  https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/managing-patients-with-gender-dysphoria

4) When a Bridging Prescription is provided, what blood tests are included for those taking feminising HRT and those taking masculinising HRT?

We do not have a specific practice policy in relation to question 4, but clinicians would assess, and manage, each case in line with the aforementioned guidelines and bearing in mind GMC and BMA professional standards.

5) Bridging Prescriptions are considered a "harm reduction strategy" in transgender healthcare (Royal College of Psychiatrists (October 2013) CR181: Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria).

Does your practice advise GPs to undertake a patient safety risk assessment before issuing, rejecting or ending a Bridging Prescription?

We do not have a specific practice policy on this but in keeping with safe prescribing our clinicians would assess safety risks before issuing a prescription.

6) The GMC recommends that GPs should collaborate with gender specialists in the provision of transgender healthcare; if the GP cannot access a gender specialist the GMC states "it would not (however), be acceptable to simply refuse to treat the patient" (LINK). 

If a GP at your practice cannot access the advice of a gender specialist, what is the protocol they will follow?

A draft protocol for management of transgender healthcare is currently under discussion in BNSSG ICB. Our practice is awaiting the outcome of this and discussions regarding funding for this additional work. We recognise that the GMC's guidelines are contradictory - as they state that doctors should not undertake work for which they do not have sufficient training and expertise. The practice would, therefore, decide based on an individual assessment including a risk assessment.