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

We do not routinely enter into transgender Shared Care Agreements (SCA) or bridging prescriptions for transgender patients. Where we have done so these are usually historic agreements and only through NHS Gender Identity Services.

You may wish to contact 3rd party services for examples of their SCAs.

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

FOI Exemption, Section 40, Exemption 2 of the FOIA applies to this request. We hold this information but we are unable to provide this data due to the low numbers i.e. the information being so specific to an individual it would identify them even if we did not release their name.

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?

Please see response to question 1.

Any tests would be defined by the individual Shared Care Agreement in place. We cannot provide this level of information as it may identify a patient.

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

Please see the response to question 3.

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?

Please see the response to question 3.

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?

The decision has not been taken lightly. The GPs at the practice have discussed how we can support transgender patients in the shared care/bridging prescription arena. It is important to note any specialist service must be sustainable so that patients receive quality care and continuity of care. This is particularly pertinent where there are medicine shortages or queries from a patient. It is the experience of the practice that we are regularly unable to seek specialist input within a timescale that meets the needs of the patient, meaning the responsibility would fall to a GP for whom transgender prescribing is not their area of expertise.

The GP team does not feel competent in taking on clinical responsibility for the prescribing of specialist medicines in this clinical area. NHS England's guidance states that when clinical responsibility for prescribing is transferred to general practice, it is important that the GP is confident to prescribe the necessary medicines.