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

Yes.

BNSSG transgender prescribing information for GPs: Transgender Prescribing - Information for GPs

And local gender identity management/referral guidance: https://remedy.bnssg.icb.nhs.uk/adults/gender-identity/gender-identity/

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

17.

We have a total of 38,383 patients at Bridge View (all 5 Surgerys).

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?

This is done on a case by case basis. Advice would be sought from a gender identity specialist.

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

This is done on a case by case basis. Advice would be sought from a gender identity specialist.

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?

Yes. Advice would be sought from a gender identity specialist.

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?

We have always been able to obtain advice from a gender specialist. If this was not possible then the issue would be discussed at a meeting of the clinical team and a plan of action agreed.