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

We will enter Shared Care Agreements with private providers as we would with an NHS service, providing the provider:

• Follows NHS standards of care,

• They practice in the UK and are CQC registered,

• Provide us with a written Shared Care Agreement,

• Initiates and provides treatment for the first three months and until on stable dosing,

• Continue to monitor and advise until an NHS GIC takes over care,

• Provide a named consultant.

We will take on shared care prescribing for patients in an NHS gender clinic, in line with Bristol North Somerset and South Gloucestershire (BNSSG) ICB advice.

We keep shared care prescribing under regular review and will be prepared to change our policy in light of any new BNSSG guidance.

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 FOI Act.

Section 40 (2) pertains to the exemption of third-party personal data from disclosure. Disclosure of this data would risk identification by interference , 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?

As prescribers our clinical team take on the individual, ethical, clinical and legal responsibility for each prescription written.

We are under no obligation to take on bridging prescriptions from private practice for patients awaiting an NHS gender clinic appointment.

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

As prescribers our clinical team take on the individual, ethical, clinical and legal responsibility for each prescription written.

We are under no obligation to take on bridging prescriptions from private practice for patients awaiting an NHS gender clinic appointment.

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?

As prescribers our clinical team take on the individual, ethical, clinical and legal responsibility for each prescription written.

We are under no obligation to take on bridging prescriptions from private practice for patients awaiting an NHS gender clinic appointment.

We will comply with the General Medical Council and the advice they set out in Good Medical Practice.

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?

Clinicians would discuss patients on a case by case basis within an appropriate clinical meeting.

We will comply with the General Medical Council and the advice they set out in Good Medical Practice.