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

As a practice, we use the guidance that is publicly available via the remedy website. This is provided by the BNSSG ICB: https://remedy.bnssg.icb.nhs.uk/adults/gender-identity/

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

We can confirm that we have transgender Shared Care Agreements in place for patients where requested by secondary care providers, 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?

As per the BMA guidance on remedy (referenced above), we would consider monitoring bloods without a Shared Care Agreement or bridging prescription in place. The blood tests would be in line with the guidance given. 

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

Where a bridging prescription is provided, the blood tests would be in adherence to the guidance provided by the BMA that is publically available on the remedy website and, where necessary, on the advice of a specialist in the field.

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?

The practice does not advise GP's to undergo a specific patient safety risk assessment for transgender patients. Our clinicians attend to transgender patients' general mental health and physical needs on a case by case basis as they would for all patients that attend the surgery.

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?

If our GP practice was unable to access the advice of a gender specialist, the GP would discuss the patient at a multidisciplinary team meeting with other GP's present.