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

We will enter Shared Care Agreements in accordance with the BNSSG ICB Pathway. The principles of which are:

• Shared Care is with agreement of all parties i.e. specialist, GP and patient.

• The appropriate stabilisation period has occurred before prescribing is handed over; duration determined by the shared care protocol e.g. 3 months.

• There is a structure in place to access on-going advice and support, detailed in the Shared Care Agreement e.g. side-effects, abnormal blood tests etc.

We generally do not accept Shared Care Agreements from private providers as our GPs do not continue maintenance treatment for any specialist medication especially if initiated through a private clinic where there is no guarantee of clinical governance or quality assurance.

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

We are unable to release the detail or number of transgender Shared Care Agreements under Section 40 (2) of the FOI Act.

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?

The practice does not undertake bridging prescriptions where there is no shared care protocol in place. 

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

The practice does not undertake bridging prescriptions where there is no shared care protocol in place. A prescriber can choose not to accept clinical responsibility because of lack of familiarity or competence in the use of a medicine or if it is used outside agreed guidance. 

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 undertake bridging prescriptions where there is no shared care protocol in place. A prescriber can choose not to accept clinical responsibility because of lack of familiarity or competence in the use of a medicine or if it is used outside agreed guidance. 

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?

Currently the route for specialist advice and guidance is not commissioned. We continue to monitor this and will always be prepared to change our approach in light of any new BNSSG formulary guidance.