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

Yes - Please see: The Lennard Surgery Transgender Healthcare Guidelines.docx

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

We have a very small number of Shared Care Agreements in place. Because of the small number we are unable to provide detailed data as there is a risk that this might lead to a confidentiality breach allowing patients to be identified.

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?

We do not usually offer to monitor bloods without a Shared Care Agreements in place.

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

N/A

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?

We would usually undertake an assessment including risk assessment when assessing patients who are self-medicating.

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?

A draft protocol for management of transgender healthcare is currently under discussion in BNSSG ICB. Our practice is awaiting the outcome of this and of discussions regarding funding of this additional work. We recognise that the GMC's guidelines are contradictory - as they state that doctors should not undertake work for which they do not have sufficient training and expertise. Meantime the practice would make a decision based on an individual assessment including a risk assessment.