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:

Follow 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 clinic takes over care; provide a named consultant.

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. 

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 have a formal specific policy/protocol for this exact scenario, other than that we as clinicians would discuss individual patients on a case-by-case basis in one of our clinical meetings.

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

As a general policy our practice does not undertake bridging prescriptions where there is no shared care protocol in place. Currently the route for specialist advice and guidance is not commissioned, clear or reliable.

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 a general policy out practice does not undertake bridging prescriptions where there is no shared care protocol in place. Currently the route for specialist advice and guidance is not commissioned, clear or reliable.

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?

In these specific situations, we as clinicians would discuss individuals on a case-by-case basis in one of our clinical meetings.