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

Transgender prescribing guidance is provided by BNSSG Integrated Care Board. Please see attached document entitled: Transgender Prescribing - Information for GPs

You can also find further guidance documents on the BNSSG ICB website here under Guidance from Gender Identity Clinics (GIC) Clinics -

• Information for health professionals for our gender identity clinic

• Gender Identity - For GPs and professionals

As per the attached document outlined above, we have adopted the approach where all requests for treatment are reviewed on a case-by-case basis at a clinical meeting.

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

After careful consideration, we have determined that we are unable to provide the requested information. The numbers you have asked for are so small that disclosing this data could potentially lead to the identification of individual patients. This would constitute a breach of their confidentiality and contravene the data protection principles outlined in the General Data Protection Regulation (GDPR) and the Data Protection Act 2018.

As such, we are applying the exemption provided under Section 40(2) of the Freedom of Information Act 2000, which relates to personal information. This exemption applies when disclosing the information would breach any of the data protection principles.

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?

A request like this would be discussed at a clinical meeting and reviewed on a case-by-case basis

Suggested blood tests for patients taking gender responsive hormones can be found in the attached documents entitled:

• Information about Hormonal Treatment for Trans Women

• Information about Hormonal Treatment for Trans Men

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

Blood tests are detailed in the documents outlines below:

• Information about Hormonal Treatment for Trans Women

• Information about Hormonal Treatment for Trans Men

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?

All requests for treatment are reviewed on a case-by-case basis at a clinical meeting.

Prescribing, changing, or stopping any prescribed treatment in any therapeutic area involves a risk assessment and shared decision making with the patient.

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 your question relates to prescribing hormone treatment.

The prescribing of hormone therapy in gender dysphoria must involve an ongoing specialist multidisciplinary team providing a holistic treatment approach to the individual to ensure that they are receiving optimal and safe care. Prescribing of hormones in this context is a highly specialist treatment. Clinicians working in general practice lack the expertise and clinical competence to safely prescribe and monitor these treatments without shared care processes in place. Again, this scenario would be discussed at a clinical meeting and reviewed on a case-by-case basis.