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

Yes - see our policy below, but note that this is currently under review: Current Mendip Vale Medical Group (under review)

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

In response to this request we have run some searches to identify patients with current Shared Care Agreements in place for transgender prescribing across our Bristol sites, see below for breakdown by surgery site:

Sea Mills - 1 patient.

This includes patients with both NHS and private Shared Care Agreements but does not include a number of other patients for whom a bridging prescription is offered or who have been discharged from gender clinic but for whom we are continuing to provide prescriptions.

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?

No, typically this would not be offered. 

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

See: Current Mendip Vale Medical Group (under review) 

Blood tests would be dependent on advice received / MDT discussion.

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?

Current guidance as in: Current Mendip Vale Medical Group (under review)

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?

We do not currently have a specific protocol for this, beyond that which is covered by the policy: Current Mendip Vale Medical Group (under review)