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

We follow the RCGP, GMC, and local BNSSG ICB (Bristol, North Somerset and South Gloucestershire Integrated Care Board) guidelines re prescribing under Shared Care Agreements, and for Bridging Prescriptions.

We do not have a set policy or protocol and treat each case and request on an individual basis.

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

There are currently 14 SCA's in place at SHS (as of 18/12/23).

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 offer monitoring bloods to patients who are self-medicating. We strongly encourage them to seek specialist support or referral to support safe care and monitoring under the supervision of an expert in gender care.

We do offer support, general advice re transition, legal issues, changing name, use chosen name, use correct pronouns, advice re NHS systems and screening programmes, and offer referral to NHS specialist GIC services.

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

We would typically follow the guidance available from the NHS GIC that they have been referred to which might include:

Feminising: Full Blood Count, Urea + Electrolytes, Liver Function Tests, glucose, lipids, prolactin, oestradiol, FSH, LH, testosterone.

Masculinising: Full Blood Count, Urea + Electrolytes, Liver Function Tests, glucose, lipids, testosterone.

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 discuss mental health and risk, as we do with many of our patient groups, understanding that there may be additional risks in the Transgender or Gender Dysphoric patient group. Because we deal with a younger population than some GP surgeries, our patients are often still waiting for a formal diagnosis of Gender Dysphoria made by a recognised Gender Specialist. We would direct them to specialist NHS services to seek a diagnosis.

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 have over recent months had improved support from our local Gender Identity Clinic at The Laurels in Exeter, so can be more confident that we will receive timely advice. We are also building links with a local Consultant Endocrinologist in Bristol who may be able to give advice especially for patients who have completed transition. We do not have a protocol to follow if we are unable to access specialist advice, but we would discuss each case on an individual basis with our GP team.