Doctors have penned an open letter to the NHS to plead with the British healthcare provider to improve care to trans patients who are aged 18 and under.

Led by Dr Helen Webberley, a NHS GP who runs a private service for trans patients in the UK, the medical practitioners have outlined the various ways they would like to see the NHS change for the betterment of trans people.

The open letter to the head of the NHS clinical effectiveness team, Jeremy Glyde, comes at the end of a 30 day public consultation on proposed changes to the Gender Identity Development Service for Children and Adolescents.

Webberley believes trans people under the age of 18 should be given cross sex hormone treatment on a case by case basis, instead of waiting for the age of 16.

‘There is no evidence that delaying treatment until the age of 16 is beneficial to the patient and our first hand experience (and that of other experts in the field) is that it can, in fact, be damaging. Treatment should be tailor-made for each case. This is the approach in the US, where many UK children end up seeking treatment.’

The letter reads:

Dear Jeremy,

As we reach the end of the 30 day public consultation on proposed changes to the Gender Identity Development Service (GIDS) for Children and Adolescents, there are a number of concerns that we* would like to highlight, in our joint capacity as guardians for the improved care and treatment of transgender patients below the age of 18.

Our key concerns are as follows:

Age of treatment

The GIDS Specification states that Cross Sex Hormone (CSH) treatment will not be given before the age of 16. Prior to this, puberty blockers will be administered.

Our position is that treatment should start when the child is physically and psychologically ready and has all the support in place around them. There is no evidence that delaying treatment until the age of 16 is beneficial to the patient and our first hand experience (and that of other experts in the field) is that it can, in fact, be damaging. Treatment should be tailor-made for each case. This is the approach in the US, where many UK children end up seeking treatment.

Age of consent

The law states that providing a young patient has shown competence according to the ‘Fraser Guidelines’ (Gillick Competency) they can inform their own medical treatment below the age of 16. However, according to guidelines put in place by the Specification, patients cannot access CSH until the age of 16. So, even if they do decide, together with their support team, that this is the right course of treatment for them, they cannot access it.

Each individual should be assessed as to whether they are able to make informed medical decisions and, if they are deemed to be ‘Gillick competent’, they should be allowed to follow a care pathway that is planned, together with their input, at a speed that is appropriate for them as an individual, rather than according to a strict, time limited protocol.

NHS patients seeking private treatment

In the proposal, it clearly states that:

The service adheres to a comprehensive, multi-disciplinary, partnership approach to GID, whereby young people and their families who decide to seek physical interventions outside the NHS will not be able to access any other intervention or support offered by the service.

The BMA and the NHS have very clear guidelines on allowing people to get the care that they want from both private sources and from the NHS as outlined in the following documents:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/404423/patients-add-priv-care.pdf

http://www.bma.org.uk/support-at-work/private-practice/setting-up-in-private-practice/contract-guidelines-on-private-practice

Nobody should be penaliezd if they supplement their NHS care with private care, nor should they lose their place on the waiting list, or be given reduced care on the NHS, because of their private care.

This is of particular relevance to this group of young people (who have been shown to be at high risk of self harm and suicide), given that the waiting time for NHS appointments to Gender Identity Clinics is far and above the referral to treatment standard of 18 weeks and they can access private assessment and treatment programs in a matter of days.

Each party has submitted its response to the consultation and these documents are available in full, on request.

There has been a significant increase in young people seeking referrals to GICs and if they are to receive fair treatment the issues raised above need to be carefully considered and addressed.

*Signatories:

Dr Helen Webberley

MBChB, MRCGP, MFSRH

General Practitioner

GenderGP.co.uk

Dr Michael Webberley

MBChB, FRCP

Consultant Physician

GenderGP.co.uk

Dr Carol Steele B.Sc., Ph.D.

CEO

Transfigurations

Transfigurations.org.uk