Doctors are prejudiced against transgender patients, MPs say

BMJ 2016; 352 doi: (Published 14 January 2016) Cite this as: BMJ 2016;352:i252
  1. Jacqui Wise
  1. 1London

Transgender patients encounter prejudice and a lack of knowledge when they use NHS services in England, the first report on transgender equality produced by a UK parliamentary committee has found.1

The cross party parliamentary inquiry found that the NHS was letting down transgender people and failing in its legal duty under the Equality Act to ensure equal access to services. As an employer and a commissioner the NHS was failing to ensure zero tolerance of “transphobic” behaviour among staff and contractors. The committee also called for a root and branch review to be conducted by the NHS.

The report said, “GPs too often lack understanding and in some cases this leads to appropriate care not being provided.” In particular, GPs too often lacked an understanding of transgender identities, the diagnosis of gender dysphoria, referral pathways to gender identity services, and their own role in prescribing hormone treatment. It said that continuing professional development and training in this area was lacking among GPs.

In evidence to the committee one transgender patient said, “The terms ‘gender dysphoria’ and ‘transgender’ are not fully known throughout the NHS . . . When I first went to my GP, in November 2014, I had to explain what both of these terms meant and had to advise him on where to refer me to next.”

The report identified much evidence of serious deficiencies in the quality and capacity of NHS gender identity services, particularly in waiting times for first appointments and surgery. Some adult clinics have waiting times of two to three years, and many people have to travel far for treatment. Such delays increase the risk of self harm and suicide, the report warned. The MPs also expressed concern at the apparent lack of any concrete plans to deal with the lack of specialist clinicians in this field.

Gender identity services continued to be provided as part of mental health services, a relic of the days when transgender identity was regarded as a disease or disorder of the mind, the report said. It said that consideration should be given to transferring these services to another specialty, such as endocrinology.

The MPs also pointed to serious concerns about treatment protocols in gender identity services, particularly the requirement for a period of “real-life experience” before genital surgery. It said that this requirement was seen as reflecting outdated, stereotyped attitudes to male and female gender identity. However, it said that it was unconvinced by the argument that the NHS should simply grant on demand whatever treatment patients requested.

The report said that the 2011 Advancing Transgender Equality action plan remained largely unimplemented and that the government must agree a new strategy for full transgender equality that it can deliver within six months.


Cite this as: BMJ 2016;352:i252


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