Re: Doctors are failing to help people with gender dysphoria
I was saddened to see that The BMJ offered no form of balance to the views put forward by Dr Barrett, especially as this article is labelled as having been commissioned and not peer reviewed.
The title of this piece includes 'Doctors are failing...' could I suggest that this would be better titled 'The commissioning of NHS services are doing an appalling job of helping people with gender dysphoria'
General Practice is going through the worst crisis in the history of the NHS. Workload is rocketing whilst workforce is shrinking in relation to the rest of the NHS and to the work expected. Despite this NHS GPs provide among the highest standards of Primary Care of all developed nations.
We do this by providing Generalist care and partly by working in conjunction with Specialists. We manage the complexities of physical, psychological and social manifestations of the human condition. We understand that society, biology, personality and pathology all interact and all patients need an individual and professional approach
Dr Barrett talks of joint care models. He carefully avoids using the more accepted term 'Shared Care'. This model is used for many specialist treatments that can be delivered and monitored in General Practice with responsibility and ongoing care being shared with specialists. These models are resourced by CCGs as they are clearly not part of Core General Practice. Examples include immunosuppressants used to treat a variety of conditions, stimulant drugs for treating ADHD and long term management of people with stable schizophrenia.
If NHS England and the Gender Identity Clinics wish to work with GPs then they need to ensure that the full package of care is commissioned from both Primary and Specialist services. NHS England guidance on specialised commissioning includes expectations of Generalists. This suggests they have seriously muddled thinking. They need to commission the whole package of care
I suspect that part of the reasons for Dr Barretts wish to avoid the term 'shared care' is that specialist clinics plan to discharge patients and leave their specialist drug management entirely in the hands of GPs.
On a final note I personally and professionally object to Dr Barrett linking the transgender status of a patient to that of being Gay or Black. My Gay and Black patients do not need me to prescribe medication to maintain their status. My Transgender patients, who have chosen medication, do require a prescription and this is medically relevant to any consultation.
Rapid Response:
Re: Doctors are failing to help people with gender dysphoria
I was saddened to see that The BMJ offered no form of balance to the views put forward by Dr Barrett, especially as this article is labelled as having been commissioned and not peer reviewed.
The title of this piece includes 'Doctors are failing...' could I suggest that this would be better titled 'The commissioning of NHS services are doing an appalling job of helping people with gender dysphoria'
General Practice is going through the worst crisis in the history of the NHS. Workload is rocketing whilst workforce is shrinking in relation to the rest of the NHS and to the work expected. Despite this NHS GPs provide among the highest standards of Primary Care of all developed nations.
We do this by providing Generalist care and partly by working in conjunction with Specialists. We manage the complexities of physical, psychological and social manifestations of the human condition. We understand that society, biology, personality and pathology all interact and all patients need an individual and professional approach
Dr Barrett talks of joint care models. He carefully avoids using the more accepted term 'Shared Care'. This model is used for many specialist treatments that can be delivered and monitored in General Practice with responsibility and ongoing care being shared with specialists. These models are resourced by CCGs as they are clearly not part of Core General Practice. Examples include immunosuppressants used to treat a variety of conditions, stimulant drugs for treating ADHD and long term management of people with stable schizophrenia.
If NHS England and the Gender Identity Clinics wish to work with GPs then they need to ensure that the full package of care is commissioned from both Primary and Specialist services. NHS England guidance on specialised commissioning includes expectations of Generalists. This suggests they have seriously muddled thinking. They need to commission the whole package of care
I suspect that part of the reasons for Dr Barretts wish to avoid the term 'shared care' is that specialist clinics plan to discharge patients and leave their specialist drug management entirely in the hands of GPs.
On a final note I personally and professionally object to Dr Barrett linking the transgender status of a patient to that of being Gay or Black. My Gay and Black patients do not need me to prescribe medication to maintain their status. My Transgender patients, who have chosen medication, do require a prescription and this is medically relevant to any consultation.
Competing interests: No competing interests