GPs are working beyond their competency to provide transgender care, BMA warns

Authors: Abi Rimmer 

Publication date:  03 Nov 2017

GPs are putting themselves and patients at risk by acting beyond their competency to provide care for transgender patients, the BMA has said.

In response to an NHS England consultation on changes to gender identity services for adults, the BMA warned that GPs were being asked to prescribe specialist drugs that were beyond their expertise.[1]

It said, “We are concerned both about the safety of patients who are prescribed drugs off licence by a non-specialist prescriber, where there is a potential for harm to the patient and consequent medicolegal risk to GPs.”

Robert Morley, executive secretary of Birmingham Local Medical Committee, said that most GPs had little experience of the hormonal drugs that they were being asked to prescribe.

“Most GPs have little experience of dealing with these patients and they are being asked to prescribe specialised drugs, usually off licence,” Morley said. “When a GP prescribes they are clinically and medically responsible for all the effects of the treatment; it’s not a question of prescribing the treatment under the supervision of a consultant, the GP becomes completely responsible for that element of the patient’s care.”

He added, “Patients are being put in a position where they are not able to obtain their drugs unless their GP acts outside of their experience and competence. It’s an unsatisfactory state of affairs that needs to be resolved as soon as possible.”

Morley said that GPs who felt unable to prescribe specialist hormonal drugs to patients felt at risk of complaints. “There is a culture of encouraging complaints against GPs for refusing to prescribe,” he said. “This is from a lack of understanding and misinformation on the behalf of both patients and specialists.”

In its consultation response, the BMA called for NHS England to implement a directed enhanced service (DES) to allow GPs and practices with the appropriate specialist skills to provide gender identity services.

Morley said, “We need the whole patient pathway to be commissioned. There is a big hole in the pathway in terms of ongoing prescribing and monitoring.”

He added, “If this work is to be done in general practice then it needs to be done properly. The best way of doing this is with GPs with a special interest to take on prescribing. They could also act as a resource of support and education for GPs and other practices that might want to skill themselves up to do this work. It would need to be commissioned because it’s not work that is covered by the core GP contract.”

A DES, Morley said, would mean that clinical commissioning groups would be obliged to offer every GP practice the ability to provide specialist services under proper commissioning arrangements.

“At the moment the irony is that if GPs are forced to prescribe because there is no one else to do it, then they are doing it without any safeguards and there is no monitoring of the quality of the service,” said Morley.


  1. NHS England. Guide to consultation: specialised gender identity services for adults. 2017. [Link] .

Abi Rimmer The BMJ

Cite this as BMJ Careers ; doi: