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The Nursing and Midwifery Council (NMC) has commissioned the Gender Identity Research and Education Society (GIRES) to prepare comprehensive transgender policy and guidance to cover NMC staff and registrants (the Guide). It will include advice on responding to trans service users.
The Royal College of Nursing (RCN) welcomes this initiative and will assist GIRES in communicating with and obtaining feedback from its members about the Guide.
The Guide should be helpful to all NMC staff and registrants, especially those who are transgender. It will also be accessible members of the trans community and those who care for them, including family members as well as professional service providers and employers.
The Guide should cover NMC's employment of trans people, regulation of trans nurses and midwives and care for trans service users. As well as providing information relating to each specific topic selected for inclusion, the Guide will serve as a signposting mechanism to the rich array of existing relevant material already produced by the NMC, RCN and other organisations.
The primary means for providing access to the Guide will be electronic. It could be hosted on the NMC website. In addition some elements of the Guide might be published in printed form, for instance advice on caring for trans service users. The NMC will use social media to disseminate information about the availability of the Guide.
The topics to be covered include
- Relationship with the NMC’s standards as well as its equality and diversity policy
- Respecting trans people
- The nature of gender variance
- Prevalence, incidence and growth
- Legal factors
- Employment policy, including transition at work and encouraging trans job applicants
- Registration and name change
- Call handling
- Support groups and advisory services
- Medical care for trans people of all ages, including specialist and non-specialist services, as well as in-patient secure and non-secure accommodation
- Curriculum and training for staff and registrants
- Risk factors, including suicidality and self-harm; sexual health; drugs, alcohol and tobacco; exercise, sport and diet; and transphobic crime
- Discrimination, including religious aspects
- Monitoring trans staff members and service users, as well as workforce attitudes towards them
An executive summary will also be provided.
GIRES will engage widely with the trans community throughout the project. To obtain expert advice, it is establishing a focus group of trans nurses and midwives. If you wish to contribute to that work, please contact the GIRES trustee who is managing the project
New Treatment Guidelines for Gender Dysphoria have been published by the British Medical Colleges.
The provision of care for patients experiencing gender dysphoria is an excellent example of an area where multidisciplinary and interdisciplinary care is not only good practice but ensures that a wide choice of treatment pathways are offered, tailored to the needs of the individual patient. This intercollegiate document provides guidelines which we hope will optimise the clinical care pathways for patients who may need to access several medical and allied health professionals here.
The Trans Mental Health Study 2012 demonstrated that GPs need better information to meet the needs of trans service users. GIRES has therefore initiated a project to develop a readily accessible online e-learning resource, for use by GPs as well as those they care for. GIRES will engage with the broad range of people, including trans individuals, clinicians and policy makers, who may have an interest in this project. The initial phase of the project is to prepare a Training Needs Analysis. The scope of that work and the way it is to be carried out are summarised here
The Trans Mental Health Study 2012 is based on an online survey that generated responses from 889 people who had personal experience of transgender healthcare and may be viewed here.
The authors of that Study received the GIRES award in 2012
World Professional Association for Transgender Health – Standards of Care
Now in its seventh edition, the standards of care are based on the best available science and expert professional consensus. The new edition reflects the current attitude that transgender people are not inherently disordered.
One of the British gender identity clinics has stated in response to a Freedom of Information request:
“Specifically, our Care Pathway follows the stages laid down within The Harry Benjamin International Standards of Care (this differs from the WPATH guidance), as we believe that hormone treatment is best undertaken after real life experience has begun.”
The clinic is using an out of date document to justify its questionable practice. WPATH has therefore made it clear in a recent letter that the new Standards of Care take precedence over all earlier versions.
The committee for the standards of care are the recipients of the GIRES award for 2011
In September 2011 GIRES donated $20,000 to the WPATH Translation Fund, which is being used to cover the cost of translating Version 7 of the Standards of Care into other languages. This will reinforce world-wide the validity of this more enlightened approach to treating gender dysphoria. Already, the Chinese, French and Russian translations are available.
GIRES plenary presentation at the LGBT Health Summit - September 2012
The slides from the GIRES presentation at the plenary session of the 2012 LGBT Health Summit can be found here
GIRES presentations at the 2011 LGBT Health Summit
Bernard Reed & Terry Reed's presentations at the 2011 LGBT Health Summit in Cardiff are available to watch online.
Click here to watch Bernard Reed's presentation
Click here to watch Terry Reed's presentation
GIRES plenary presentation at the LGBT Health Summit - 6 September 2010
Commissioners and providers of health and social services face major challenges in caring for the trans community. The rapid growth in the number of people, of all ages, who are seeking medical treatment for profound and persistent gender dysphoria is placing an increasing strain on both health and social services for trans people in the UK. In addition to handling this growth in demand, these services have to upgrade their practices in line with (a) the improved standards set by international guidelines, (b) the approaches followed in advanced overseas countries, (c) the needs expressed by service users and (d) the duties imposed on them by the Equality Act 2010 and other legislation. Unless these services are expanded and improved, the emotional health and wellbeing of trans people will be placed at increasing risk. As well as describing the magnitude and nature of this task, the presentation includes practical suggestions about the most effective way in which commissioners and providers can respond.
Download it here
Guidelines for health organisations commissioning treatment services for trans people
Foreword by Lynne Jones MP
These guidelines have been produced by the Parliamentary Forum for Gender Identity to assist commissioners to make appropriate decisions in respect of providing funding for all aspects of the treatment required by people experiencing any degree of gender dysphoria. They are complementary to the Department of Health’s publication “Guidance for GPs, other clinicians and health professionals on the care of gender variant people”.
The Forum comprises Parliamentarians and the UK's leading experts on gender identity, in both the legal and medical fields, including Professor Kevan Wylie, Chair of the Committee set up by the Royal College of Psychiatrists in collaboration with the Royal College of Physicians and Surgeons and other colleges and societies to develop new standards of care for the treatment of trans people. Many of the leading advocates from the trans community also take part in our work, including those who have been instrumental in liaising with ministers and senior civil servants to bring about the successful passage and implementation of the Gender Recognition Act 2004.
I would like to acknowledge the work done to compile this document for the Forum by the Gender Identity Research and Education Society (GIRES).
The document may be dowloaded here.
Report of the 2008 study to capture the patient experience of NHS transgender services, to assess the positive and negative aspects and to inform future development of the service.
WPATH Clarification on Medical Necessity for Sex Reassignment Surgery
The World Professional Association for Transgender Health has issued a ”Clarification on Medical Necessity for Sex Reassignment Surgery“. This is in response to questions about the medical necessity of transgender treatments and sex reassignment surgery, particularly in the U.S.A.,where insurance exclusions often prevent access to health care for transgender people. The WPATH Board of Directors has issued a clarification statement which is now available on the Resources page of the WPATH web site. Questions about this statement may be directed to the WPATH office, or to Mr. Jamison Green, Chair of the Public Policy, Advocacy & Liaison Committee of the Board. A parallel statement for international use (without the U.S. insurance focus, and reflecting ICD-10, to which the U.S.A. is not a signatory) is also under development. The clarification may be viewed here.
Medical record-keeping for trans people can be a challenge for clinicians and staff. Names and titles must be changed to reflect current gender status; this should always be done as a matter of courtesy and is not dependent on having a Gender Recognition Certificate. However, most doctors prefer to have evidence of the permanency of the name change, by way of Deed Poll or Statutory Declaration before making official changes to the patient notes. Treatment must not be withheld on the basis that a patient has not provided either of these documents.
According to the GP notebook site: "Trans patients have a legal right to change their name and gender on their NHS records and would be able to bring a civil claim against any GP or practice which refused to accede to their request".
"The process is as follows:
" the patient informs the GP, or directly informs the PCT, that they are transitioning and that in future they would be known by their new name and gender. They can write a "Statutory Declaration", they may have a deed poll document, or they may simply make a request. This request should be in writing, signed by the patient;
" the GP writes to the Registration Office at the PCT. The GP may write a letter of support confirming the gender role change and that this change is intended to be permanent, but this is not a requirement;
" the Registration Office then writes to the Personal Demographics' Service National Back Office. The National Back Office will create a new identity with a new NHS number and requests the records held by the patient's GP. These records are then transferred to the new identity and forwarded to the GP;
" on receipt, the GP surgery changes any remaining patient information including the gender marker, pronouns and names."
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