Transgender Patients/Gender Reassignment/Gender Incongruence

Contents

1. Inclusive Care and Legal Obligations
2. GP Responsibilities (GMS Contract)
3. Local Support Pathway – NHS Somerset ICB and WellBN
4. Changing Name and Gender on Medical Records
5. Screening and Recall Guidance
6. SNOMED Coding for Trans and Non-Binary Patients
7. Update for Patients Under 18 (March 2025)
8. Additional Resources

 

Sullivan review: process change for re-assigning gender and sex identity in the GP record

An independent review published by Professor Alice Sullivan that looked at data, statistics and research on sex and gender has identified a serious safeguarding risk in the current process of re-assigning gender and sex identity in medical records for children and young people. In response, the Secretary of State for Health and Social Care has ordered an immediate halt to issuing new NHS numbers and changing gender markers for those under 18. General practice teams may still amend name and title fields and add a reminder note to the patient record, but will no longer need to apply for a new NHS number. Alternative methods for recording gender identity in the medical record are under consideration, with further guidance expected in due course.

1. Inclusive Care and Legal Obligations

• Trans and non-binary patients are protected under the Equality Act 2010.
• Practices must use patients’ chosen names and pronouns.
• Discrimination or failure to provide appropriate care can result in referral to the GMC.
• Staff should complete LGBTQ+ awareness and safeguarding training.
• Staff should also be aware of the NHS Constitution, which underlines equitable care for all patients.”

2. GP Responsibilities (GMS Contract)

GP practices are required to

• Ensure equal access to core NHS services for all trans and non-binary patients.
• Refer to NHS Gender Identity Clinics (GICs) directly—no mental health diagnosis required.
• Prescribe hormone therapy in shared care with GICs (where clinically appropriate).
• Offer screening based on anatomy, not just recorded gender.
• Support patients in changing their gender or name on records.

3. Local Support Pathway – NHS Somerset ICB and WellBN

      New Support Pathway for Patients Experiencing Gender Incongruence

NHS Somerset ICB has partnered with WellBN, a GP practice in Brighton that hosts a specialist gender clinic, to offer enhanced                       support for Somerset patients experiencing gender incongruence.  This clinic provides remote/consultative support rather than in person       care in Brighton.

This service provides informed, early guidance around a range of gender-affirming options including:

• Hormone therapy (prescribing from age 18)
• Speech and Language Therapy (SALT)
• Fertility preservation
• Support for social transitioning

This service is designed to complement the national Gender Identity Clinic (GIC) pathway by offering locally facilitated early support,              where appropriate.

    Eligibility Criteria

• Aged 16 or over (hormone prescribing from age 18)
• Registered with a GP practice in Somerset

    Referral
For full details on how to refer, please see the Somerset ICB referral guidance – Gender_incongruence_pathway

4. Changing Name and Gender on Medical Records

     Key Points

• Patients can change name and gender on NHS records without a Gender Recognition Certificate.
• Changing the gender marker leads to a new NHS number and is irreversible.
• Title changes that don’t align with sex at birth (e.g. Mr for someone assigned female) also require a new NHS number unless ‘Mx’ is used.
• NOTE – It is import to update letters, prescriptions, and lab results to reflect new identity to avoid misgendering.

      Process for Practices

1. Submit a request via the PCSE Enquiries Form with relevant details and patient confirmation.
2. PCSE will issue a deduction and new NHS number.
3. Register the patient with the new identity and create a fresh record.
4. Transfer medical data manually, redacting references to previous gender where needed.
5. Document this process with the patient and maintain essential clinical information neutrally.

5. Screening and Recall Guidance

     NHS screening is based on the gender recorded in a patient’s record. GPs must offer screening  based on   anatomy            and clinical risk.

Identity	Registered Gender	Cervical	Breast	Bowel	AAA
Trans woman	Female	❌	✅	✅	❌ (can request)
Trans woman	Male	❌	On request	✅	✅
Trans man	Female	✅	✅	✅	❌
Trans man	Male	On request	On request	✅	✅
Pregnant trans man	N/A	N/A	N/A	N/A	✅ (antenatal screening as usual)

Breast Screening for Trans female Patients

The LMC were recently contacted about how to arrange breast screening for a trans female patient who does not wish to change their pronoun to her/she. Unfortunately, at the moment digital systems need a patient to be registered female in order for automatic screening to be triggered.

If a patient does not wish to change their registered sex in the system, then the GP can contact the Breast Screening lead directly (Zoe.Goldthorpe@SomersetFT.nhs.uk) – who is happy to call the patient in for screening without needing to change the information recorded on the system.

TRANS Men – “screening based on anatomy” means e.g., trans men with a cervix still need cervical screening, trans women with breasts may need breast screening.

Cervical screening for patients registered male (e.g., trans men) must be arranged manually by practices.

6. SNOMED Coding for Trans and Non-Binary Patients

We have sought further advice and the Snomed browser has the following:

1108101000000105  – Provision of information about NHS screening programmes available to transgender and non-binary people – this would suggest that the trans or non-binary patient is fully informed about the screening programmes and could be used to identify them.

Perhaps also adding one of the following screening codes:

715011000000109  – Breast screening administration – free text could be added to indicate whether screening is due or not.

512501000000109  – Breast Screening Offered

811481000000106  – Breast screening disclaimer received. – to indicate that the patient has opted out of breast screening.

1104621000000103  – Cervical cancer screening offered

112241000119107  – Cervical Cancer screening declined.

1104671000000104  – Cervical cancer screening not offered.

171169001  – No smear – no cervix

There are few codes which would apply, without adding something to indicate that the patient is either transgender or non-binary, so we would suggest that the practices search for the main code initially, then link it to one of the other codes – as any of the screening codes could be used for any patient.

7. Update for Patients Under 18 (March 2025)

As of March 2025, NHS England has paused the ability to change gender markers or NHS numbers for patients           under 18, following recommendations from the Independent Review led by Professor Alice Sullivan.

    Interim Practice

• No changes to NHS numbers or gender markers for under-18s
• Name/title changes can still be made (preferably using neutral titles)
• Use visible alerts or notes in records to reflect affirmed gender

Further national guidance is expected.

1. Additional Resources

• NHS Screening Information for Trans Patients
• PCSE: NHS Number and Gender Marker Changes
• GMC: Trans Healthcare – Ethical Hub
• Gender_incongruence_pathway (1)
• SNOMED Clinical Terms Browser: https://termbrowser.nhs.uk
• Supporting Trans Patients: Guide for Staff at the GP Surgery

Gender Identity toolkit: The toolkit has been produced in collaboration between the Institute of General Practice Management, Indigo Gender Service, Practice Index and Pride in Practice.
It is designed to support the knowledge and confidence of general practice teams providing inclusive and equitable care to trans and non-binary patients. The barriers trans and non-binary patients face range from direct discrimination to supportive healthcare professionals lacking the knowledge or confidence to provide appropriate care. Concurrently, the number of openly trans and non-binary patients seeking gender-affirming care from their GP and other healthcare professionals is increasing. The Gender Identity Toolkit is a practicable resource to improve the availability of inclusive and equitable care for trans and non-binary patients at a crucial moment.