Information for Transgender Patients

Information for transgender patients - Or those wishing to change their name, title and / or gender on their NHS records. We are proud to have you as our patient.

We support all patient groups and are committed to accessibility and inclusion but we also know we may not always get things right. If there is anything you think we can improve or change to make accessing our services easier for you, please email bnssg.pmg@nhs.net

The aim of this information is to inform you of the process, discuss how your medical information is stored and the important screening tests you need. We hope that it is helpful.

Confidentiality

We hold your medical records in the strictest confidence, regardless of whether they are electronic or paper. We take all reasonable precautions to prevent unauthorised access to your records. Access to medical records is audited. Your NHS records are only shared with our practice team and other organisations directly involved in your care that have a genuine need for it e.g. community health services, hospitals, mental health services, social care, NHS 111. We will not share your information with any other third party without your permission unless it is an exceptional situation (e.g. life or death situation) or where the law tells us to.

For more information on how your data is shared and stored by the NHS, including opting out of sharing data, please see here

Processes

Changing your name on your NHS records

Please fill out a change of name form available at reception. Please hand the form into reception or email to us bnssg.pmg@nhs.net. No proof of ID is needed. This name will be used by staff, on the automated call-in screen, and communications from the Practice (e.g. SMS, letters, email). You can request to change it at any time.

Changing your title on your NHS records

You can change your title on your NHS records to any of Mr/Mx/Miss/Mrs/Ms without changing your gender or name. No proof of ID is needed. Just ask any member of staff or email us at bnssg.pmg@nhs.net.

The NHS computer system is currently binary and the only titles it currently accepts with a male gender marker are Mr or Mx. The only titles the computer system accepts with a female gender marker are Mx/Miss/Mrs/Ms. This computer system and titles available are set nationally and are out of our control. If you wish to choose another title, we can add an alert to your notes, so we as a practice know your gender identity, please discuss further with any staff member.

Changing your gender marker on your NHS records to male or female

You can do this at any time, please book an appointment (ideally face to face) with a GP to discuss this. No proof of ID is needed.

You do not need to have undergone any form of gender affirmation treatment, have been referred to a gender identity clinic or have any official documentation.

When you change your gender marker on your NHS records, you will be given a new NHS number. Your previous NHS records will be merged onto your new NHS record (excluding any information related to my previous identity e.g. gender, title, name, pronouns, previous NHS number). This process is not reversible. Should you wish to revert back to your original gender marker, you would receive a third NHS number.

The system is currently very binary and only accepts a male or female gender marker on your NHS records. This is a national process and out of our control. If you wish to choose non-binary or another gender identity, we can add an alert to your notes, so we as a practice know your gender identity.

Referral to an NHS Gender Identity Clinic

Please book a GP appointment to discuss referral – you do not need to have socially transitioned, have counselling or psychotherapy or any tests for the referral. We will send the referral as soon as you request it. You can choose which GIC to be referred to see here.

Hormone therapy can reduce your fertility, please let your GP know if would like to be referred to discuss egg or sperm storage whilst waiting for your appointment at the gender clinic. Your GP can also discuss other ways to support you whilst awaiting your appointment e.g. medications to stop periods and ensuring your physical health is optimised ready for hormone treatment.

Private providers - Gender Identity Clinics

In the UK there are a number of private gender identity services, ranging from those mirroring the NHS offer – led by a team of clinicians (including doctors, psychologists) who also work at NHS gender clinics. Other clinics do no offer the equivalent of the NHS service e.g. online service only, do not have GMC registered doctors and are not UK based. We are unable to recommend any specific clinics. However signs of a safe and effective service according to NHS England’s current commissioning protocol (2013) would be:

The assessment and diagnosis of gender dysphoria is made by a clinician e.g. psychologist who specialises and is experienced in gender dysphoria. This is over a minimum of two core assessment consultations
They ask for your full medical history
The decision to start hormone therapy is made by a doctor who is registered and based in the UK, has relevant training in gender dysphoria and at least two years’ experience working in a specialised gender dysphoria practice, such as an NHS Gender Identity Clinic
The clinic is based in the UK
They discuss the following with you and give you opportunities to ask questions:
- potential risks and limitations of, and alternatives to hormone therapy, as well as its potential benefits
- The likely impact of hormone therapy on fertility including egg or sperm storage and how to access this.
- The likely permanent changes that hormone therapy will make to your body
- When on hormone therapy the need for effective contraception, regular monitoring (blood tests, blood pressure, weight), smoking cessation, maintaining a healthy weight. Also, what changes you should make to your medication if you were to have an operation

How long will the process take?

A new NHS number can take over 4 weeks to come through to us. Once we receive your new NHS number, we will create a new registration for you at the practice within 5 days, and will aim to merge your old records to your new records (excluding any information related to your previous identity) in a timely manner to ensure minimal disruption to your care.

We suggest you order 2 months supply of your medication beforehand.

You should be informed of your new NHS number by PCSE. If you do not receive this, please contact us and we can give it to you. You may need to inform any hospitals you are under (e.g. waiting for an appointment, surgery or treatment) of your new NHS number so they can update your records.

Cancer screening tests

Unfortunately, currently national cancer screening test invitations are sent out based on the gender marker on your NHS records. This system is currently very binary and only accepts a male or female gender marker on NHS medical notes. This is a national decision and out of our control. If you wish to choose non-binary or another gender identity, we can add an alert to your notes, so we as a practice know your gender identity, please discuss with a GP (see below).

Importantly, patients who have changed their gender marker on their NHS records may not be invited to some of these cancer screenings, meaning there is a risk of missing cancer. Please see NHS screening Guidance for Trans Patients for more information. Please discuss with your named GP to discuss this further.

Cervical cancer screening in trans men and non-binary people with a cervix

We welcome you to have your cervical screening at the GP surgery by highly trained staff. Please book a telephone appointment with a GP or nurse who performs cervical screening to discuss this.

Please see this NHS video on cervical screening in trans men here.

We can also offer adaptions such as:

An appointment at the beginning or end of the clinic
Bring a friend/partner, bring your own blanket to cover the lower half of your body
Choose to have the door locked or unlocked
Chaperone in the room
Bring a phone/tablet and headphones to play music or watch a video
Different sizes of medical equipment - you can take one home with you to practice with beforehand if this is helpful
At your appointment, other people in the waiting room will be waiting for a range of different appointments and will not be aware you are there for cervical screening
Medication and lubricant to make the procedure more comfortable

You can also contact a specialist NHS clinic to have your cervical screening performed there (nearest is London). Please see some options below:

56T at 56 Dean Street - London The My Body Back Project - London CliniQ - London Clinic T - Brighton The Butterfly Clinic - Liverpool The My Body Back Project - Glasgow

Local Support Groups

TransBristol

A safe space where trans identified people in Bristol can share ideas, provide support and plan things.

Visit their website here

Bristol Crossroads

A safe, secure, friendly social meeting place for TG people of all kinds and those questioning their gender, their partners and close family. A community support group run by volunteers.

Visit their website here

Gay West

A social and support group for LGBT people in Bath, Bristol, and surrounding areas.

Visit their website here

Hidayah LGBTQI+

The Leading Queer Muslim Charity - Hidayah are a charity providing support, mentoring, and social connection opportunities to LGBTQI+ Muslims.

Visit their website here

LGBTQ+ Support & Services

LGBTQ+ support services available for young people, their carers and familites

Visit their website here