The role of the GP in caring for gender-questioning and transgender patients

The National LGB&T Partnership welcomes that the RCGP have established a position on the role of the GP in caring for gender-questioning and transgender patients and recommendations for ensuring these patients receive equal access to the highest standard of care. We particularly welcome the assertion that “GPs are expected to approach the holistic care of gender-questioning and transgender patients as they do with every patient – openly, respectfully, sensitively and without bias” and the recognition that “The gaps in education, guidance and training for GPs around treating gender dysphoria for both adults and children, and managing broader trans health issues, also needs to be urgently addressed”, particularly the recommendation that “if GPs feel a lack of knowledge or experience about the healthcare needs of trans people, they…address their training needs as part of continuing professional development.” 

However, our support of the position statement is not without its hesitations.

We of course welcome further research which will support the development and extension of positive support for trans people, however we are concerned that there is yet again call for further research when we know that this is used as a stalling mechanism in policy change and that national and international evidence is increasingly widely available, as is community-developed intelligence. The possibility of future innovations should not be used as a reason to ignore or undermine current good practice.

We welcome the progressive position that “people who are uncomfortable or distressed by their biological sex or gender roles and behaviours assigned to them by society, but do not wish to alter their sexual characteristics” deserve appropriate support. We call on NHSE to describe how this support will be provided through a model which restricts provision of care through the NHS England commissioned services (GICs) to those who receive a diagnosis of gender dysphoria.

We contest that GPs are “being pressured into prescribing”, particularly given the numbers of service users who state their GP is refusing to prescribe, even after instruction from a GIC, and also argue that prescribing should not be seen to “fall outside the limits of one’s competence” when detailed clinical guidance on hormone therapy has been available to GPs in the NHS publication Guidance for GPs, other clinicians and health professionals on the care of gender variant people since May 2008.

We have some concern that the statement made in section 28 ii may prevent those GPs who might feel competent prescribing from the point of a patient’s presentation to them from doing so, as they are instructed to “refer patients to a GIC or equivalent if they exhibit signs of gender dysphoria and request treatment”. This is compounded by the fact that the position statement also refers to the GP “taking on the ongoing prescribing of medication for patients and the monitoring of any side effects…after a patient has been discharged from a GIC”. The statement also acknowledges the lack of capacity of GICs, long waits between appointments, and long distances that many patients are required to travel to attend. Many trans people will not be discharged from the GIC until after they have received surgical interventions, which, between the requirements of the service specifications and the capacity-affected long waiting times between appointments is often a number of years after starting hormone treatments. Requiring patients to travel to GICs to obtain prescription, administration and monitoring of their hormone regimens during this time is clearly unreasonable.

We encourage the RCGP and the NHS to further investigate the opportunities and detailed complexities of altering NHS data collection systems with regards to sex, gender and trans status, so as to find a solution which serves patients, practitioners and researchers, as the suggestions outlined in UK Wide Policy Recommendation iii (page 10) do not appear to sufficiently consider the appropriateness of the changes recommended.

We are pleased to see that the statement suggests it is “vital that frontline GPs, patients and the broader trans community are involved in the design and implementation of changes to the current system”, and welcome the RCGP to call on the National LGB&T Partnership, it’s members and colleagues to support them in this work.

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#LBTWomensHealth18 – If you’re not counted you don’t count.

Mike Cullen at the LGBT Foundation wrote the following blog post for us about Sexual Orientation and Trans Status Monitoring and Lesbian, Bisexual and Trans Women’s health.

LBT Health Week is a great opportunity to talk about monitoring, which continues to be a key part of the work of the LGBT Partnership and has been for a number of years. For those of us working in the sector we’re very aware of the health inequalities that LBT women experience, such as poor mental health, sexual and reproductive health inequalities and higher rates of cancer. Yet often these inequalities are not addressed by mainstream services and so the needs of our communities go unmet. To put it simply, if we’re not counted we don’t count.

Invisibility within services means that they are unaware of the specific health needs our communities often experience. Monitoring the sexual orientation, trans status and gender identity of service users is the simplest way to start addressing clipboardthat.

It means that an evidence base can be built and as a result targeted preventative work can be done to help reduce these inequalities. We know for example that LB women are less likely to access cervical cancer screenings than their heterosexual counterparts. Monitoring means that when LB women access services health care professionals can ensure they are given the correct information.

Another benefit of monitoring is that it shows you are acknowledging someone’s identity and are seeing them as a whole person. This helps to reduce barriers to accessing services and creates an environment of openness where people are more likely to discuss their health concerns. When services have a fuller picture of who is sat in front of them, they are able to diagnose and treat people faster, as well as signpost to services suited to individual needs. Monitoring alone isn’t going to reduce all of the health inequalities that LBT women experience, but it’s a great first step.

 

 

For further guidance on monitoring please visit lgbt.foundation/monitoring

Sexual Orientation Monitoring Standard introduced

The National LGB&T Partnership welcomes new sexual orientation monitoring as game changer towards better LGB health and social care services

The National LGB&T Partnership has welcomed the launch of a newly published NHS Information Standard for sexual orientation monitoring as a significant game changer in the future health and social care provision for lesbian, gay and bisexual people (LGB) in England.

Released by NHS Digital today (5th October 2017), it aims to better meet the needs of LGB people through improved data collection. The new standard will provide a mechanism for recording the sexual orientation of all patients and service users aged 16 years and over across all health services and Local Authority social care providers in England.

The Standard was commissioned by NHS England and developed by LGBT Foundation working with NHS Digital, the Department of Health, Public Health England and a cross-system group with representation from leaders across health and social care as well as organisations representing the workforce. It also involved an extensive consultation with organisations across the health and social care system, service users and the public.

Research by LGBT Foundation has shown that LGB people are disproportionately affected by a range of health inequalities and experience significant barriers to accessing health and care services.1

  • LGB people are twice as likely as the general population to commit suicide.
  • LGB people are seven times more likely to use drugs, twice as likely to binge drink, and show higher levels of substance dependency compared to their heterosexual peers.
  • LGB people are more likely to experience many cancer risk factors including stress, smoking, problematic alcohol use and poorer diet and exercise.
  • LGB people are less likely to access mainstream health services, including cancer screening.
  • LGB people are more likely to rate their experiences of health and care services as poor, and fear that they will suffer unequal treatment as an LGB person.

The research also pinpointed the better sexual orientation monitoring as a vital step towards addressing these specific health inequalities and improving access to care.

The sexual orientation Information Standard sets out a consistent question and answer options for recording this data:

Which of the following options best describes how you think of yourself?

  1. Heterosexual or Straight
  2. Gay or Lesbian
  3. Bisexual
  4. Other sexual orientation not listed
  5. Person asked and does not know or is not sure
  6. Not stated (person asked but declined to provide a response)
  7. Not known (not recorded)

Research has shown that between 90-95% of people are happy to be asked this question, as long as they understood why it was being collected, and that it is similar in terms of public acceptability to collecting demographic data on religion, a question which is now commonplace on demographic forms. 2,3

Commenting on today’s launch, Paul Martin, Chair of The National LGB&T Partnership said:

“The Partnership is thrilled to see the sexual orientation monitoring standard go live today. This issue has been a key focus for the Partnership for years, as much of the work we want to do with LGB communities has been limited by the lack of evidence around need.

Today’s launch is a significant step in the right direction towards addressing LGB health inequalities.”

 

 

If you would like more information on sexual orientation monitoring, please visit Lgbt.foundation/SexualOrientationMonitoring or email nationallgbtpartnership@gmail.com

 

1,2 http://lgbt.foundation/bhp

3 Office for National Statistics, July 2017, Sexual Identity: update on research and testing, Census Roadshows. Available at: https://www.slideshare.net/secret/HwBiX0XCGQSAGN.

Consultation: NHSE Gender Identity Services for Adults

The National LGB&T Partnership has developed a response to the national consultation on Adult Gender Identity Services in England, which closes on Monday October 16th 2017. More information, and links to respond to the consultation, can be found here: www.engage.england.nhs.uk/survey/gender-identity-services-for-adults/

To read our response, which may be reproduced in your own response, please click here.

The role of the LGBT sector in tackling inequalities in health

National LGB&T Partnership leads project to identify how best to work across systems to reduce inequalities in health and wellbeing

National LGB&T Partnership leads project to identify how best to work across systems to reduce inequalities in health and wellbeing

Public Health England has funded the National LGB&T Partnership to lead a project for the next 6 months to encourage and support specialist and mainstream service providers and others to improve the offer for LGBT populations as a way of tackling general as well as specific inequalities in health and wellbeing. Success in reducing inequalities in health and life expectancy will not be achieved if LGBT communities are not a central part of efforts to tackle inequality overall.

Inequalities in health are worsening. There is a 19-year difference in life expectancy for those born in the richest and those in the poorest areas. The causes of ill health, and inequality, are complex. They encompass action on the social determinants of health such as poverty, housing, employment and education, as well as access to health services and information about healthy living. The additional challenges routinely faced by LGBT people mean that responses need to be specific and appropriate.

There is no one cause and as such, there is no one organisation that can provide solutions. Listening to our communities and targeting our efforts – as well as the efforts of others –  to prevent ill health are key roles for the LGBT sector.

LGBT communities have resources and assets that are valuable in securing improvements; these include friendship networks, sport and faith groups, and other community organisations, as well as proud histories of activism and mobilisation. There are also resources in mainstream organisations which have yet to be unlocked.

Collaboration is key. Bringing statutory, voluntary and community sector organisations and LGBT people together is critical to better understand the challenges, identify solutions and take concerted, coordinated action.

Outputs from the project include a series of focused round table events and a resource for services identifying key issues, policy drives and examples of good practice. Whole systems work in two pilot sites – the London Borough of Lambeth and Leeds – will provide learning for other areas to implement.

Any questions or suggestions, contact David Woodhead – david.woodhead@lgbtconsortium.org.uk

Cervical Screening Awareness Week – 12th -18th June

Kate Sanger – Head of Communications at Jo’s Cervical Cancer Trust wants LGBT people with cervixes to get screened.

Cervical cancer does not discriminate. It can affect anyone with cervix. However it can be prevented. This is why the news earlier this year that lesbian and bisexual women are being told they do not need to attend smear tests is very concerning. Smear tests prevent a huge 75% of cervical cancers from developing and save an estimated 5,000 lives every year in the UK, they provide the best form of protection against cervical cancer, a disease that claims two lives every day in the UK.

Anyone living with a cervix should fully understand the steps they can take to reduce their risk of cancer and feel supported and empowered to take those steps. This means attending smear tests. Almost all cases of cervical cancer are caused by persistent high-risk human papillomavirus (HPV). HPV is extremely common, so much so that 80% of people will have HPV at some point in their lives. HPV lives on the skin in and around the genital area and is passed through skin-to-skin contact. In the majority of cases the immune system simply clears the infection however in some cases it can cause abnormal cells to develop in the cervix which, if not detected through smear tests and treated, could develop in to cervical cancer.

Research tells us that across the UK one in four women do not attend their smear test when invited, attendance is now at a 19 year low and diagnoses of cervical cancer are worryingly high. We know from research that the reasons women don’t attend are wide ranging.  Some women feel embarrassed, others are afraid the test will be painful, others report preferring not to know if something is wrong, many don’t understand what the test is or don’t think it is relevant for them. There are already many barriers to attending smear tests and for lesbian and bisexual women, incorrectly being told they do not need to attend smear tests is simply adding a further barrier to a test that could potentially save their life. We know that trans people with cervixes are even more likely to avoid getting smear tests, for the reasons above and also due to both fear and distrust of the medical profession, and, for some, discomfort around their bodies.

A significant part of our work at Jo’s Cervical Cancer Trust involves working with women and health care professionals to raise awareness of smear tests, overcome the barriers to the test and tackle any misconceptions and stigma that may be putting lives at risk. This is one of the reasons that we have launched a new LGBTQ section of our Forum. We want to provide a supportive environment where members of the LGBTQ community can talk openly about any concerns or issues they may have relating to cervical screening, screening results, and cervical cancer.

For more information visit – www.jostrust.org.uk 

Independent Choices’ new LGBT+ IDVA #LBWomensHealth17

Health isn’t limited to physical health, and physical and mental health are closely linked. Poor mental and physical health can be a result of being, or feeling like you are, less able to access health and other services which might support your wellbeing, such as safe housing. Being safe and secure is a determinant of both physical and mental health.

Independent choices tell us below about their new LGBT+ IDVA.

The LGBT+ IDVA (Independent Domestic Violence Advisor) is Independent Choices new service in conjunction with The LGBT Foundation Manchester, which specifically works with LGBT+ people who are experiencing domestic abuse.

Domestic abuse can take many forms, including: coercive control, physical, financial, sexual, and emotional abuse. There can be additional factors that can make it more difficult for somebody who is LGBT+ to seek support for domestic abuse. These can include being threatened to be outed to family, friends or work colleagues. They can include using your gender identity or sexual orientation as a method of control.

Domestic abuse isn’t well recognised in the LGBT community – There hasn’t been much information or discussion in the LGBT communities about domestic abuse. Most information on domestic abuse relates to experiences of heterosexual women. This lack of understanding means that some people may not:

  • Believe it happens in LGBT relationships.
  • Recognise their experience as domestic abuse if it does happen to them.
  • Know how to respond if they see domestic abuse being experienced by their friends.

Encouraging Disclosure It can be hard for LGBT domestic abuse victims/survivors to seek help because they may not want to disclose their sexuality to police or other organisations. Because of the general homophobia and transphobia in modern societies, LGBT victims/survivors of partner violence may be concerned about giving gay and lesbian relationships a ‘bad name’ and may refuse to speak up about the abuse they’re suffering.

When people do seek help, police and other agencies may misunderstand the situation as a fight between two men or women rather than a abusive intimate relationship, and LGBT people may be discouraged from disclosing if service providers use language which reflect heterosexual assumptions. For example, if a woman has not disclosed her partner’s sex, and is asked about her boyfriend/husband; if her abuser is a woman she may feel that she cannot disclose this or that it mustn’t count.

The Independent Choices IDVA will work with people to reduce the risk of further domestic abuse. This can include safety planning, support with housing, signposting to health and wellbeing services, support with attending court and reporting to the police if appropriate. Independent Choices want  LGBT communities to know that there is a service that understands their needs and to discuss options to be safer.