GMC stands by guidance urging GPs to prescribe hormones to trans patients

The GMC has defended its advice that GPs should prescribe hormone therapy to transgender patients in some cases, despite GPC concerns that it would push them to prescribe beyond their competence.

GMC deputy chief executive Susan Goldsmith wrote to the GPC on Friday, saying the recommendation would stand but committing to ‘re-word’ the guidance to make it clear hormone drugs should only be prescribed by GPs in exceptional circumstances.

The GMC released controversial guidance in March urging GPs to provide patients with a ‘bridging prescription’ of hormone therapy in special circumstances – before they are seen by a specialist.

It said GPs should only consider this as a ‘harm reduction strategy’ in cases where patients are turning to self-medication with drugs from unregulated sources while they await specialist treatment.

The reply responds to a letter sent by GPC chairman Dr Chaand Nagpaul earlier this month, warning that the advice could push GPs to prescribe specialist drugs that are ‘clearly outside of their expertise and competence’.

Ms Goldsmith stressed the GMC ‘would not want’ GPs to feel they are being forced to prescribe beyond their competence.

Gender dysphoria

But she added she did not believe providing care for patients with gender dysphoria was a highly specialist treatment area requiring specific expertise. The same hormone treatments are ‘commonly  used in general practice for treating patients with prostate cancer or endometriosis’, she said.

‘While [Good Medical Practice (GMP) guidance] states "you must recognise and work within the limits of your competence", this principle cannot be a bar to doctors taking on new responsibilities or treating unfamiliar conditions,' she warned.

‘We would expect GPs to acquire the knowledge and skills to be able to deliver a good service to their patient population. For some unfamiliar conditions or medicines, this may mean undertaking training or working with support or supervision for a period, in order to ensure that patients receive safe, effective care while a GP is extending or updating their knowledge and skills.’

Dr Nagpaul argued that the guidance placed unfair pressure on GPs and signalled a worrying precedent of expecting them to undertake a heavier load of specialist prescribing.

Ms Goldsmith said: ‘I am sympathetic with the difficult situation that GPs find themselves in: we recognise that the push to manage various long-term conditions in primary rather than secondary care, while improving patient experience, is putting increasing pressure on GPs’ resources.

‘Our principal concern is making sure that these vulnerable patients are not left with nowhere to turn.‘

She added that advice supporting GPs to treat trans patients, and how the GMP applies to this, was available online.

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