GMC transgender advice could push GPs to prescribe beyond competence, warns GPC

GMC guidance that calls for GPs to initiate hormone therapy in some transgender patients before they see a specialist could make GPs 'feel coerced' into prescribing specialist drugs outside of their clinical competence, the GPC has warned.

GPC chairman Dr Chaand Nagpaul has written to GMC chairman Professor Terence Stevenson highlighting ‘widespread concerns’ from the profession over recommendations for GPs to prescribe specialist drugs that are ‘clearly outside of their expertise and competence’.

It comes after the GMC released guidance in March recommending that GPs could initiate hormone therapy in transgender patients before they are assessed by a specialist.

It suggested that GPs should only provide ‘bridging prescriptions’ of hormone therapy when patients are attempting to self-medicate with products bought from an unregulated source and if they have a long waiting period to see a specialist.

GP prescribing

But Dr Nagpaul said the recommendations signal a push towards GPs undertaking more specialist prescribing, which places ‘worrying expectations’ on them and could pressurise them to prescribe treatments beyond their clinical competence.

Instead of expecting GPs to ‘bridge’ the gaps, he said patients deserved better access to specialised treatment – where they can receive a specialised comprehensive assessment and wider support prior to drug treatment.

He also expressed concerns over the potential medico-legal consequences if any complaints occurred as a result of GPs prescribing these drugs.

‘Our key concern is to ensure that GPs can prescribe safely within their limits of competence, and this includes the ability to decline to prescribe, where appropriate,’ his letter to the GMC said.

‘Current guidance is unequivocal that initiating hormonal treatment for patients with gender dysphoria should be done by a specialist as part of a comprehensive assessment process.

Hormonal treatment

‘It is simplistic to consider that the needs of patients awaiting specialist treatment can be met simply by a technical process of issuing a prescription to avoid the harm of self-medication, when in fact the patient should be entitled to a specialised comprehensive assessment and wider support prior to treatment.

‘This is an important matter of principle which could apply to other clinical areas where there are delays in treatment, and it would be quite unacceptable if GPs are expected to provide treatment beyond their competence in order to "bridge" such deficiencies.’

Professor Stephenson said: 'Transgender patients have the right to be treated with the same respect, sensitivity and understanding as all patients. As the BMA says, "there is a legitimate and moral need to ensure that patients with gender dysphoria receive prompt and timely care".

‘Our new guidance, which is based on national guidelines endorsed by several medical royal colleges, is intended to support doctors with an area of care which we know many find challenging. It is only right that we provide further clarification if necessary and we will respond to the points raised by the BMA as quickly as possible.'

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