Shared Care with Private Gender Clinics/providers

Summary of protocol:

Trumpington Street Medical practice may agree to shared care for gender-affirming hormone treatment with private gender clinics, but only where clear safety and specialist criteria are met.

Shared care will only be considered if all the below criteria and monitoring requirements are met as laid out in this protocol.

The practice will not be able to prescribe hormone treatments for gender incongruence outside of this protocol including requests for “bridging” prescriptions.

Patients are advised to avoid procuring hormone medication from online sources without qualified specialist advice.

1. Purpose

This policy sets out the circumstances under which Trumpington Street Medical Practice will consider entering into a shared care arrangement with private gender identity services for the prescribing and monitoring of gender-affirming hormone therapy. The policy is designed to ensure patient safety, clinical accountability, and compliance with NHS and GMC guidance.

Shared care is not automatic and will only be agreed where the criteria below are fully met.

2. Scope

This policy applies to all patients registered with Trumpington Street Medical Practice who seek shared care prescribing for gender-affirming hormone treatment initiated by private gender clinic.

3. General Principles

The initiating gender clinic retains overall clinical responsibility for diagnosis, hormonal treatment initiation, dose adjustment, and interpretation of monitoring.

Trumpington Street Medical Practice will only take over the prescription of hormonal treatment once the dose and regime of medication is stable and the shared care criteria are met.

Shared care will only be accepted where the gender clinic is able to demonstrate appropriate clinical governance, specialist expertise, and clear communication.

4. Eligibility Criteria for Shared Care

Shared care will only be considered if all of the following criteria are met:

4.1 Specialist Assessment and Diagnosis

The patient must have been assessed by a specialist gender dysphoria clinic

A minimum of two assessments must have been completed prior to the initiation of hormone therapy.

One of these assessments must:

• be conducted by a UK, GMC registered Consultant Psychiatrist and
• make a formal diagnosis of gender dysphoria/incongruence

The Specialist clinic must provide a shared care protocol with written guidance for monitoring requirements, current dosing/ medication regime and documentation of planned follow-up.

5. Prescribing and Medication Management

Trumpington Street Medical Practice may issue hormone prescriptions and administer injectable medication only if:

• The medication name, dose, route, and frequency are clearly specified in writing.
• The dose is stable before prescribing responsibility can transfer to Trumpington Street Medical Practice. Prior to this during the titration phase or change of formulation the prescription must be provided by the private clinic
• Ongoing follow-up by the gender clinic is clearly documented and planned.

6. Monitoring and Blood Tests

Trumpington Street Medical Practice will perform blood tests requested by the gender clinic provided they are standard NHS blood tests which we would otherwise organise should the patient have been seen by the NHS Gender clinic.

The private gender clinic remains fully responsible for:

• Specifying which blood tests are required,
• Interpreting all results,
• Advising on any dose changes.

Any dose amendments must be clearly communicated in writing to Trumpington Street Medical Practice in a timely manner.

7. Ongoing Specialist Review

Once the patient has been stable on hormone treatment for a minimum of one year, they must:

• Continue to have at least annual reviews with the gender clinic.

There must be ongoing evidence of engagement with the specialist service and review in order to remain under shared care at the practice.

8. Circumstances Where Shared Care Will Not Be Provided

Trumpington Street Medical Practice will not issue hormonal medication under shared care arrangements if any of the following apply:

• The patient has not been assessed by a UK, GMC registered Consultant Psychiatrist with a confirmed diagnosis of gender dysphoria.
• The patient has not had a minimum of two specialist assessments, including one by a Consultant Psychiatrist, prior to hormone initiation.
• The patient fails to attend required blood tests.
• The patient does not continue to attend at least annual follow-up appointments with the gender clinic once the treatment regime is stable.
• Monitoring requirements or dose instructions provided by the private clinic are unclear, unsafe, or inadequately communicated.
• The prescribing request falls outside accepted NHS practice or the competence of primary care in keeping with Good Medical Practice requirements.

9. Bridging Prescriptions

Trumpington Street Medical Practice does not provide bridging prescriptions for gender-affirming hormone therapy.

This includes:

• Prescribing hormones prior to completion of specialist assessments,
• Prescribing while awaiting assessment or follow-up by a gender clinic,
• Prescribing in the absence of a confirmed diagnosis of gender dysphoria by a Consultant Psychiatrist.

10. Review of Policy

This policy will be reviewed regularly or in response to changes in national guidance, NHS commissioning arrangements, or regulatory requirements.

Updated December 2025