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I will focus my questions mainly on the role of GPs in designing a service model, because I am deeply concerned about how this is going to play out. Designing a service model never really seems to involve GPs—HIS, for example, only took written evidence from them.

First, is the provision of shared care for gender identity healthcare contractual in the GMS contract?

Yes—according to the BMA, the GMS contract is clear that this is not part of shared care, and that it is outside the contract for core work that GPs would provide.

Does a GP sit on your board to make that agreement?

I declare an interest as a practising NHS general practitioner.

Good morning. Given the recommendations to move to a regional model to provide gender services, do GPs, who will input to the service design, sit on your panel? I ask specifically about a GP who is on the panel and in the room at every meeting and not just consulted or asked for input.

Providing monitoring and prescription of medication.

All gender-related medication.

Where that decision is being made—you said that it was made at board level.

Under HIS criteria 6.1, it is suggested that there are

“local pathways”

to

“support shared care across services and settings”,

with flow charts showing discharge of patients into primary care, but with no set gender clinic follow-up. How can we expect GPs to be able to provide that care that you spoke about earlier when you said that GPs would organise the dual-energy X-ray absorptiometry—DEXA—scans under such stressed circumstances?

Can we opt out and say, “No—we don’t want to do this”? I say “we” meaning GPs.

I come to my final question. There is a big difference between the case of a patient who accesses NHS care, who is prescribed medication and then—normally—has a period of follow-up discussion, and that of one who goes into a private setting, who receives an initial diagnosis and then their GP is asked to prescribe medication. How can we ensure that there is a standardised approach across the NHS, not only to patient safety but to the safety of the clinicians who are involved?