I am on the waiting list for an NHS gender clinic. Will my position in the waiting list be compromised if I also seek gender affirming healthcare with a private service?

Many people worry that they may be penalised if they access gender affirming healthcare privately while they are on the waiting list for an NHS gender clinic. However, it is within people’s rights to choose freely between private care and NHS care without being penalised.

This is the official position of the Department of Health’s Guidance on NHS Patients Who Wish to Pay for Additional Care Privately, which states:

• NHS organisations should not withdraw NHS care simply because a patient chooses to buy additional private care.
• The NHS should continue to provide free of charge all care that the patient would have been entitled to had he or she not chosen to have additional private care.

This is also the official position of the British Medical Association’s guidance on The Interface Between NHS and Private Treatment, which states:

• Patients who are entitled to NHS funded treatment may opt in to or out of NHS care at any stage.
• Patients who have had a private consultation for investigations and diagnosis may transfer to the NHS for any subsequent treatment. They should be placed directly onto the NHS waiting list at the same position as if their original consultation had been within the NHS.

And so, it would be unethical and procedurally incorrect for an NHS gender clinic to penalise you because you are also seeking gender affirming healthcare from a private service.

Will NHS gender clinics accept referrals, assessments, treatment recommendations from private services?

Although accessing private gender affirming healthcare should not compromise your right to access gender affirming healthcare under the NHS, NHS gender clinics may vary regarding whether or not they will accept referrals, assessments, and treatment recommendations from private services.

For example, the NHS Nottingham Centre for Transgender Health states that “we can only accept a diagnosis and transfer of care from another NHS England Gender Identity Clinic, GIDs or NHS Gender Service Pilot, therefore a private diagnosis cannot be taken into account”. Similarly, the NHS Gender Identity Clinic states that “with regard to private gender specialists … we are unable to endorse hormone therapy or take over management until we have assessed the patient ourselves”.

Given that different NHS gender clinics may have different policies regarding what they accept from private services, it is advisable that you ask your specific NHS gender clinic about how the gender affirming healthcare you have received privately will be continued under the NHS.

What are the guidelines for NHS GPs whose patients are accessing gender affirming healthcare through private services?

NHS England’s guidance on Primary Care Responsibilities in Regard to Requests by Private Online Medical Service Providers to Prescribe Hormone Treatments for Transgender People states:

• A request by a private online medical service that a GP accepts responsibility for prescribing endocrine treatments for trans and non-binary people, and for testing and monitoring, may be no different from what an NHS-commissioned specialised Gender Identity Clinic may request under current commissioning arrangements.
• GPs must cooperate with Gender Identity Clinics and other gender specialists by prescribing medications, providing follow up, and making referrals as recommended by those specialists.
• It may be appropriate for a GP to issue a prescription where an individual is already self-prescribing via an unregulated source, and where the prescription is intended to mitigate a risk of self-harm and is supported by appropriate specialist advice.

And so, NHS GPs are recommended to follow the advice of specialist gender services, whether they are commissioned by the NHS or a private provider.