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MichaelT @mjt273
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New adult gender identity service specifications are out: engage.england.nhs.uk/survey/gender-…
Initial thoughts (based mostly on a quick read of the NHS report into what has been changed):
1) They've decided to rename gender identity clinics "gender dysphoria clinics", to emphasise that people with diverse gender identities who don't have dysphoria don't need to go there
I can kind of see where they were going with this, but given varying views about the term "dysphoria", overall I'm not keen on the name change.
2) They have allowed for self-referral. This is very, very positive given the problems of delayed GP referrals
3) They're moving forward with a more primary care focused service. I am overall positive about this, but think it needs careful handling. There are some really positive plans for early adopter pilots in some parts of the UK.
However, the problem will be health areas that are less enthusiastic (and perhaps aren't co-operating with existing arrangements). Also, rural areas - in my neck of the woods, the health area covered by "local arrangements" is still hours of driving or crap public transport.
4) They're bringing performance measurement. As a former performance management officer for a Council, I think performance management is, in general, a good thing - provided you've got the right measures and people use common sense
This does not always happen. However, I think any performance management is likely to be better than the existing situation of not knowing how long waiting lists are, months to get letters, no system for consistently checking quality and safety
5) They're going to look again at facial hair epilation arrangements. I'm less qualified to comment on this - I guess looking again is good, taking it out of the service spec while they do the looking is less good?
6) Surgery referrals will go via a central system. This one's complicated - basically, once your GIC (or GDC or whatever they're calling it now) has agreed you're ready for surgery, they will send your details to this centre.
The centre will then say to you "Right, we have 5 surgeons who can do this procedure. Surgeon 1 is very close to you, but has a long waiting list, surgeon 2 is further away but has great performance outcomes, surgeon 3 is middling, and so on." You then choose.
I can see the advantages of this if it works well (given we are seeing various problems with GICs not actually knowing who does surgeries, patients getting sent back to GICs if their surgeon can't do the procedure).
However, there is also the potential for it to be a bureaucratic nightmare and another source of delays. Overall I think I'd lean to cautiously positive about this one.
7) They've had another look at some of the equality impact assessment. As noted above, one upshot of this is changing the name and trying to double down on gender identity services beign focused upon people with a diagnosis
8) They've acknowledged that non-binary people feel services are currently binaristic, but say that's justified because there is less evidence on treating non-binary people.
This one's annoying - the reason there is less evidence is mainly because gender identity services have spent the last fifty or sixty years gatekeeping access to services in line with binary norms.
However, compared to the old service spec, they have acknowledged NB people exist and should have access to care, and that care should be focused on individuals not one size fits all
9) They won't budge on access to adult services below the age of 17. They have backed down on proposals to potentially keep young people in youth services for years after the age of 18, and will look into a better integrated adolescent service.
10) They have removed wording about GICs not accepting referrals for people with acute physical or mental health problems. There is some more specific wording about ensuring patients are able to give informed consent.
This is good. The old wording was vague enough that many trans people could have found their referrals blocked for unnecessary reasons, ironically worsening their health
11) They won't make any changes on BMI limits. However, those should not act as a blanket bar to surgical referral - rather, you will get referred to the surgeon and discuss with them whether BMI is an issue.
12) As before, they say including breast augmentation and facial feminisation surgery in the new service spec needs to go through a different process of approval, and claim they intend to develop evidence on this.
13) They have clarified wording so as not to exclude intersex people who experience gender dysphoria. This is good.
14) They have said viewpoints that object to the existence/healthcare of trans people are out of their remit and passed such comments over to the Government Equalities Office. Who have no doubt filed them with the similar comments submitted to the national LGBT survey.
15) They are still going to require patients to be registered with a GP, but will look at whether their new primary care model can take into account issues for groups who are less likely to be registered with a GP.
16) They've rejected an informed consent model - though I do think a primary care model could potentially have many of the benefits associated with informed consent. Closer, quicker, more responsive services would go a long way to improving things.
17) They don't agree with equality issues raised around older people, substance misuse, race, family members, pregnancy/maternity or religion - they think the service spec does not disadvantage people in relation to protected characteristics in these fields.
18) They say they're going to take forward work to ensure people in the criminal justice system have access to healthcare
19) Between September and December 2018 they're going to develop the procurement strategy. [/End]
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