1 Introduction
1.1 Policy statement
The Earlsfield Practice is committed to providing safe, consistent, and evidence-based care
for patients seeking hormone treatment for gender dysphoria/gender identity services.
The practice will not take over prescribing initiated by private providers. NHS referral
pathways are available to ensure safe access to appropriate care. Shared care requests
from NHS specialist services will be considered on a case-by-case basis, taking into account
the medication involved, safety considerations, and GP partner experience.
2 Policy
2.1 General principles
• We do not accept shared care prescribing requests from private providers for gender
identity hormone treatment
• Patients will be offered referral via NHS gender identity clinics (GICs) or other NHSapproved routes
• Shared care prescribing will only be considered if:
• The request comes from an NHS specialist service, and
• The medication is appropriate, safe, and within the GP partners’ competence
and experience
GPs are not mandated to accept shared care prescribing and may decline where this falls
outside professional competence or safety standards.
2.2 Referrals and Access to Care
• Patients requesting assessment for gender dysphoria or hormone therapy will be
referred to an NHS Gender Identity Clinic (GIC) via the standard NHS referral
process
• Patients will be informed that NHS pathways may involve waiting times, but this
ensures safe, multidisciplinary care and appropriate follow-up
Information about NHS GICs and referral processes will be made available via practice staff
and on the practice website.
2.3 Shared Care prescribing principles
• Private provider requests: Declined automatically, in line with practice policy. Patients
may continue privately or transfer to NHS care.
• NHS provider requests: Considered on a case-by-case basis by GP partners.
Factors considered include:
• The specific hormone or medication requested
• Monitoring and follow-up requirements
• The GP partner’s competence and ability to safely prescribe and monitor
• Local SWL ICB prescribing guidance and formulary positions
If declined, the patient and specialist provider will be informed promptly with a clear
explanation.
2.4 Clinical governance and GMC guidance
• This policy is underpinned by the GMC’s Good practice in prescribing and managing
medicines and devices guidance on shared care
• GPs may decline prescribing where:
• The treatment is outside their competence
• Monitoring arrangements are unclear or unsafe
• Specialist oversight is inadequate
An audit of gender identity prescribing requests and decisions will be carried out annually to
ensure consistent application of this policy.
2.5 Communication with patients
• Patients will be informed in a supportive, respectful, and clear manner about:
• The practice’s prescribing boundaries
• Available NHS referral options
• Reasons for declining private shared care requests
Standard information letters will be provided, and updates will be added to the practice
website for transparency.
2.6 Responsibilities
• Partners: Accountable for final decisions on shared care requests and overall
governance
• Practice Manager/Admin Staff: Ensures requests are triaged, policies applied
consistently and communication is sent to patients/specialists
• Prescribing Clinicians: Follow this policy when approached with hormone
prescribing requests and escalate uncertain cases to the partner