In a major overhaul of transgender healthcare, NHS England has announced plans to allow general practitioners to specialise in 'gender medicine' and prescribe hormone treatments. Health officials have labelled the move an 'immediate priority' to address a system in crisis.
Overwhelmed Services and a New GP Role
The decision follows an independent review of adult gender clinics led by Dr David Levy, a consultant in general medicine. His report found services are struggling to cope with rising demand, placing patients at serious risk. New referrals have doubled from around 5,000 in 2022–23 to 10,000 in 2024–25.
Dr Levy warned the number of people waiting for a first appointment could be far higher than the estimated 40,000, with some predicted waits exceeding 15 years. In response, NHS leaders said they would facilitate a new GP role specialising in gender medicine to 'provide leadership and knowledge-sharing' across primary care.
Key Changes to Patient Pathways
The proposed changes will significantly alter how patients access care. Under the new framework:
- Specially trained GPs will be able to prescribe cross-sex hormones after a patient has received one year of specialist care, reducing reliance on overstretched clinics.
- Patients will no longer be able to self-refer to specialist clinics and must be aged 18 or over to be eligible.
- Individuals may be discharged back to their GP for ongoing management sooner than under the current system.
The review highlighted that 25 per cent of referrals to adult clinics are for patients aged 17 to 19, with more than half under 25. The majority were born female. It also noted that around half have a co-existing condition like autism or ADHD, alongside a broader range of complex biopsychosocial issues.
Puberty Blocker Trial and Professional Concerns
The lack of capacity, coupled with a lack of evidence on long-term outcomes, is a key reason the NHS is planning a formal puberty-blocker trial. If it proceeds, these drugs could be given to children taking part as early as January next year.
However, the trial faces significant ethical scrutiny. Health Secretary Wes Streeting has admitted he 'wrestles' with the decision, stating children cannot consent to the drugs, and some healthcare professionals warn it risks 'grave physical harm' to vulnerable children, including potential permanent damage to fertility.
Professor James Palmer, NHS England's national medical director for specialised services, acknowledged the urgent need for improvement: 'Too many people are waiting far too long to get care... we need to ensure care is equitable wherever patients live.' The health service says it will use Dr Levy's recommendations to drive widespread service improvements.
