"You have the right to all the treatments available to everyone else including, for instance, fertility treatments. In addition, case law in the:
North West Lancashire Health Authority v A, D and G, Court of Appeal, 1999).
confirms that the NHS should provide treatments that include hormones and, where necessary, surgery. These are deemed to be valid and appropriate treatments for gender variant conditions, whereas extended psychotherapy is not, on its own, a sufficient treatment.
In its judgment, the Court of Appeal acknowledged that the authorities (Primary Care Trusts) who make decisions about funding have the right to accord this treatment ‘low priority’. However, it would be unlawful for them to use this power in such away as to deny gender confirmation treatment to transsexual people altogether."
TL;DR: You have the right to treatment, however PCTs have the right to regard your treatment as 'low priority'. This means the funding may be delays because the money goes elsewhere first. It would however be unlawful for them to have a blanket ban on treatment for trans people.
What treatment will the NHS fund for me?
"Generally, you will be able to obtain funding for specialist psychiatric assessment and for hormonal medication. In addition, a few PCTs will fund hair removal, especially on skin from a donor site that is to be used in later surgery. Speech therapy may also be included in the package of care provided by a gender identity clinic (GIC) or a private gender specialist, and some PCTs are willing to fund this treatment. However, when you are considering surgery, you may find that the PCT limits this, in line with the view that there are ‘core procedures’ – which would usually be funded – and ‘non-core procedures’ that may be deemed ‘cosmetic’ or ‘aesthetic’.
In the case of trans women, this is likely to mean that facial feminising surgery, for instance, will not be covered. Even breast augmentation may be deemed aesthetic, and therefore not funded, despite the fact that this surgery may be essential to the success of the transition to the new gender role. The exclusions of such types of surgery are in line with local policies, and apply to anyone, whether or not they are a transsexual person. Chest reconstruction for a trans man, however, is likely to be regarded as ‘core’ surgery."
TL;DR: Hormones, chest surgery and gender confirmation surgery (lower surgery) are core procedures.
How do I see a gender specialist on the NHS?
Generally, you need to see your GP first, then see the local mental health service (CAMHs for under 18s). They will assess you for psychiatric / mental health issues that may be causing your gender identity issues. Once they are satisfied that that isn't causing it, they should refer you on to you local gender identity clinic (GIC)* - Local unfortunately often doesn't mean local, it will be the nearest one your PCT (primary care trust) funds.
"Thus, the pathway typically takes in:
contact with your GP (primary care);
referral by the GP to a local psychiatrist (secondary care);
referral by the local psychiatrist to a GIC; in some instances, the referral may be made to a private gender specialist approved by the PCT (tertiary care);
referral by the GIC, or private gender specialist, to a surgical unit, which may occasionally be private and even overseas; for genital surgery, the surgical unit will usually require referrals from two experienced clinicians (tertiary care); and
the GP will usually provide your ongoing hormone prescriptions and also tests to monitor your health, pre- and post-surgery; this will be based on the advice of the GIC or private gender specialist (primary care)."
But, please note: "This localised approach might be economical because it limits the need for costly appointments at the GIC. If you live a long way from a GIC, another benefit would be that you would avoid a time-consuming and expensive journey. It might also offer you more scope for greater flexibility and choice among the different elements of the treatment package. However, this localised approach might not be suitable for all service users, especially those with complex medical needs. Also, many GPs do not feel sufficiently experienced in gender variant conditions to take on the responsibility for this treatment. A second referral from another doctor is still necessary for gender confirmation surgery (gender reassignment surgery)." - Same citation as above.
TL;DR: While most people will follow the normal procedure, it's not completely necessary. Your treatments don't actually have to be done by the GIC but this is all dependant on your GP being happy to take over your care etc. It's not very common but it is possible.
What happens if I want to get some of my treatment from a private doctor?
"The British Medical Association has issued clear guidance:
Patients who are entitled to NHS funded treatment may opt into 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.
A Department of Health Document: "This is in accordance with the British Medical Association policy that states:“Patients who are entitled to NHS funded treatment may opt into or out of NHScare at any stage. Patients who have had private consultation for investigations anddiagnosis may transfer to the NHS for any subsequent treatment. They should beplaced directly on the waiting list at the same position as if their originalconsultation had been within the NHS.” "
TL;DR: You have the right to choose private or NHS care as and when you wish to. You can choose to go privately for hormones then go to a gender clinic for surgery, for example. It can be a little complex and sometimes the GICs won't take over your care straight away as they may want to follow their own assessments too, but you will not be barred from any NHS care should you choose to go privately for something. You GP is also perfectly within their rights to prescribe from a private doctor.
How long does it take to get funding for your Gender Identity Clinic to come through?
The Tavistock clinic is funded nationally so this shouldn't be a problem, your PCT should reply to your funding request within 2 months. If it has been 2 months since you were referred, it's time to start calling your GIC to find out what is happening with your referral.
TL;DR: A while. Anything from weeks to months, but start chasing it if it's been 2 months.
Can I have surgery without having hormones?
Yes. Some clinicians my explain why hormones before are beneficial (if you want to go on hormones at all), but it is your choice.
"Treatment should be patient-led; no aspects of treatment should be imposed rigidly. The clinician will need to allow choices thatwere not necessarily foreseen at the outset to be made alongthe way."
TL;DR: Yes. Your treatment is lead by you and no treatment can be rigidly imposed on you. It's your health.
COMPLAINTS / APPEALS PROCESS - NHS
On what grounds could the Primary Care Trust delay or refuse funding for my treatment?
"The NHS is legally required to fund treatment but PCTs are allowed to take into account reasonable local priorities. This gives rise to wide differences in local funding policies, in that there are substantial local differences in the types oftreatment that are covered and the speed at which funding is approved.
In England, the Department of Health (DH) allocates the money for funding the treatment of all conditions to the 152 PCTs. The decision of the court in the NorthWest Lancashire Health Authority case established the right to treatment for transsexualism but PCTs are still allowed to make different decisions about how they prioritise funding, provided that this is done on rational grounds. For instance, some Trusts have said that they are according very low priority to certain conditions because they need to cut funding in order to avoid being in deficit; and some have argued that there is no evidence that the treatment is successful. You may wish to dispute this if you are appealing against a PCT decision (see Section 3).
So, in practice, the process of allocating money for treatment, as well as the actual amounts of money made available, varies. Consequently, some PCTs will fundmany treatments for trans people readily but others accord all the treatments a very low priority."
TL;DR: The NHS is legally required to fund treatment but PCTs can take local priorities into account. They may say that funding for trans things is a very low priority because they wouldn't have the money to pay for it if they funded it at that time. They might also use the argument that there is no evidence that the treatment of transsexualism is helpful (this can be argued against if you are appealing your PCTs decision). Funding varies from PCT to PCT.
Can my GP refuse to treat me?
No. "Doctors are required to treat trans people for their gender variant condition but if they feel unable to do so in a sympathetic and supportive manner, then theyshould immediately find an alternative doctor who can."
TL;DR: Your doctor can't refuse you treatment just because they don't agree with your 'decision'. If they don't feel like they can treat you, they must refer you straight on to another doctor who will treat you with proper respect.
What should I do if my treatment is denied or unreasonably delayed?
"It is always open to you to put your case to the PCT and/or the more recently established Specialised Commissioning Groups that have now become responsible for certain aspects of the commissioning process for the treatment of trans people.You will probably need to progress through different stages, starting with an appeal, rather than a complaint.
Your initial contact should be through the Patient Appeals and Liaison Service (PALS). Usually you will find leaflets or information in the waiting area, or you can ask the receptionist for information about PALS."
TL;DR: Appeal FIRST, then complain if that doesn't work. First contact is through Patient Appeals and Liaison Service (PALS).
Writing a letter to the PCT – what should I say?
"In addition to supportive letters from your doctor(s), you might write to your PCT including some or all of the following information:
your legal right to be treated (see sections 1.1 for North West Lancashire Health Authority v A, D and G, Court of Appeal, 1999; and section 1.10 for HumanRights Act);
ways in which you have complied with your gender specialist’s readiness criteria (see footnote 20 under paragraph 2.7); including
information about the time you have already waited;
additional information regarding the impact that non-treatment is having on your life and the resultant stress (see sample letter below);
evidence that the treatment proposed is appropriate for you, and that there is a track record of successful outcomes over many years of treating trans people in this way (see Is treatment successful at section 3.11); and
you may wish to emphasise that the condition is not a life-style choice and your treatment is medically necessary."
How can I lodge a complaint against a gender identity clinic?
"Making a complaint against the GIC (rather than an individual doctor within it) involves a similar process to that outlined above for the PCT. You should start byapproaching the complaints manager and if that does not produce a satisfactory result, then you should talk to PALS, and work through the formal complaints procedure if necessary. So, the process would be much as described above.
However, if the GIC you are attending is a ‘foundation trust’ it may not have this twotrack complaint procedure. So, in such cases you will need to contact the complaints manager who is within the Mental Health Trust that is responsible for the GIC you are attending. The Trust’s complaints procedure should be on display."
Do I need a Gender Recognition Certificate (GRC) to change my name / title anywhere else?
"Some organisations may mistakenly believe that they are not supposed to change their records to show your new name and appropriate title (Mr, Miss, etc..) until you have obtained a Gender Recognition Certificate. This is incorrect and in most cases would constitute discrimination.
Furthermore, nobody is entitled to see or record the details of a Gender Recognition Certificate if you have one. If someone requires proof of your legal gender then you could show them your birth certificate.
The Gender Recognition Certificate (GRC) exists only for the Gender Recognition Panel to instruct the Registrar of Births to make a new entry in their register, from which a birth certificate can be drawn. The document states clearly that it has no other purpose. Recording sight of a GRC would automatically lead to a breach of Section 22 of the Gender Recognition Act, since sight of the record by any other person would constitute an unlawful disclosure of protected information. Officials should therefore be gently advised against making up rules involving GRCs."