In new advice, NHS England said GPs could continue to prescribe puberty suppressants to some children and young people if they felt “competent to do so”.
The announcement comes after the Government recently extended until 26 November the legal ban on private prescriptions of puberty suppressants, which was first introduced in May under the Conservative government.
In a letter to GPs last week, seen by Pulse, the commissioner set out guidelines on how to deal with patients under 18 who want puberty-blocking hormones, in light of the new regulations.
Regarding prescriptions, NHS England said young people who are currently taking medicine and are no longer able to access prescriptions are “advised to speak to their GP”.
In these cases, GPs must “offer to see the young person” and assess whether a referral to child and young people’s gender services or mental health support is needed.
However, from 1 September GPs will no longer be able to register young people directly onto child gender service waiting lists and will only be able to accept referrals from paediatric or mental health services.
“Continuation of puberty-blocking hormones can be considered where your GP determines you have the capacity to do so and can confirm that treatment has been administered in the six months up to 3 June 2024,” the letter added.
If GPs decide to continue prescribing puberty-suppressing drugs for gender dysphoria, their prescriptions “will need to be authorised as ‘SLS’ to meet NHS regulations”.
NHS England also told GPs that they should advise their patients “not to buy GnRH analogues (or any other medicines) from unregulated sources such as the internet, friends or street dealers”.
If children and young people are obtaining puberty suppressants from these sources, GPs should consider whether ‘safeguarding procedures’ should be considered.
The report advised that patients who discontinue medication “may benefit from psychological and possibly psychiatric support”, citing the “incidence of mental health problems” among gender dysphoric young people seeking sex reassignment surgery.
The letter, signed by NHSE’s director of primary care Dr Amanda Doyle and director of specialist services Professor James Palmer, recommended that GPs meet with patients to “fully understand the risks of continuing/initiating treatment” due to the “limited evidence base” set out in the Cass review.
GPs will also have to “exercise due diligence” to determine whether a patient was first issued with a prescription in the six months up to June 3, 2024, under the rules.
↓Article continues below this sponsored ad↓
Still need to gain some CPD before the year is over? Sign up to the next Pulse 365 virtual conference to gain up to 10.5 CPD hours in your portfolio and develop your skills across a wide range of clinical topics.
↑advertisement↑
The letter said: “This must be submitted in the form of documentary evidence. The form of evidence (letters, prescriptions, etc.) that the doctor must rely on to determine whether treatment has commenced is not prescribed by law, but whether treatment has already commenced is ultimately a question of fact.”
Current Regulations
It is an offence to supply puberty blockers to a patient under the age of 18 unless:
- Have previously been provided with an NHS prescription.
- They are provided with a UK private prescription for either:
- The date must be on or before 3 June 2024 (27 August for Northern Ireland).
- Repeat prescriptions annotated by the prescriber as “SLS” and indicating the patient’s age, provided the original prescription was issued within six months of 3 June 2024 (27 August in Northern Ireland).
- As above, but for purposes other than treating puberty suppression.
From 26 June 2024, GPs will only be able to issue NHS prescriptions for GnRH analogues if:
- Patient is aged 18 years or older
or
- Patients are 17 years of age or younger and are seeking treatment for a condition other than gender dysphoria/gender incongruity
or
- The patient is 17 years of age or younger and has had a prescription for puberty suppression issued in the six months ending June 26, 2024 (in which case the prescription may continue to be issued).
Prescription of puberty suppressants by prescribers registered in the European Economic Area (EEA) or Switzerland is prohibited under all circumstances to patients under the age of 18.
Source: NHS England letter to GPs
Before the private prescription ban was introduced in May, NHS England had banned the routine prescribing of puberty suppressants to children with gender dysphoria on the NHS after a working group determined there was not enough evidence to support their “safety or clinical effectiveness”.
In July, Health Minister Wes Streeting said he would “defend” an emergency ban on private prescriptions that was being challenged in the High Court by transgender rights activists.
This was followed by claims on social media that there had been a “surge” in suicides since the High Court’s decision in 2020 to regulate puberty blockers.
But suicide prevention experts have rejected these claims and warned against puberty suppressants being used as a “touchstone” in the debate.
Last month the BMA called for a moratorium on implementation of the Cass review’s recommendations on the treatment of transgender children.
The doctors’ union Independent Report It is due to be completed by the end of the year following “concerns” expressed by doctors and academics.
Pulse Lighting Contest 2024
Want to be the next Pulse blogger? Enter our writing contest today.
