- Gender incongruence – the term used in ICD-11 to refer to the experience of having a gender that does not match the sex you were assigned at birth.
- Transgender – an umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth.
- Non-binary – an umbrella term for people whose gender identity doesn’t sit comfortably with ‘man’ or ‘woman’. Non-binary identities are varied and can include people who identify with some aspects of binary identities, while others reject them entirely.
- Trans man – a term used to describe someone who is assigned female at birth but identifies and lives as a man.
- Trans woman – a term used to describe someone who is assigned male at birth but identifies and lives as a woman.
You’’ll find more terminology in our glossary.
Under the Equality Act (2010) trans people are entitled to freedom from discrimination when accessing healthcare. From the moment they come out as trans, trans people all ages are protected under the ‘gender reassignment’ characteristic. This also includes non-binary people.
It’s important not to make assumptions about your patients. Like anyone else, trans people may be disabled, neurodiverse, from a faith background, from a variety of ethnic and racial backgrounds, and have a range of sexual orientations.
When talking to patients on the phone, it is important to be aware that voice pitch does not signify gender. Trans people can find it extremely upsetting when somebody gets their gender wrong – for example, calling a trans woman ‘sir’. You can avoid causing significant distress to your trans patients by avoiding the use of gendered language until you know the gender of the patient you are talking to.
Pronouns are the words used to refer to people’s gender in conversation – for example, ‘he’, ‘she’, or ‘they’. Be aware that a person’s pronouns may not align with the sex marker on their medical record. If you’re not sure about a patient’s pronouns, just ask them.
Changes to medical records
A trans patient is able to change their name and/or title using the same routes as any other patient. Patients can change their sex marker on their records at any point and do not need to have accessed any transition related healthcare in order to do so. There is no need for proof of a legal change to change a patient’s name on their medical record, so you do not need to ask for a deed poll.
Changing gender marker will result in a new medical record with a new NHS number – work with the patient to help them understand the benefits of migrating their previous medical history into their new record. When changing gender on the record, it is encouraged to select either M or F in order to facilitate records, invites and referrals. ‘Not specified’ is an option for non-binary patients. It is, however, useful to explain to them that the NHS record system is currently very binary and it may be worth aligning their patient record with the cancer screening programmes. Make a record of the conversation and outcomes.
Many non-binary people use the title Mx, rather than Mr or Ms. Ensure that you use the correct title for trans people when you send them correspondence or on electronic screens in the waiting room. If you’re not sure which title a patient uses, just ask them.
Surgery staff should consider the privacy of trans people when talking to them about appointments, prescriptions or other requests they might make at the reception desk. Trans patients might feel anxious about other patients overhearing your conversations, so ensure that there are options to speak to the receptionist privately.
Arriving for appointments
Arriving for appointments and sitting in the waiting room can be a source of anxiety for some trans people. Some trans people may wish to access appointments at the start or end of a clinic to avoid a crowded waiting room environment.
Not all trans people will have changed the name on their medical records – ask the patient which name they would like you to call out for the appointment or display on the notice screens. Another option would be to call all patients for appointments using their initial and surname.
It’s important to consider that non-binary people do not currently have the option to record their sex/gender correctly on their medical record. Avoid using patient self-check in systems that ask the user their sex/gender, as it can be upsetting to non-binary people to refer to themselves using language that does not align with who they are. It many also be useful to inform patients that they are welcome to present directly to reception if they are uncomfortable using self-check in systems.
Mental health support
Whilst being trans is not a mental health condition, trans people are disproportionately impacted by mental health difficulties. These can be exacerbated by long NHS waiting lists and anxiety over accessing hormone treatment and surgery. Surgery staff can help trans patients by being approachable and reassuring. It is also important remember not all trans people’s mental health difficulties are related to them being trans.
Some trans patients will benefit from trans healthcare that specifically caters to trans people.
Details of trans inclusive mental health services: https://www.transactual.org.uk/transorgs
Sources of CPD and further reading on trans inclusive practice in the GP surgery
Royal College of General Practitioners
- LGBT health hub https://elearning.rcgp.org.uk/mod/page/view.php?id=9380
- E-learning module https://rcgpportal.force.com/s/lt-event?id=a1U1i000001ROrrEAG&site=a0d0Y00000AeOP6QAN
- Position statement https://www.rcgp.org.uk/representing-you/policy-areas/transgender-care#
General Medical Council
- Trans healthcare hub https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare
- Gender dysphoria https://www.nhs.uk/conditions/gender-dysphoria/
- Non-surgical care pathways https://www.england.nhs.uk/publication/service-specification-gender-identity-services-for-adults-non-surgical-interventions/
- Surgical care pathways https://www.england.nhs.uk/publication/service-specification-gender-identity-services-for-adults-surgical-interventions/
LGBT+ sector organisations
- TransActual https://www.transactual.org.uk/healthcare
- CliniQ https://cliniq.org.uk/
- GIRES https://www.gires.org.uk/e-learning/
- The Clare Project https://clareproject.org.uk/resources/
- Pride in Practice https://lgbt.foundation/prideinpractice