National Gender Identity Healthcare Reference Group minutes: 1 August 2024

Attendees and apologies

• Professor Nicola Steedman, (Co-chair), Deputy Chief Medical Officer, Scottish Government
• Dr Ewan Bell, (Co-chair), Associate Medical Director, NHS Dumfries and Galloway
• Dr Fiona Clunie, Consultant Psychiatrist/Medical Lead, Chalmers Gender Identity Clinic, NHS Lothian
• Dr Paul Connelly, Clinical Lecturer in Diabetes & Endocrinology, University of Glasgow
• Professor Graham Ellis, Deputy Chief Medical Officer, Scottish Government
• Hayley Fairgrieve, Gender Lead Nurse/Advanced Sexual Health Practitioner, Chalmers Gender Identity Clinic, NHS Lothian
• Linsey Galbraith, Principal Information Analyst, Public Health Scotland
• Jane Harris, Head of Programme, Postgraduate and Post-registration Education and Continuing Professional Development, NHS Education for Scotland
• Jennifer Jamieson, Adult Services Manager – Sexual Health, NHS Greater Glasgow and Clyde, for Rhoda Macleod
• Dr Amber Keenan, Clinical Lead, NHS Highland
• Jennifer Layden, Health Improvement Scotland
• David Parker, Senior Educator, NHS Education for Scotland
• Dr Ruth Pearce, Lecturer, University of Glasgow
• Dr Alison Poupart, Interim Consultant Clinical Psychologist, NHS Greater Glasgow and Clyde
• Dr Emily Retkiewicz, Clinical Psychologist, NHS Grampian
• Dr Craig Wheelans, National Medical Advisor, Specialist Healthcare Commissioning, National Networks & National Planning, NHS National Services Scotland
• Head of GMS Contract Team, Scottish Government
• Representative, LGBT Health and Wellbeing
• Representative, LGBT Youth Scotland
• Representative, Scottish Trans
• Representative, Transparentsees
• Scottish Government Secretariat

Apologies

• Catriona Johnson, Associate Director, NHS National Services Scotland
• Kimberley MacInnes, Service Manager, Raigmore Gender Identity Clinic, NHS Highland
• Rhoda Macleod, Head of Sexual Health, Prison and Police services, Sandyford Gender Identity Clinic, NHS Greater Glasgow and Clyde

• Dr Susan Rooney, Clinical Lead, Sandyford Gender Identity Clinic NHS Greater Glasgow and Clyde
• Dr Fiona Wardell, Standards and Indicators Team Lead, Healthcare Improvement Scotland
• Lived Experience Coordinator

Items and actions

Welcome and minutes of previous meeting: Paper A (minutes)

Nicola Steedman (NS) welcomed attendees to the eighteenth meeting of the National Gender Identity Healthcare Reference Group (the Group). Apologies were noted.

NS welcomed the General Medical Services (GMS) Contract Team from the Scottish Government, and introduced two new members to the Group; Dr Fiona Clunie as Medical Lead for Chalmers Gender Identity Clinic, NHS Lothian and Hayley Fairgrieve, Gender Lead Nurse, NHS Lothian.

Minutes of the previous meeting were approved and NS noted that the minutes will be published online in due course.

NS highlighted for member awareness that the High Court of England and Wales had ruled that restrictions on the independent prescription of GnRH analogues in England, Wales and Scotland is lawful in response to a judicial challenge to UK Government legislation.

It was also noted that the British Medical Association had issued a statement (31 July) stating they will evaluate the Cass Review and publish an independent report by January 2025.

Updated Terms of Reference

The Scottish Government presented a draft updated Terms of Reference to the Group which removed some of the language relating to the Bute House agreement which has now ended.

It was agreed that some language would be amended further following discussion and an updated draft would be circulated to members.

Policy update/risk register

The Scottish Government provided an update on the progress of current workstreams and highlighted changes to the risk register.

It was highlighted that allocations for 2024-2025 have been issued to Health Boards, and the related risk regarding financial allocations would be removed from the risk register.

Independent Healthcare interactions with NHS - current expectations

The GMS Contract Team provided an overview to the Group on the general relationship nationally between independent healthcare and NHS primary care services.

Some members highlighted inconsistencies in how current guidance on interaction between primary care and independent healthcare is interpreted by different GPs and variation between GPs in their willingness to support independent gender identity healthcare.

Current guidance was published in 2009 and highlights that GPs are independent contractors and must make decisions based on their own judgement, considering what they determine is medically appropriate for individual patients whilst recognising and working within their clinical competence.

Feedback to Lived Experience report

A response to feedback given by the Lived Experience Coordinator (LEC) and third sector organisations to the group at its 22 February 2024 meeting was discussed. This included updates on key themes raised by through the LEC and third sector orgs ongoing engagement with people with lived experience of accessing or waiting to access NHS gender identity services in Scotland.

The Group noted the importance on lived experience in the work of the reference group and strategic framework workstreams.

A discussion followed around how some of the information gained from this engagement could be used to prevent duplication in consultation exercises.

September publications and comms plan

An overview of timelines for upcoming publications was given alongside an overview of the expected communications plan for these publications. A number of framework workstreams are nearing completion and several publications are expected over the coming months.

The Group noted this update.

TransparenTsees - feedback from families of children and young people impacted by recent developments

Transparentsees provided a verbal update on feedback they have received from parents and families of children and young people who have been impacted by recent developments within young people’s gender identity healthcare in Scotland in the context of wider UK action.

The Group acknowledged that this had been a very challenging time for many families and were grateful for them sharing their experiences with the Group. The importance of hearing their voices was acknowledged and shared goals of improvement in clinical service delivery were reiterated.

Commissioning Young People's Services

An update was provided on the establishment of work by Chief Operating Officer Directorate in Scottish Government to commission a Children and Young Person Gender Service for NHS Scotland in a paediatric clinical setting.

This was a recommendation in the Chief Medical Officer’s report to the Scottish Parliament on 5 July 2024.

It was noted substantive consultation with lived experience and those impacted by any future change would be embedded at the appropriate point in this process.

Post strategic framework priorities – next steps

Due to the meeting overrunning, it was agreed this item would be discussed at the next meeting of the Group.

University of Glasgow update on research progress

An overview was given on the progress of research projects being administered by the University of Glasgow into the long term health outcomes for people accessing NHS gender identity services in Scotland.

It was confirmed that projects are broadly progressing well and the Group expressed enthusiasm for this research and the expectation of results in the medium future.

AOB & Close

The next meeting of the Group was confirmed for 01 October 2024.

Due to the time it was advised that any other business could be raised through the secretariat and circulated to the Group.