NHS gender identity services: strategic action framework 2022-2024

Background

Strategic context

This Strategic Action Framework sits alongside wider work supporting Scotland's recovery from the COVID-19 pandemic (including the NHS Recovery Plan), as well as work to address inequality and disadvantage experienced by minority population groups.

As our Covid Recovery Strategy notes, individual policies 'cannot be viewed in isolation and all have a part to play in making Scotland a fairer place' - this publication therefore sits clearly in the context of wider strategic plans.

Scotland's National Performance Framework (NPF) sets out the vision for how we create a more successful Scotland. It focuses on how the wellbeing of people living in Scotland can be increased across a range of economic, social and environmental factors laying out national outcomes to help achieve its purpose. Of these outcomes this Framework contributes to relevant NPF outcomes which are 'we are healthy and active', 'we live in communities that are inclusive, empowered, resilient and safe' and 'we respect, protect and fulfil human rights and live free from discrimination'.

Additional, relevant wider national policy is listed in Annex B.

Current services

There are currently four GICs providing services to adults in NHS Scotland. These are based in four NHS Health Boards:

• NHS Grampian
• NHS Greater Glasgow and Clyde
• NHS Highland
• NHS Lothian

A separate service for young people, NHS Greater Glasgow and Clyde's Young Person's Service, accepts referrals from across Scotland.

In 2012 we published the Gender Reassignment Protocol (GRP), which aimed to improve and standardise gender reassignment clinical pathways in NHS Scotland. The NGICNS was set up in 2014 as a Managed Clinical Network within NHS National Services Scotland to support the implementation of the GRP.

Following a letter from the Chief Medical Officer, NGICNS and NHS National Services Scotland are now working to review and update this clinical protocol. An updated GRP will be delivered in summer 2022. The work to update the GRP and the delivery of the commitments in this Framework are interconnected and each will support and inform the other.

Regional variation in care

People accessing gender identity services have highlighted variation in the time between referral and first appointment between GICs. However, geographical variation in ongoing provision of care after accessing a GIC in the NHS Board areas where people live is also frequently raised.

In keeping with the core principles of Realistic Medicine we recognise the need to address this variation and potential geographic inequalities. Implementation of actions in this Framework from 2022 will ensure equitable access not only to specialist services, but also to subsequent care and support trans people receive from NHS Boards, including through primary care.

Gender reassignment surgery

Due to the specialist nature of gender reassignment surgery, this is provided by the NHS via a four nations contract managed by NHS England.

Under the governance of NHS England, the Gender Dysphoria National Referral Support Service manages referrals for gender reassignment surgery from all UK nations. No NHS gender reassignment surgery currently takes place in Scotland.

We recognise the importance of accessing treatments locally where appropriate, as well as building resilience in provision. We have therefore committed in this Framework to look at the potential for providing gender reassignment surgeries in Scotland. We anticipate that this would complement and be part of the current four nations NHS contract.