Gender Incongruence in children and young people

Overview

The Gender Identity Development Service run by Tavistock & Portman NHS Foundation NHS Trust closed in March 2024.  

The NHS is providing new services for children and young people with gender incongruence.

The National Referral Support Service managed by NHS Arden and Greater East Midlands (Arden & GEM) Commissioning Support Unit, is holding the national waiting list on behalf of NHS England, NHS Wales 

They will be transferring children and young people from the existing waiting list to the new services in order of their original referral date.

From 1st September 2024, a referral onto the national waiting list for the specialist Children and Young People’s (CYP) Gender Services can only be made by an NHS-commissioned secondary care level paediatric service, or CYP mental health service (CAMHS). Other agencies including GPs, children's social care and schools will no longer be able to refer directly onto the waiting list for the CYP Gender Services.

Although GPs can no longer refer directly into the national waiting list, it is likely that the first point of contact with healthcare services is through primary care. Clinicians in primary care are not expected to have expertise in the management of gender incongruence but should have the skills to identify a potential presentation of gender incongruence, to identify co-existing and other health needs, to action the appropriate interventions and referrals for these, and to determine whether referral, according to agreed criteria, into secondary care services for them to review and consider onward referral to the specialist service.

To support the initial discussion with primary care, young people and the parents/carers of children and young people are encouraged to complete a national standardised Gender Experience Summary (GES). This form is available on the National Referral Support Service (NRSS) website as a digital form and a downloadable paper form which can be found on this site https://www.ardengemcsu.nhs.uk/services/clinical-support/national-referral-support-service-for-the-nhs-gender-incongruence-service-for-children-and-young-people/ . This form can then accompany referrals to secondary care service. Although the GES is not a required form to action a referral, it will improve the completeness (and ownership) of the information provided and reduce the likelihood of further information being requested. 

At the discussion with primary care service options are considered with the child and parent/carer (where appropriate) using the GES if completed. Primary care teams are supported by the MindEd modules .

The full service specification for the referral pathway can be viewed here: Service specification: national referral support service for specialist service for children and young people with gender incongruence (england.nhs.uk)  and further supportive information can be found here for both families and professionals https://www.ardengemcsu.nhs.uk/services/clinical-support/national-referral-support-service-for-the-nhs-gender-incongruence-service-for-children-and-young-people/

Restrictions on Puberty Blockers - May 2024

The government has introduced regulations to restrict the prescribing and supply of puberty-suppressing hormones, known as ‘puberty blockers’, to children and young people under 18 in England, Wales and Scotland. See links below for details:

• New Government Restrictions On Use Of Puberty Suppressing Hormones
• New restrictions on puberty blockers - GOV.UK
• The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (Extension) Order 2024 (legislation.gov.uk)

Some children and young people may be concerned or distressed by these changes. If they are already under the care of CYP mental health, they can contact their team for advice. If not, their GP team should assess and sign post or refer for mental health support as required. 

Referral

From 1st September 2024, a referral onto the national waiting list for the specialist Children and Young People’s Gender Services can only be made by an NHS-commissioned secondary care level paediatric service, or CYP mental health service (CAMHS). Other agencies including GPs, children's social care and schools will no longer be able to refer directly.

It is suggested that young people are encouraged to complete the Gender Experience Summary (GES). This form is available on the National Referral Support Service (NRSS) website Download the Gender Experience Summary Questionnaire

At the discussion with primary care, service options can be considered with the child and parent/carer using the GES, if completed. The following outcomes are suggested:

• Decision with child and parent/carer (where appropriate) not to refer
  onward with or without subsequent primary care review.
• Referral to Children and Young People mental health services if needs
  are identified using standard local arrangements for referral.
• Referral to general paediatrics if specialist mental health needs are not
  identified using standard local arrangements for referral.
• Referral to autism or neurodevelopmental healthcare service (usually
  within CYPMHS or Paediatrics) according to local arrangements.
• Joint referral to Children and Young People mental health services and
  Paediatrics if required.

Resources

Happy Maps has a section on Primary School age-group Gender Identity, Puberty and Sex

Gender Identity Support line - (provided by the Gendered Intelligence charity) - this has been recommended by the Exeter GIC clinic and may be useful to support patients during the long wait for an appointment.

The Patients and Parents section of the National Referral Support Service website provides further sources of support while waiting for an appointment.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.