Today I received an email from the Interim Chief Operating Officer of Halton CCG, located at Victoria House in Runcorn, Cheshire, replying to my inquiry which details the basic care path that Halton & St Helens PCT follows. Here is that email:
There is no single universally accepted pathway for patients with gender dysphoria. There is a recommended pathway that has been established by the North West Specialised Commissioning Team which we follow locally – work in which I was involved in when I worked with that team. This is based upon the WPATH Standards of Care, often referred to as the Harry Benjamin criteria. The recommended pathway can be summarised as follows:· Patient sees his/her General Practitioner for assessment and management of gender dysphoria. The GP refers the patient to a local specialist in gender dysphoria where that is available or to the local NHS mental health provider for access to further evaluation.· Patient is assessed by the local NHS psychiatrist, who may or may not be an expert in the field of gender dysphoria. If the local psychiatrist considers the case to merit further evaluation and can rule out the presence of an obvious mental illness that may be the cause of the symptoms of gender dysphoria, the patient is referred on to the Gender Identity Clinic (GIC).· Depending on the operational policy of the GIC confirmation of funding may be requested from the patient’s PCT before an outpatient appointment is made. It is important to note that the PCT making the decision need to be aware that there could be a surgical cost at the end of the pathway and that this could be several years in the future.· The Gender Identity Clinic - Experts in gender dysphoria assess the patient and initiate Real Life Experience (RLE), prescribing hormones and monitoring the patient, usually in partnership with the patients own GP. During this period, patients may additionally require psychotherapy, speech therapy, group sessions and other interventions. After 12-24 months of assessment, the patient is seen by two consultants (one of whom has not previously been involved with the care and treatment of the particular patient, acting as a second opinion) for a final assessment to judge if the patient is suitable for surgery. If the patient is considered suitable and is personally ready for surgery, a referral is made to the preferred provider for consideration of Gender Reassignment Surgery (GRS).· The provider of GRS requests confirmation of funding for surgery from the patient’s PCT and provides an outpatient surgical consultation appointment once funding is confirmed.· The PCT considers the request for funding and once it is ensured that the patient meets the criteria, confirms funding for GRS.· Patient undergoes appropriate GRS and returns to follow-up with GIC.· Patient discharged from GIC when appropriate and returns to primary care for maintenance hormone therapy and monitoring, if appropriate.You will have to travel for aspects of this care, such as assessment at a GIC and, should you wish to have surgery, for surgical interventions, as there are no local services due to the specialised nature of the interventions you require. You should, however, expect support from your GP in terms of arranging ‘shared care’ and local monitoring working in partnership with GIC to minimise travel to and from these centres.To summate, Halton GPs are following the WPATH Standards of Care and recommended pathways based upon these. This said, there is clearly a need for improved liaison between the services providing specialised interventions and your GP to enable them to deliver as much care to you locally as possible.
This path, as outlined above, is missing one thing though. According to my sources, Halton & St Helens PCT refuses to fund the top surgery for both FTMs and MTFs. Knowing this, I emailed a reply back asking if this was true and to be given the PCTs policy on funding for surgery. When/if I get a response, I will post it up here.
If you have any questions, please comment below and I will either answer them (if I know the answer) or will forward them to my contact in the Halton CCG.