Care of Transgender Patients: A General Practice Quality Improvement Approach

Abstract

Background: With increasing numbers of gender minority/ trans patients, primary care must ensure high quality lifelong care is offered. Aim: To improve the quality of medical care for gender minority/ trans patients. Design and Setting: Initiation of a quality improvement project using population census, patient cohort and audit of standards in a single general practice. Method: Retrospective notes review against an audit standard. Results: One practice has 68 trans patients (population prevalence of 337/100 000). Monitoring guidelines from multiple private and NHS gender identity clinics (GICs) were found to be inconsistent. It was not possible to use an appropriate primary care audit standard as no UK-wide guidance was identified. Initial audit against an international secondary care guideline which was developed following a recognised process suggests health monitoring of transgender patients may be substandard in nearly two thirds (62%) of cases. Patients with gender dysphoria are experiencing long waits for NHS GICs (mean 26 months) and frequently self refer to private services. They receive a mean 2.7 assessment appointments prior to treatment, which consists of 85% hormone prescription uptake. 20% of patients stopped hormone treatment, of which half detransitioned. All detransition has occurred in the last three years. Conclusion: There is a need to develop consistent, national evidence-based primary care guidance that includes standards for monitoring and dealing with complications, including detransition. Funding: None to declare. Declaration of Interest: None to declare. Ethics Approval Statement: The study went through IRAS process, but formal ethics committee permission was not required for a quality improvement retrospective review of notes auditing against standards.