NHS England clinical policy on puberty suppressing hormones

NHS England has recently published its clinical policy on puberty suppressing hormones. This sets out that puberty suppressing hormones are not available as a routine commissioning treatment option for treatment of children and young people in England who have gender incongruence/gender dysphoria.

Commenting on the publication of this clinical policy, Duncan Rudkin, Chief Executive of the General Pharmaceutical Council (GPhC), said:

“We recognise the challenges that pharmacy professionals may face in relation to prescriptions for puberty suppressing hormones. 

“We understand that many children and young people experiencing gender incongruence or dysphoria are waiting for lengthy periods to be assessed or to receive treatment, and that this can have a significant negative impact on their mental health. It is important for pharmacy professionals to be able to identify children, young people and families who may be vulnerable, or at risk, and signpost them to appropriate support services. 

“We ask all organisations involved in providing these types of services to make sure that there are clear routes for pharmacy professionals in their country or area to refer children and young people for the support and care they may need, and that waiting times are reduced as far as possible. Otherwise we’re mindful that people may try to seek alternative options such as sourcing unregulated products online or through private clinics outside of the UK which exposes them to additional risks.

Clinical appropriateness of prescribed medicines

“Pharmacy teams providing pharmacy services to children and young people with gender incongruence or dysphoria, need to advise on, prescribe, supply, dispense or administer medicines within the limits of their training, competence and scope of practice. The starting point is that pharmacy professionals must provide person-centred care, within the current relevant legal and regulatory context.

“We expect health and care professionals to take account of relevant national and local policies and guidance, alongside our standards and guidance.  For pharmacy professionals in England, this includes to familiarising themselves with this clinical policy from NHS England and ensuring they take account of it when making decisions in relation to puberty suppressing hormones. 

“Pharmacy professionals in Scotland and Wales should continue to practise in line with relevant polices and guidance in their countries and seek advice from their local health board if needed.

“We also understand that some pharmacies are being presented with prescriptions for puberty suppressing hormones, and other medications relating to treatment for gender incongruence, that have come from prescribers working for private clinics based in Great Britain or overseas.

“We expect pharmacies to have taken active steps to assure themselves that all prescribers, including those working for private clinics based outside the UK, comply with relevant UK and national regulatory and professional guidance.

Further advice for pharmacy professionals

“In January 2023, we published an article about Gender identity and pharmaceutical care for children and young people and we have recently updated this article to reference the new NHS England clinical policy on puberty suppressing hormones. Whilst the NHS England clinical policy just covers England, the issues discussed in this article will be of use to pharmacy professionals working across Great Britain.

“We encourage all pharmacy professionals to re-read this article, as it provides useful advice on inclusive and compassionate care when providing any services relating to gender incongruence in children and young people, including supporting vulnerable and at-risk patients, and making decisions about the clinical appropriateness of medicines.” 

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