Gender identity services for children and young people: interim update for pharmacy teams

April 2024

We wanted to highlight some significant developments in recent weeks in relation to gender identity services for children and young people, what they may mean for pharmacy teams, and our next steps.

We recognise the challenges that pharmacy professionals may face in relation to prescriptions for puberty suppressing hormones. We hope the updates below, and our previous statements and articles on this issue, will be useful in helping to deal with these challenges and to continue to provide person-centred care.

NHS England clinical policy on puberty suppressing hormones

In March, NHS England 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 or dysphoria.

We published a statement in response to the clinical policy, which sets out our expectations of pharmacists, pharmacy technicians and pharmacy teams providing pharmacy services to children and young people with gender incongruence or dysphoria.

The statement emphasises that 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 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. 

The Cass review- final report

On 10 April 2024, Dr Hilary Cass submitted her final report and recommendations to NHS England in her role as Chair of the Independent Review of gender identity services for children and young people.

The review was commissioned by NHS England to make recommendations on how to improve NHS gender identity services, and ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria receive a high standard of care, that meets their needs, is safe, holistic and effective. 

The report describes what is known about the young people who are seeking NHS support around their gender identity, and sets out the recommended clinical approach to care and support that these young people should expect, the interventions that should be available, and how services should be organised across the country. 

The report re-states that "[the] fundamental principle of clinical medicine … [is] that treatments should be offered based on the best available evidence.” (See page 47 of the report)

The report was informed by a University of York review which collated the findings from relevant studies and used them to determine the most appropriate clinical approach and models of care, assessment and treatment. 

It also makes recommendations on the quality improvement and research infrastructure required to ensure that the evidence base underpinning care is strengthened.

Service update relating to the Young People Gender Service in Scotland

On 18 April, NHS Greater Glasgow and Clyde (NHSGGC) published a service update that advised that the prescription of puberty hormone suppressants and gender affirming hormones to young people has been paused following the research findings of NHS England and the publication of the Cass Review.

Patients have been formally notified of the pause while NHSGGC works with the Scottish Government to engage in research with NHS England that will generate evidence of safety and long-term impact for therapies.

Our next steps

We are carefully considering the final report from the Cass Review in full, and any communications or other actions that we may need to take in response. 

One of the recommendations of the report is that the Department of Health and Social Care (DHSC) should work with the GPhC to define the dispensing responsibilities of pharmacists of private prescriptions and consider other statutory solutions that would prevent inappropriate overseas prescribing.

We have already started engaging with the DHSC to discuss how best to take forward this recommendation. And we will provide further updates as our work in response to the Cass Review continues.

We are also reviewing the implications of the other developments referenced above for pharmacy services and for pharmacy regulation.

We are planning to share a further communication with pharmacists, pharmacy technicians and pharmacy owners giving an update on our response in the near future, so please look out for that further update.

Further information

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

In advance of our next update, we would encourage all pharmacy professionals to re-read this article previously published in Regulate, 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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