A transgender woman in West Sussex is facing significant disruption to her healthcare after her general practitioner (GP) informed her they can no longer prescribe her hormone replacement therapy (HRT). Joanne Monck OBE, a prominent advocate for transgender rights, has received treatment from her GP for 12 years and is now being directed to a specialist clinic in Brighton, a change she describes as discriminatory and frustrating. This situation highlights a growing concern among transgender individuals regarding access to essential healthcare within the National Health Service (NHS).
Monck, who began hormone therapy and gender surgery in 2017 after living as David for 58 years, relies on regular doses of estrogen to maintain her well-being. “It’s totally wrong,” she told ITV News Meridian. “I’ve been having my prescription from my GP for 12 years. Why have they stopped giving it to me? Why do I have to go to a gender identity clinic now to get it? I was furious. I grasp my gender.” The case underscores the challenges transgender individuals can face in navigating the healthcare system and maintaining continuity of care.
Growing Concerns Over Access to HRT
The situation experienced by Monck is not isolated. Trans Actual, a transgender charity, reports that increasing numbers of transgender people are encountering similar obstacles when attempting to access hormone therapy through their GPs. Chay Brown of Trans Actual explained, “We found that trans people often avoid having to go to the GP for other medical appointments and often have little confidence or they’re not very confident. They feel healthcare professionals aren’t going to understand their needs and this is coming from experiences like being refused their hormone prescription and just generally feeling like they’re getting poorer treatment than they would get if they weren’t trans.” This lack of confidence can lead to delayed or forgone medical care, impacting overall health and well-being.
NHS England operates under a system of shared care agreements, where specialist gender clinics assess and diagnose patients and local GPs administer and monitor treatment. However, a recent review of adult gender services revealed that many GPs feel they lack the necessary expertise to adequately support transgender patients. The review highlighted concerns about limited experience and the complexity of prescribing hormones. Latest Pond Surgery in Lancing, Monck’s GP practice, confirmed that they are now requiring an Enhanced Shared Care Agreement (ESCA) for all patients receiving hormone prescriptions, a requirement not currently in place for Monck.
GP Surgery Cites Patient Safety and Expertise
In a statement, New Pond Surgery explained their decision, stating, “To ensure the highest standards of patient safety, and following a prescribing audit and updated prescribing guidance, we will now only provide prescriptions for patients who need this care who are also supported by an Enhanced Shared Care Agreement (ESCA). All NHS prescribing in this area should be happening via shared care agreements… This is not in-place with this patient at this time.” The surgery emphasized that they will continue to prescribe Monck’s medication until the specialist team assumes care, ensuring no interruption in her treatment. They also noted that they are not currently signed up to the NHS Sussex TNBI (Transgender, Non‑Binary and Intersex) Locally Commissioned Service, as they do not possess the specialist skills required to provide this level of care safely.
NHS England acknowledges the issue and is working to address it. Recommendations from the adult gender services review include establishing sustainable local arrangements for hormone prescribing, developing pilot programs involving GPs with extended roles, and ensuring local primary care support for hormone prescription and monitoring. The organization states We see taking forward these recommendations as part of an ongoing improvement program. Hormone replacement therapy (HRT), while commonly associated with menopause symptom management, is a vital component of gender-affirming care for trans women, inducing feminine physical traits through the administration of estrogen.
The situation highlights the need for increased training and support for GPs in providing care for transgender patients. Without adequate access to primary care, transgender individuals may face significant barriers to maintaining their health and well-being. The ongoing efforts by NHS England to implement the recommendations from the recent review are crucial steps towards improving access to care and addressing the concerns raised by both patients and healthcare professionals.
Disclaimer: This article provides informational content about healthcare and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition.
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