Background & Terminology

Transgender - An umbrella term describing people whose gender is not the same as, or does not sit comfortably, with the sex they were assigned at birth.

Gender Incongruence - The term, used in ICD-11, referring to the experience of having a gender that does not match the sex assigned at birth.

Gender Identity - A person’s innate sense of their own gender, whether male, female, non-binary, agender or something else. Gender identity may or may not correspond to the sex someone was assigned at birth.

Non-binary - Someone who does not identify as a man or a woman or who identifies as both or as something else completely. A non-binary person may or may not identify as trans.

Pronouns - Words used to refer to people’s gender in conversation (for example, ‘he’ or ‘she’). Some people may prefer gender neutral language (for example, ‘they/them’ and ‘ze/zir’).

Changing Name, Pronouns & Titles

• We do not need any proof - if the patient offers a copy of a deed poll, this should be recorded in the record
• Do not assume the pronouns that the patient would like to use - ask what they would prefer
• Titles do not need to match the gender marker

Pronouns aren’t collected in a patient’s registration, but it may be useful to set a warning for the patient to remind colleagues to use their chosen pronouns. (See also )

Changing Gender Marker

Gender Reassingment - Records

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1️⃣ Reception

1. Book a consultation with a senior GP
2. Generate the document ‘Gender Marker Change’ on EMIS, and arrange for the patient to collect the form from reception before their consultation. (We can email this to the patient for them to print themselves if it is easier. Ensure the document is sent as a PDF.)

2️⃣ Senior GP

1. During the appointment, discuss:
• What information from their previous record they wish to be transferred (see Medical Records section below - most patients will be happy with a full record transfer)
• Explain the risk associated with incomplete records
• Advise that the process is irreversible, and if they wish to revert to their assigned sex’s gender marker, they will need a third NHS Number
• Advise the patient how this will affect screening recalls (see Screening section below for more information)
• Communication how long the process is likely to take
• PCSE usually take 1 week, but can take up to a month
• We will also need additional time to transfer and summarize records
2. Once completed, task Clinical Admin, and send form for scanning. The original will need to be kept until it can be scanned and attached to the new record.

3️⃣ Reception

1. Scan document from GP
2. Notify PCSE using the enquiries form (Patient Registrations → Adoptions & Gender Reassignment)

4️⃣ Reception

1. PCSE will send a deduction and an email with the new details for the patient. This should be accepted, and the patient registered with the new details (the previous record must not be updated with the new NHS number)

Please note: When registering new patients please do not use Select ‘I’ (Indeterminate) as the sex category. Please only select either ‘M’ for Male or ‘F’ for Female. This ensures that the appropriate screening invitations go correctly to individuals.

2. PCSE will then send a new record envelope

5️⃣ Clinical Admin

1. Within 5 days, we should have created the patient’s record, and transfer medical information from the original record (see Medical Records section below)
2. Ensure the patient is added to the Trans Patient Database

Medical Records

For most patients:

• The previous record should be summarised (See ).
• Some patients may be happy with their old records to be kept under their new identity. If this is the case, this should be recorded and consent gained (usually during appointment with Senior GP).
• We can offer to redact Name, Gender and previous NHS number (using a black marker, and by printing and rescanning digital records).
• If they would like clinical information that reveals a previous identity to be removed, this should be re-summarised, removing the gender specific details.
• Their consent form must be kept and scanned to their new record.

Screening

• Explain to patients that they will not be recalled when changing gender marker.
• Patients should be told which screenings are appropriate for them, and remind them when they should take place.
• Where relevant, and with patient’s permission, identify the patient as transgender on sample paperwork.
• Place alerts on the patient to ensure they are informed in good time.