Effective and collaborative leadership and governance are critical to promoting an inclusive culture and supporting people to access gender identity services. Organisations should incorporate Realistic Medicine principles when delivering services including value-based medicine, shared decision making and trauma informed practice.6, 7, 21, 22
Good clinical and care governance includes adverse events management, whistleblowing, escalation procedures and robust data monitoring.23-27 Governance structures should demonstrate clear lines of accountability between NHS boards of treatment and residence, and for multi-disciplinary and multiagency working.
Services benefit from clear multidisciplinary and multi-agency pathways and protocols, which are evidence based and informed by current practice. Organisations should implement the relevant national policies, frameworks and other related guidance.1 Organisations should ensure they have sufficient staff capacity to facilitate person-centred care and support on a timely basis at all stages of the clinical pathway.28 Nominated lead clinicians for gender identity services should provide essential oversight and assurance. Organisations should implement National Waiting Times Guidance29 across gender identity healthcare including specialist gender identity clinics.
Services should work in partnership at a local, regional and national level. This should be multidisciplinary and multi-agency, including primary care, pharmacy, independent healthcare providers, other public sector partners and third sector partners. Effective planning and partnership working should be underpinned by robust information and shared care arrangements. Continuity of care throughout the person’s journey or at key points in their life improves patient outcomes. This may include moving from a young person’s service to adult services or moving into a care home or supported accommodation.30, 31
Where a person has to travel for care and treatment, there should be clear and accessible policies for the reimbursement of patient expenses and costs. These should be in line with NHSScotland policy.32
Clinically relevant information, records and care plans should be kept throughout and shared as appropriate. Consent should be obtained in line with national policies and procedures. Information should only be shared with the person’s representative with their consent and in line with legislation and national guidance for example, child and adult protection policies.25, 26, 33, 34
Organisations should demonstrate effective planning, management and continuous quality improvement and assurance of these services. The collation, analysis and review of service and outcome data, including feedback from people with lived experience is integral to service design and monitoring.19, 35, 36