Read standard 7: Referral to gender identity services

Rationale

NHS boards should have clear referral pathways for gender identity services which are well described and accessible. Primary care has a central role in ensuring people are referred to the appropriate service. Referrals to gender identity services should follow referral criteria and be made by appropriately trained healthcare professionals.

People who have been referred should be supported throughout the process. They should receive information regarding the referral which includes anticipated timeframes for the initial appointment and what to expect at appointments. Gender identity services should regularly communicate with people on waiting lists, as required and in line national and local standards.²⁹ Services should signpost people to support services, including third sector organisations, as appropriate.⁶ Protocols should be in place to ensure that the original date of referral is maintained when people have moved between NHS boards, across other UK NHS services, or have moved from a young person’s service to an adult service.

Good communication and partnership working between services ensures continuity and consistency of care for the person. This is enabled by a multidisciplinary approach and the sharing of relevant information, following appropriate consent. Collaborative working ensures ongoing care or treatment between primary care and specialist gender identity services.

Who is responsible for meeting this standard?

All organisations and staff in line with their roles, responsibilities and workplace setting.

Criteria

7.1

NHS boards have referral pathways for:

specialist gender identity services
other related gender identity healthcare services including speech and language therapy and fertility preservation.

7.2

Specialist gender identity services have clear policies and procedures, which include:

a service specification, setting out who the service is for, and what it provides
referral pathways and criteria, including which healthcare professionals can make a referral to the service
the information required for the referral
support, including updates on waiting times where appropriate, for people waiting to be seen
communication of decision making when a referral is not accepted.

7.3

Specialist gender identity services have protocols and policies with clear lines of responsibility and accountability:

for the review and triage of referrals by appropriately trained staff
to ensure that people who have moved between NHS boards, UK NHS services or providers, or who have moved from a young person’s service to an adult service, keep their original date of referral.

7.4

Primary care and other referrers to specialist gender identity services:

understand when to refer to the gender identity service and when a referral to another service may be more appropriate
listen to and involve people in decisions about referrals
support the person during the referral process, including signposting or referral to other services such as mental health support where appropriate.

7.5

Specialist gender identity services ensure that people who have been referred receive clear information on:

where they have been referred
expected timelines, with regular updates
who to contact for further support.

7.6

There is partnership working across the system to ensure that referral mechanisms are accessible, reliable, transparent and effective.

What does this standard mean for...

What does the standard mean for people?

You will be referred to the right service at the right time for the care you need.
You will have access to information about gender identity services, where they are located and how the referral happens.
You will be kept updated on anticipated waiting times.
You will be offered additional and/or other support where required as you wait to be seen.
If you move to a new area, you will retain your original referral date.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace settings:

will support people to receive the right care at the right time
understand referral pathways and criteria for gender identity services and when a referral to another service is more appropriate
understand and follow professional guidance, best practice and protocols
know who to contact for specialist advice, additional support or referral updates where appropriate.

What does the standard mean for the organisation?

Organisations:

demonstrate partnership working with primary care and community services such as onward referral to specialist gender identity services
provide clear referral criteria and options for people who do not meet these criteria
provide clear pathways for referral to specialist services, which are applied and widely disseminated
ensure referrals, waiting times for initial assessment and any other barriers to access services are monitored and appropriate action is taken to minimise unnecessary delays.

Examples of what meeting this standard might look like

Demonstrate waiting time management initiatives for specialist gender identity services.
Standardisation of referral information and forms across specialist gender identity service providers.
Audit of referral information, processes and acceptance rate and feedback from service users.
Examples of partnership working across the care pathway.