Need advice regarding GICs in the UK

[CaitlinH]

Hello, I can't help by giving any personal experience of either private or NHS (still pre everything) but I've been doing some research of the new guidelines for England and apparently the NHS has been advised that the real life test is not required for HRT and they should stop enforcing it ( I don't know whether they follow this or not since they always say they work "flexibly" within the guidelines  )

Dr. Curtis looks like the best option to me since he is trans himself and says on his site "Patients DO NOT need to have lived in role prior to the prescription of hormones." So I think going to him would probably be best despite the expense. I simply could not deal with being told I have to humiliate myself by going full time pre-hormones and laser just to "prove it".

Hope that helps a little and good luck

Thanks Izla, I appreciate the advice and completely agree with the humiliation part. I don't want to have to make myself extremely uncomfortable just to satisfy some cisgender gatekeeper's ridiculous requirement for assistance with transitioning. I'd rather pay and have a good experience with a medical professional who treats me as a person rather than a lunatic who needs to prove that they're trans enough for their help. I've not read a single positive experience from trans people who have been treated by Dr. James Barrett at Charing Cross, and am also really disgusted with the way he has attempted to shut down (and succeeded in the case of Dr. Russell Reid) the private GICs in the UK.

The GICs don't follow the NHS guidance from what I have seen. They don't do hormones before RLE and the guidance also says the mtfs should get 6 IPL sessions on facial hair or electro before RLE paid for, and they don't do that either. I know literally nobody who has got either out of them.

That's a real shame, but honestly not too surprising.

[Seras]

That's because Dr Barret is simply flat out rude when he isn't being intentionally offensive.

[Beverly]

The GICs don't follow the NHS guidance from what I have seen. They don't do hormones before RLE and the guidance also says the mtfs should get 6 IPL sessions on facial hair or electro before RLE paid for, and they don't do that either. I know literally nobody who has got either out of them.

This is simply wrong.

For a start it is 8 sessions + 1 test for hair removal. Leeds GIC definitely do it because I have a lot of friends at Leeds and they get it. I have a letter for it from Charing and I am seeing the electrolygist next week.

That's because Dr Barret is simply flat out rude when he isn't being intentionally offensive.

Dr Barrett is very forthright, I can see why some people have problems with him. I was upfront with him and I had no trouble with him at all. In fact I have found all the medical staff at Charing to be easy to deal with.

I have never dealt with Dr Curtis but three of my friends have and they found him a pleasant person to deal with.

[Seras]

Being forthright is not incompatible with either being rude nor offensive. It certainly helps one to express both of those qualities though so I expect you are correct.

[kira21 ♡♡♡]

This is simply wrong.

For a start it is 8 sessions + 1 test for hair removal. Leeds GIC definitely do it because I have a lot of friends at Leeds and they get it. I have a letter for it from Charing and I am seeing the electrolygist next week.

I am sorry, but it is simply right :-) I said "from what I have seen", and it most definitely is what I have seen. You are right though, it is eight sessions. I have known a few people to ask for it and not get it. I am pleased to hear that some people are getting it though. You are the first person I have heard of who has. I don't get the feeling that there is a massive amount of consistency between the GICs.

[GracefulSilhouette]

I've got an appointment to see Dr Curtis is June. If I am eventually recommended HRT via him, how does this work with getting a prescription on the NHS through my GP.

Does Dr Curtis essentially write a recommended prescription i.e. dosages etc and it is up to the GP to fulfil that or not?

I know that if the GP is not willing then you can buy from Dr Curtis direct, but I would like to have any future prescriptions on the NHS. I only ask the above question as my GP isn't experienced with trans related things, so wouldn't be confident prescribing unless it was spelt out to him and the monitoring of dosages was done elsewhere.

[Seras]

He can do and if your GP is willing then you are lucky.

[NIP]

I've got an appointment to see Dr Curtis is June. If I am eventually recommended HRT via him, how does this work with getting a prescription on the NHS through my GP.

Does Dr Curtis essentially write a recommended prescription i.e. dosages etc and it is up to the GP to fulfil that or not?

I know that if the GP is not willing then you can buy from Dr Curtis direct, but I would like to have any future prescriptions on the NHS. I only ask the above question as my GP isn't experienced with trans related things, so wouldn't be confident prescribing unless it was spelt out to him and the monitoring of dosages was done elsewhere.

Long story short, there is nothing stopping a GP from prescribing HRT on a qualified (GP) specialist's recommendation, private or not. They are FORCED to cooperate in this manner if you are seeing a GIC, as well as carrying out blood tests. Seperate NHS doctrine means you can mix and match NHS and private care wherever you want SO LONG as that private care would be availible to you on the NHS. There are many, probably at least half, of GPs that will refuse to cooperate with anyone other than GICs because they are bigots, and don't think they will get in legal trouble if they just do the GIC stuff. Then there are the GPs that are just plain terrified of care involving transgender people and they don't want to learn anything new, and they don't want to take the risk that HRT will grow you a new arm or something (as the person prescribing a medication is technically responsible for it, not that that stops emergency GPs dishing out anything you turn up with an empty box of and say "I desperately need more of this" - yeah I got given anti-psychotics a long time ago like this and they didn't even check my medical history, just took my word for it that I hadn't stolen the box or something and that that was my dose - I love it when they go to the trouble of printing out that special NHS prescription dosage label that gets stuck on the box with WHAT YOU JUST TOLD THEM on it, but anyway).

Then you get the GPs who don't have a clue, but they actually care about helping people, so, they do it. They'll probably even go out of their way to learn a bit extra about it, and be especially helpful. Then there are the GPs that have actually had other cases, and are competent at it from the go, and perfectly willing to carry out the care you're entitled to with no fighting. I finally found one of the latter. It was so, immensely refreshing. One tip though, you'll probably find if there's a GP from the first bigot category at your GP practice, that you'll be in a much better position if you just switch practices. I've found that practices tend to have a certain code of ethics constant amongst the doctors there (GP practices are usually a collective effort by GPs that have chosen to work together, so if they're entertaining a bigot GP, doesn't say much about the rest of them).

[Jayne]

The GICs don't follow the NHS guidance from what I have seen. They don't do hormones before RLE and the guidance also says the mtfs should get 6 IPL sessions on facial hair or electro before RLE paid for, and they don't do that either. I know literally nobody who has got either out of them.

It's not the GIC who are messing up the rules, before the new rules London GIC were a nightmare for following outdated guidelines. Within a month of the new rules I was on E, i'm due to start T blockers in almost 2 weeks.
I saw Dr Lorimer last year & he was quite chuffed when he said I was the first person he'd had the chance to refer for electro.
Then things went sour, a request has to go from your GP to NHS funding for this to go ahead, they are the ones who told me I have to wait until after i've been on HRT & presenting as female for a year before I can have my facial hair removed. . . . . SHEER PENNY PINCHING MADNESS!! Sorry, i'll calm down now.
I now have both my GP & dermatologist writing letters to support my need for electrolysis as I can't have IPL treatment or wear make-up.
I've kept every letter i've had & if NHS funding turn me down again then i'll be taking legal advice as they are the ones ignoring the rules

The penny pinchers don't seem to realise that every MTF needs to have IPL/Electrolysis before they start to transition as you have to let the hair grow for 3 days before treatment, I thought the NHS was founded on the principle of improving the quality of life not making it harder.

[NIP]

I thought the NHS was founded on the principle of improving the quality of life not making it harder.

It was, but that was immediately following the second world war, when the British public experienced an unusual period of collective solidarity and decided to let a still-socialist (old) Labour do something for the collective good of everyone. The British public then returned to their old senses when they forgot the second world war, and successive Conservative governments turned the NHS into what you see today, which will be but a shadow of the one you'll see if they get another term (the name will probably refer to the British equivalent of US Medicare/Medicaid). Fun fact: contrary to popular belief Thatcher actually treated the NHS better (!) than our current Conservative-led coalition is doing so today; the NHS has been in it's "longest funding desert" since it came into existence, when you factor in inflation, for over a year. There isn't even enough money in the system to properly deal with immediately life threatening conditions like stroke or heart disease, let alone electrolysis for a small portion of the population. And, ultimately, the blame stops at the British public, and not the Conservatives, or the NHS, or the private healthcare companies lobbying to take a nice juicy bite out of our collective wellbeing, because the British public chose to put the Conservatives there, knowing full well what the consequences would be (in the case of political parties, the past is a fantastic predictor of the future). But, hey, on the bright side, I might not to have to play video games to immerse myself in a cyberpunk dystopia for much longer! Bring on the Grey Death. (Deus Ex, anyone?)

[Seras]

Classic.
Obviously it is entirely the Conservatives fault that there is not enough money for the NHS and nothing to do with the several year long world wide recession or the sorry state of the treasury after the previous governments long period of over spending wastefulness. 

The problem isn't any singular party, it is morons distorting the truth, to serve their political agenda and score points whether politicians or members of the public.
Not that this is a political forum but this sort of stuff is why many people have become disillusioned with our current political system and it annoys me.

---

The reality is that transgender treatment on the NHS has absolutely nothing to do with politicians and everything to do with the doctors, whether at the top of the GIC ladder or the GPs, (though of course some of them do great) and their unwillingness for whatever reason to give us a decent system that actually serves our needs in a fair and modern way.

[NIP]

Classic.
Obviously it is entirely the Conservatives fault that there is not enough money for the NHS and nothing to do with the several year long world wide recession or the sorry state of the treasury after the previous governments long period of over spending wastefulness. 

The problem isn't any singular party, it is morons distorting the truth, to serve their political agenda and score points whether politicians or members of the public.
Not that this is a political forum but this sort of stuff is why many people have become disillusioned with our current political system and it annoys me.

---

The reality is that transgender treatment on the NHS has absolutely nothing to do with politicians and everything to do with the doctors, whether at the top of the GIC ladder or the GPs, (though of course some of them do great) and their unwillingness for whatever reason to give us a decent system that actually serves our needs in a fair and modern way.

I'm going to do my best to be polite. I'd appreciate if you could refrain from calling me a moron though, as I think I've achieved enough academically to not be labelled as such. Firstly, if you'd read my post properly, you would have noticed that I specifically said the fault lies not with the Conservatives, who are merely there to conserve the wealth of the already wealthy, and generally preserve the status quo. They really haven't changed all that much in several hundred years. I said the fault lies with the British public that chose to elect them to this position of power. It might be FPTP, and it might be a liberal democracy, but the voters do, technically, have the last say. Politicians might be able to do whatever they want for a full term, but they can't put themselves there.

Now, regarding the "several year long world wide recession" and "the sorry state of the treasury" and "the previous governments long period of over spending wastefulness". In all cases I would suggest you did some research into economics and both world and UK history before making sweeping statements. It needn't be dry textbook literature, Ha-Joon Chang does an excellent job of presenting the realities of our world in a remarkably readable format. You might also enjoy the works of Adam Curtis, who's popularly regarded as one of the best living documentarians.

Cycles of boom and bust are just a part of a capitalist system that is based on the myth of a stable ecosystem. There is no equilibrium in nature. Human memories, however, are remarkably short. We had a "several year long world wide recession" in the 90s. If anything, it was worse than this one. It blasted the "Asian miracle" into smithereens, and it all started with a reckless, ludicrously overvalued property bubble as well. This one just happened to be in Asia, rather than the US. The 90s also happened to be the decade where Labour managed to invest so heavily in the NHS, something which they didn't manage quite so well in the 00s.

Regarding "the sorry state of the treasury", I can only recommend you read some economic history, and you'd realise that the "deficit" we have now is really rather laughably small. How much do you think the second world war cost, exactly? (See: http://en.wikipedia.org/wiki/File:UK_GDP.png) And immediately following this rather dire economic situation, Labour created many of the social institutions we enjoy today, such as the NHS.

As for "the previous governments long period of over spending wastefulness", you'd find if you did some research that our present economic circumstances are not because of some massive social spending drive by Labour in the late 90s/early 00s (it never really manifested, though to an extent it did for reducing child poverty (which I'm sure you'd disagree with), one of Blair's primary promises, following the problem reaching such levels under the previous Conservative government that some developing nations were beating us), but because of the financial deregulation of the previous Conservative governments, and it's continuation under Blair.

As for your last statement regarding the problem being GPs inside the NHS, and not politicians governing it, I'd say it betrays a dangerous misunderstanding of how the system works. Please educate yourself here: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx. You'll see the outer banding on that nice infographic quite clearly I hope. It says: "Parliament, Department of Health, Other Government Departments, Secretary of State". These are political establishments, I hope you understand, and they have the final say. We're lucky we get nearly as good treatment as we do here, and you can largely thank Blair for incorporating (kinda) the European Convention on Human Rights into UK law. (Apart the bit about personal freedom and protection from the police and state, Blair didn't like those clauses.) That's the only reason why we can change the gender markers on our birth certificates, for instance.

[Jayne]

Excuse me while I daintily sidestep the politics. . .

In my experience the problem is definately with the funding team, they are interpreting the rules differently from everyone, they say that electro is available but only AFTER transition instead of it being one of the first priorities.
I can see only two reasons for this, reason one being that some idiot pencil pusher hasn't read the rules properly or reason two means that they want to delay granting this funding in the hope that we'll be desperate enough to pay to have it done privately.

[NIP]

Excuse me while I daintily sidestep the politics. . .

In my experience the problem is definately with the funding team, they are interpreting the rules differently from everyone, they say that electro is available but only AFTER transition instead of it being one of the first priorities.
I can see only two reasons for this, reason one being that some idiot pencil pusher hasn't read the rules properly or reason two means that they want to delay granting this funding in the hope that we'll be desperate enough to pay to have it done privately.

It's usually a variant of a combination of the latter. Typically it's not because they haven't read the rules, it's because they have, have found them ambiguous, and suppose they can get away with it. They're not spiteful people. (They chose to work in healtcare, didn't they?) They're given a budget, and have to provide a certain standard of care in a certain order of priority while killing and maiming as few people as possible and not causing a public mess in the media. They aren't gatekeeping us because of some god complex, but because they suppose they're not going to get in trouble treating us as third or lower priorities. What we need is the political will to make the rules concrete and unambiguous, and increase the amount of money that PCTs/CCGs/the latest acronym have to spend on patient care. Then you'll find you're treated a lot more pleasantly.

[Seras]

Heh, namedropping a few books and linking a biased Wikipedia graph does not a convincing argument make. While using WW2 debt as evidence of the acceptability of the current national debt due to its relative size is just funny, as is the 18th century comparison. The use of and attitude towards the national debt in this current day and age is not even comparable to how it was used just 50/60 years ago, let alone the time periods you are referencing. We don't even have a good excuse for our debt yet it is almost at WW2 levels, per capita, with 2005 currency value, and look here is my very own skewed graph to prove it!:


Graph data from: http://www.ukpublicspending.co.uk/spending_chart_1692_2011UKp_13c1li011mcn_G0t

Of course I suggest rather than derailing this topic further if you wish to continue this discussion that you start a topic where you may espouse your political views to your hearts content in the politics section of the forums and PM me a link to it.

Obligatory on topic short paragraph:

Nor does working in healthcare necessitate a morally good person.

Riddle me this. If the government and policy makers are ultimately responsible for the care given by the NHS then how come when new guidelines are introduced for the GICs and GPs to follow why do all the GICs and GPs not follow them? I was quite happy recently to learn about the new guidelines with regards to HRT before RLE and suchlike, I was quite disappointed to learn they are not being implemented by everyone concerned. The policy and rules are the same for everyone, the variable is the doctors involved in the treatment (or lack of it). Some follow the new better guidelines, some do not. Why?

[Jayne]

Late last year they were guidelines but I thought they were rules now, i've heard about some differences since I read a version last year.
I'm not on a PC so can't read the NHS PDF until I can get to a PC.

The staff at my GIC & local surgery have all said the new rules say you should have facial hair removed first, funding interpret the rules differently so they are heartless petty minded penny pinching rats with a god complex in my eyes.
They are the people who decide (in rare cases) that life saving medication is too expensive, I think it's fair to say that anyone who decides a persons fate must have a god complex to some degree. GP's & surgeons don't let their god complex effect their work because they meet us & therefore see us as people, the accountants just see us as a case number.

Sorry, rant over i'm happy again

[NIP]

Heh, namedropping a few books and linking a biased Wikipedia graph does not a convincing argument make. While using WW2 debt as evidence of the acceptability of the current national debt due to its relative size is just funny, as is the 18th century comparison. The use of and attitude towards the national debt in this current day and age is not even comparable to how it was used just 50/60 years ago, let alone the time periods you are referencing. We don't even have a good excuse for our debt yet it is almost at WW2 levels, per capita, with 2005 currency value, and look here is my very own skewed graph to prove it!:


Graph data from: http://www.ukpublicspending.co.uk/spending_chart_1692_2011UKp_13c1li011mcn_G0t

Of course I suggest rather than derailing this topic further if you wish to continue this discussion that you start a topic where you may espouse your political views to your hearts content in the politics section of the forums and PM me a link to it.

Obligatory on topic short paragraph:

Nor does working in healthcare necessitate a morally good person.

Riddle me this. If the government and policy makers are ultimately responsible for the care given by the NHS then how come when new guidelines are introduced for the GICs and GPs to follow why do all the GICs and GPs not follow them? I was quite happy recently to learn about the new guidelines with regards to HRT before RLE and suchlike, I was quite disappointed to learn they are not being implemented by everyone concerned. The policy and rules are the same for everyone, the variable is the doctors involved in the treatment (or lack of it). Some follow the new better guidelines, some do not. Why?

It's not for your benefit that I was arguing. Hence if this is continued it won't be in PM. I know you are not going to be convinced, not with a mountain of evidence. You think I pick an argument with every right-winger I run into? I'd shout myself hoarse in this country! But you are misrepresenting the realities of our situation, and obfuscating the clear fact that if people want change, they need only select a political party willing to deliver it. Need I remind you that the Conservatives were the biggest hindrance in getting the level of care that we now enjoy. If it was for them, we wouldn't be allowed to retain our marriages when we changed our legal genders. We probably wouldn't even be able to change our legal genders at all. And if it wasn't for them, the ECHR (something I bet you just hate, but aren't really sure why) would never have be implemented into UK law, and there would be no guidelines for TG/TS care at all, and everyone would have to pay out of pocket!

And my point wasn't that working in healthcare necessitated being a morally good person. I'm not sure where you got that. Red herring fallacy, anyone?

Also, you've failed to actually address the point of my argument, i.e. by making reference to the structure of the NHS in reality (rather than the one inside your head, which I can't seem to find any documented evidence on). You've just reiterated your original point (which doesn't even make it an argument) and then attempted another personal attack. I'm disappointed. And I suggest you look up the definition of a "guideline" rather than say a "rule" or a "law".

Late last year they were guidelines but I thought they were rules now, i've heard about some differences since I read a version last year.
I'm not on a PC so can't read the NHS PDF until I can get to a PC.

The staff at my GIC & local surgery have all said the new rules say you should have facial hair removed first, funding interpret the rules differently so they are heartless petty minded penny pinching rats with a god complex in my eyes.
They are the people who decide (in rare cases) that life saving medication is too expensive, I think it's fair to say that anyone who decides a persons fate must have a god complex to some degree. GP's & surgeons don't let their god complex effect their work because they meet us & therefore see us as people, the accountants just see us as a case number.

Sorry, rant over i'm happy again

The "accountants" don't make the rules (not that they are rules, they are, as you said, only "guidelines". They just have limited control over how to achieve as many of them as possible without getting the local NHS Trust any further into debt. These rules are made primarily by the Department of Health, which are then voted on in Parliament by, you guessed it, MPs and Lords, and not GPs. I might point out that even though the guidelines were modified in the UK to include things like electrolysis (as per pressure largely from the Council of Europe (not the EU, Jayne, don't worry!), Trusts weren't actually given any more money by the state to implement them. Which basically exacerbated the already bad problem of NHS spending freezes levied by on high (by a Conservative-led coalition that explicitly promised to do the opposite, but hey) combined with ever tightening of rules and guidelines on the delivery of that care. Demanding that a person split the same amount of money between a group twice as large as the one before, but while giving the same amount of money to each as before, just doesn't work for obvious reasons. And the NHS Trusts can't borrow any more money, because the government won't let them, and they still have to pay off the massive PFI loans that they were encouraged to take out under Labour (because public sector borrowing is bad, right Jayne?).

[Seras]

I'm not even a right winger, I do not affiliate with any political parties. I do not have any ulterior political motive.

1) You implied that since people work in healthcare they surely cannot be spiteful. I simply stated that working in healthcare does not necessitate a morally good nature as you imply by such a statement. Whether or not someone works in healthcare says literally nothing for their morality. Red herring indeed.

2) Just because you link a chart that shows the government makes the rules does not mean you have proven they have the final say. As I stated in my short paragraph there, as the caregivers, the doctors themselves have the final say (I do not understand how it could ever be different). If anything, the people who make the rules have the first say and then it goes down the ranks like Chinese whispers. I did not make any ad hominem attacks, perhaps you refer to the picture I linked? That is referring to me and the general attitude in this topic currently as much as anything since this discussion reminded me of it and I laughed a little to myself. You should be aware, if I wanted to insult, I would do so directly.

Oh and by the way, fallacy fallacy. 
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Nor did I ask you to continue this via PM. If you re-read my last post you will will notice I suggest that if you feel strongly about this that you can make a topic for it in the politics section (and please to PM me a link to it when you do) of this forum rather than de-rail this thread further. Of course I am not an admin or moderator so feel free to ignore me.

Anyway the soap box is all yours. I shall not post again unless it is on topic. Though I am sure I shall be sorely tempted.

[Jayne]

@ NIP, I agree that the accountants don't make the rules (or guidelines in this case), they do however interpret them differently to GP's & GIC's.
If the guidelines, my GP & my GIC state that electro should be one of the first things to be tackled in a MTF transition then surely it is the accountants who are wrong & for this reason I am only going to have one more attempt at getting thois funding for which I am fully entitled, if I am turned down again then i'll seek legal action against the NHS.
Just to be crystal clear, I have no interest in financial gain from possible legal action but the threat of a court case & bad publicity for miss-enerpreting the guidelines may be the only way to force them to give me my treatment, if I have to go this far & they cave in & fund the electro then i'd drop legal proceedings in a heartbeat.

[NIP]

@ NIP, I agree that the accountants don't make the rules (or guidelines in this case), they do however interpret them differently to GP's & GIC's.
If the guidelines, my GP & my GIC state that electro should be one of the first things to be tackled in a MTF transition then surely it is the accountants who are wrong & for this reason I am only going to have one more attempt at getting thois funding for which I am fully entitled, if I am turned down again then i'll seek legal action against the NHS.
Just to be crystal clear, I have no interest in financial gain from possible legal action but the threat of a court case & bad publicity for miss-enerpreting the guidelines may be the only way to force them to give me my treatment, if I have to go this far & they cave in & fund the electro then i'd drop legal proceedings in a heartbeat.

I agree you should certainly take legal action if they keeping screwing around. Whereas I believe the accountants are just too worried about their debt problems to have time for overt bigotry, some GPs sure as hell don't have this problem. I've had to fight with a couple, who needed certain rules pointed out to them. That said, the electrolysis thing - it's just a guideline, and the comissioning groups got no more money to pay for it, as I pointed out earlier. So it's very likely they'll come back with a no, simply because they don't have the money to spend on things they aren't forced by law to finance at any cost. The only upgrade when it comes to electrolysis is that your GP now HAS TO put in a funding request if you ask them, because it's there in the guidelines. But if they don't want to, they're not going to work for you to get the funding. In my experience, a GP who likes you is willing to do a lot more to make sure the commisioning group approves your funding rather than someone elses. They may even sit on it themselves. I've had a "no" for funding turn into a "yes" when a GP got pushy on my behalf for something unrelated to TG/TS things in the past.