Letter from Gender Clinic.

[JMJW]

A letter saying I have to wait in excess of two years for an appointment. Which is longer than what's on their website, which gives a general figure of eighteen months.

So a letter just to tell say how they won't see me. I don't understand why they do that. I know the referral was made, I'm seeing the one who made the referral on Friday and they sent the same letter to her as well. So why not just send the one letter? Why they gotta raise my hopes like that.

So that's nineteen months to go. Sucks.

I decided for my final college project I'm gonna make art about them. I'm going to meticulously illustrate the place.

[SailorMars1994]

Thats pretty cruddy they would just cut you out in the cold like that :/

[FTMDiaries]

A letter saying I have to wait in excess of two years for an appointment.

Yup. That's the current state of affairs with the NHS. We may not have to pay for it upfront, but we certainly do have to wait for it!

You were referred to Nottingham, right? They have one of the longer waiting lists right now. In fact, patients who are currently getting their first appointment there were referred to them around August 2015 - and you'll have to wait even longer than they did. So perhaps you might want to consider a different GIC, or maybe you could go private whilst you wait?

The worst in the country is Leeds with a waiting time of up to 3 years (although that's going down towards 2 years now they've hired a new doctor), followed by Nottingham. Sheffield's about 18 months & they're trying to reduce that; Daventry is about 15 months, as is The Laurels in Exeter. Charing Cross have lowered their time to 13 months. If you'd like to change your referral, just mention it to your GP on Friday and ask to be re-referred somewhere else.

If you went private, you could go to Gendercare, Transhealth, or Dr Helen Webberley. They'd at least get you started on HRT whilst you wait. It'd probably cost something in the region of £300 to get started, so it's worth considering whether you could afford to spend that amount of money to speed things up.

Alternatively, you could ask your GP whether they could give you a bridging prescription of HRT, perhaps with the support of a local endocrinologist. Or if your GP doesn't want to get involved, perhaps they could refer you to a local endocrinologist who would prescribe HRT for you. 2 years is far too long to wait for vital medical treatment.

Also, whilst it's true that you may have to wait more than 2 years for that first appointment, you should bear in mind that most GICs don't prescribe HRT until you've had at least 2 therapist sessions and one doctor session. In some clinics, those sessions are up to a year apart. That's worth considering when choosing the right GIC: it's not just the time to first appointment that you need to consider... but how long you'll need to wait between subsequent appointments. Even with the best clinics, you're still looking at another year after your first appointment before they prescribe HRT.

[Kylo]

Yeah, the waits have gotten crazy the last 2-3 years, referrals up 400% plus from the year before I got referred... they obviously don't have enough services and staff to cover the new patients. It sucks because on the one hand it's amazing we even have the service on the NHS, considering... on the other nobody should be stuck waiting 2-3 years just to see a specialist. I'm at Exeter which was supposed to be one of the "faster" ones... it ain't. Still waited nearly 2 years just to get past the psychotherapist. Surgery wait times aren't great either.

In the meantime you'll have enough time to think about what you want from it all, I guess. I suppose that was the case for me. Hadn't made up my mind at first what things I wanted... by the time I saw the supervising doctor for treatment approval I was 100% sure

[Floof]

Thats an awfully long wait, so sorry to hear you cant get access sooner.. I was fortunate that I got in contact with my clinic in Norway a few years before transgender issues very much came into the public eye here. Now waits are a lot longer for new referrals than they were when I got my foot in the door -about 6 months wait for me.. Of course with how the Norwegian clinic does things it took a full 7 years from my first apointment until I got started on HRT.. for the last 2 of those years I was living full time too!

My 6 months wait was actually 9 months originally; I sort of kept calling them and telling them if any slot opened up I'd be right over with only one days notice -8 hour drive..- and they did eventually manage to fit me in me sooner than expected. I dont know how things work with the NHS, is this something you could consider trying for yourself?

[davina61]

see my GP on Wednesday next week to ask for HRT and will get her to change to Daventry, closer to me anyway than Notts. 4 YEARS just ready for my retirement then.

[Janes Groove]

Yikes! 3 long years of living without HRT support? I thought I had it rough having to wait 40 days and 40 nights for my 1st HRT appointment with Planned Parenthood.  I couldn't do it. I'd beg, borrow or steal (disclaimer: just an expression. please don't steal the money) the 300 quid and get started now. One can always stop at anytime if it feels wrong.

[Susan]

Or go to another clinic. If that is not possible lobby the government to rectify the problem.

Sent from my Vivo V5 using Tapatalk

[FTMDiaries]

I sort of kept calling them and telling them if any slot opened up I'd be right over with only one days notice -8 hour drive..- and they did eventually manage to fit me in me sooner than expected. I dont know how things work with the NHS, is this something you could consider trying for yourself?

Sorry to jump in but I thought it might help if I answered this.

Cancellation lists are a very rare thing in the NHS. Some NHS GICs do have cancellation lists (e.g. Charing Cross and The Laurels) but Nottingham, where the OP has been referred, actively discourage this sort of thing. Plenty of people have asked for short notice/cancellation appointments at Notts and the clinic just isn't interested.

[FTMDiaries]

Or go to another clinic. If that is not possible lobby the government to rectify the problem.

The problem with UK GICs is that there simply aren't enough staff members to treat the huge numbers of patients coming through their doors. One of the downsides of socialised medicine is that it's painfully slow to react to market forces. Unlike private clinics - who can hire or fire staff whenever their patient numbers change - government clinics have their budgets set in advance and there's no flexibility to allow them to respond to sudden changes in the market.

And that's precisely what happened. After the broadcast of a couple of documentaries about trans people, GD became much more visible in the UK & started trending in the media... leading to more people recognising that they might be trans & seeking a referral to a GIC. As a result, over the past 5 years or so there's been a rapid increase in the numbers of patients looking for treatment. But these increases caught the GICs by surprise and because they were still stuck with their old budgets, they were unable to hire the staff they needed in order to respond quickly. This has led to the current ridiculous backlog.

There's been a lot of lobbying behind-the-scenes over the past few years, and we've been pushing very hard for additional staff & clinics, but the cogs turn very slowly in the NHS and it often takes a couple of years for the resources to become available. The good news is that pretty much all of the GICs in England have now received additional funding from the Government to hire new staff, which will help them work through their backlog of patients. The bad news is that there are very few qualified doctors, psychotherapists and counsellors out there who are trained in Gender Dysphoria, so they're having to hire (relatively) untrained GPs and then train them up on GD on-the-job. That's where we are now: lots of new staff are being recruited, but it's hard to find the right people and there's usually a learning curve before they get up-to-speed.

So they are working on it, and the problem should improve dramatically over the next year or two. Waiting lists are already going down, but it's just a bit of a nightmare right now.

[JMJW]

The letter explicitly states that they are unable to expedite appointments under any circumstances.

They then of course state they are unable to prescribe any prescriptions until I am seen. Now seeing as the NHS practice that referred me did receive this letter as well, I doubt they will offer any bridging. But I will ask at least for low dose, as the worst that can happen is they say no.

I doubt I could afford to go private, but depending on their answer, I may have to do some accounting and see if it's viable. Either way I got some serious thinking to do.

[FTMDiaries]

The letter explicitly states that they are unable to expedite appointments under any circumstances.

Which of course means that they don't offer cancellation appointments & their 24+ months wait really will be 24+ months (although it's possible it'll speed up slightly). Basically, they're telling you you shouldn't get your hopes up that you'll be seen any sooner.

They then of course state they are unable to prescribe any prescriptions until I am seen. Now seeing as the NHS practice that referred me did receive this letter as well, I doubt they will offer any bridging.

I read something very interesting yesterday: when a GP contacts the GIC to ask for permission to give you a bridging prescription, they're actually asking the GIC to take shared responsibility for your treatment. That's why Notts have said what they said in the letter: they get inundated with requests from GPs for more info about bridging prescriptions but they're unwilling to take shared responsibility for a patient they've never seen. So they're basically telling GPs upfront to not ask for advice.

It's the GMC that recommended GPs should be able to offer bridging prescriptions, but the advice is intended as a means of harm reduction. The idea is that if your GP finds out you've been taking hormones on the black market, they should be able to prescribe them instead so they can eliminate the risks of you taking something that may harm you.

Here's the GMC's advice to GPs on this subject. You'll note that they say GPs should only consider a bridging prescription if you're already self-medicating; and the bridging prescription will stop you from risking self-harm; and they've sought the advice of a gender specialist. So if you have been considering taking hormones on the black market, it might help to mention that to your GP.

So yeah, it's possible that your GP may interpret Notts' letter as the clinic refusing permission for the GP to do it. But that's not what the letter says: it simply says they're not willing to support your GP until they've assessed you. It might help if you explain the situation to your GP (including the real meaning of that letter), and if you print out & give them a copy of NHS England's Interim GD Protocol, paying particular attention to p. 16 (or give them the details of the link).

This is where the private clinics (such as Gendercare) come in handy: their doctors are gender specialists and they're happy to advise your GP on how to administer hormones. Alternatively, your GP might contact a local endocrinologist who might be willing to do the same.

Best of luck for tomorrow; I hope it goes well for you. And if they refuse, just remember that you can get a second (or third, or fourth!) opinion, and there are other pathways available.

[JMJW]

The Psychiatric nurse didn't shut down the bridging option and I was told to make an appointment with the GP if I'm interested.

I'm going to Trent PTS trauma therapy as soon as my final college project is over. But even before then I will try to get fit. I'm also going to lift the current embargo I have on dressing up (was made under the rationale that I have no time and I can suffer out the next nine weeks, but the hell with that. I'm conditioned into thinking dressing up, even exercising is a luxury to be done only when I get this free time I never seem to have. But no, these are needs. Suffering out the next nine weeks will make the work worse anyway.

[sophie1904]

I know private healthcare isn't for everyone but as someone also on the NHS in the UK, I've been referred to the GIC in Edinburgh and don't even have a waiting list time yet - I'm assuming years and years and years ...

Saying that, I've been working with Dr Webberley at Gender GP and while it does cost money, to put it in perspective, I'm paying:

£60 / one time fee for a psychological assessment over the phone
£195 / one time fee for setting up patient details / admin
£30 / every 28 days for private prescriptions / guidance
£15 / every 28 days for hormones

So we're looking at upfront costs of about £250 and then £45 a month. I first contacted them on January 1st and got my first set of hormones this morning.

My GP was also willing to do blood tests which saved on costs and also would be willing to prescribe the hormones (in Scotland, prescriptions are free) but for £15 it doesn't really seem worth it.

I'll stress that I don't think this is for everyone but it really wasn't as expensive as I expected it to be so thought I would detail the expenses.

Personally, I intend to be de-facto transitioned before my first GIC appointment 2 years (or longer) from now!

[PinkThorn682]

Yeah, the waits have gotten crazy the last 2-3 years, referrals up 400% plus from the year before I got referred... they obviously don't have enough services and staff to cover the new patients. It sucks because on the one hand it's amazing we even have the service on the NHS, considering... on the other nobody should be stuck waiting 2-3 years just to see a specialist. I'm at Exeter which was supposed to be one of the "faster" ones... it ain't. Still waited nearly 2 years just to get past the psychotherapist. Surgery wait times aren't great either.

In the meantime you'll have enough time to think about what you want from it all, I guess. I suppose that was the case for me. Hadn't made up my mind at first what things I wanted... by the time I saw the supervising doctor for treatment approval I was 100% sure

In fact an NHS referral is supposed to take no more than 18 weeks. The fact they're not hitting that is a sign of how overstretched the GIC system is.

[FTMDiaries]

The Psychiatric nurse didn't shut down the bridging option and I was told to make an appointment with the GP if I'm interested.

Congrats! That's very promising, but of course it's up to the GP. I'd recommend making that appointment with the GP & tell them the psych nurse supports it. Ask them whether they'd be willing to prescribe them themselves or if they'd like to contact an Endo for support. If it helps, there's an endocrinologist in Harrogate who is happy to work with trans patients' GPs to help them with bridging prescriptions; PM me if you'd like his contact details.

I'm going to Trent PTS trauma therapy as soon as my final college project is over. But even before then I will try to get fit. I'm also going to lift the current embargo I have on dressing up (was made under the rationale that I have no time and I can suffer out the next nine weeks, but the hell with that. I'm conditioned into thinking dressing up, even exercising is a luxury to be done only when I get this free time I never seem to have. But no, these are needs. Suffering out the next nine weeks will make the work worse anyway.

Good for you. It sounds like you're making lots of positive steps in the right direction.

[davina61]

That's helpful info for me as going to GP on Wednesday to try for HRT, but also have the option of Gender GP but that will stretch my finances

[davina61]

Looks like it worked, booked in for a blood test next Wednesday to check liver function, GP was great when I explained about bridging prescription ect , Hopefully will start HRT soon.

[JeanetteLW]

 Good news !  Hoping you do get to start soon.

  Hugs,
    Jeanette

[FTMDiaries]

Looks like it worked, booked in for a blood test next Wednesday to check liver function, GP was great when I explained about bridging prescription ect , Hopefully will start HRT soon.

That's great news! You're right that this sounds promising; hope it goes well for you.