As of 31 March 2013, England's* Primary Care Trusts (PCTs), who used to pay for treatment for Gender Dysphoria, have been abolished. The old PCTs have been replaced by Clinical Commissioning Groups (CCGs) - but CCGs are not responsible for paying for treatment for GD. GD treatment is now funded by NHS England's Local Area Teams (LATs), who are entirely different organisations to the old PCTs.

This means that if you have a funding application or appeal that hasn't yet been approved, there is a possibility that your application might be delayed. If it was sent to your old PCT (now your CCG) they might simply reject it because they don't deal with GD funding any more. You might then face a wait whilst a new application is made to the new LAT instead.

New patients shouldn't notice any difference. You still have to go to your GP as the first port of call and they should commission the services you need accordingly - they'll just send your application to your LAT. However, it remains to be seen whether we will face delays in our treatment whilst everyone gets used to the new system - particularly if your doctor doesn't deal with a lot of trans* patients.

In theory, all doctors and GICs should be aware of this and recent applications should've been sent to your new LAT. Also, you'd hope that your old PCT would've handed over their pending applications to your new LAT when they closed down. But it's possible that they didn't and your referring doctor won't even realise that the system has changed until they get the refusal letter from your old PCT. You'd then have to wait even longer whilst they make a new application to your LAT... all of which adds up to an additional delay that I doubt anyone here needs in their lives.

As a precaution, I would suggest that anyone who is concerned about an outstanding funding application or appeal should contact whoever has made the application (i.e. your GIC; your doctor; your psychiatrist) and ask them to check whether it is being processed by the right people.

And if you're a new patient, it might not hurt to mention in passing that you've heard that it's the LAT that funds GD treatment now. Just in case your doctor doesn't realise it yet.

Here's a guide from NHS England about how and why they will fund specialist treatment, and why the new CCGs will not fund it. The provision for GD treatment for under-18s is on page 126; the provision for adults is on page 128: http://www.england.nhs.uk/wp-content/uploads/2012/12/pss-manual.pdf

And as a caveat, I don't work for the NHS - I just wanted to share the information I've researched whilst attempting to figure out how exceptional funding is decided now that our PCTs have been abolished.

* Sorry, but I haven't researched whether the rules have changed in Scotland, Wales or Northern Ireland.

thanks for that.

D: Actually want to cry after reading that haha. Thanks for the info though, will definitely bring it up with my psychiatrist

The reason that FTM researched this is because he was helping me with a problem caused by this change.

I had an appeal for electrolysis pending on the NHS & now this has been delayed as a result of this change, my appeal went in a few days after the change, I handed it to the person responsible & he didn't tell me about this change.
After constant delays caused by GP's & PCT's not knowing the correct procedures for transitioners this straw almost broke the camels back, there's only so much a person can take!

I'd like to publicly thank FTM for researching this info & I hope this thread help people to avoid delays, as he said, if you have a pending application for funding then it would be best to see your GP to ensure that the application is going through this new system & not the old one.

This has caused issues for me. I had to apply to the PCT for funding at Charing Cross. It took a year in total to get my first initial appointment. Then 6 more months to get a second appointment with a prescription. That's where this change bit me in the ass.

CHX prescribed a drug that the NHS won't fund anymore so they just twiddled their thumbs and said they can't do it. Because the funding isn't there (so that was a year well spent). After many back and forths (why's it so much hassle just to get people to communicate?) I finally got a simple solution sorted (a slightly different drug that the NHS can fund....) but my GPs won't take any initiative they won't do a thing unless CHX says so. I suggested that I took anti-androgen pills while I waited for the injection to get started but they said 'that wasn't what they said'. Even though I have a prescription for anti-androgens to take 2 weeks after my injection (to combat the initial raise).

So yeah this PCT thing can still affect you even if u already got approved ages ago. Its finally sorted out now and I'm actually getting started tomorrow. I am glad too! Since I came off my original meds (transdermal patches) and started the estrogen pills the NHS gave me my T level has gone up (I know because of physical stuff and how I feel) and its upsetting me.

Hi Joswin, i'm sorry to hear this.
My GP is already sick of the problems these changes have caused & it's only been 2 weeks.

Having these problems has set my depression off seriously, i'm sooo sick of the NHS right now

Ironically, NHS Scotland recently redid their treatment protocols, allowing for the funding of FFS, BA, and BR, - procedures previously deemed cosmetic.  Crucially they also have a little line that states that "The list of procedures is not exhaustive and other procedures will be considered where they are deemed necessary for the well-being and social integration of the patient." - that's a paraphrase, but its essentially whats there.  Funding is still in the control of the PCT - and this has caused me problems previously when I was at the end of my tether with my voice and was seeking surgical assistance when they claimed to have never heard of the procedure (CTA) or anyone "within the service" who has performed it.  I've launched another campaign to try and get help with this with the aid of this new protocol.

Ironically though, it saw me fast-tracked for GRS privately (NHS funded) at a private hospital.... in 57 days \o/

Kate