Gender Plus Hormone Clinic Also known as Gender Plus Healthcare Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Staff followed a robust audit programme and ensured they were continuously practicing safely and in line with national guidance. Leaders were committed to working collaboratively with other services to ensure joined up treatment and care for patients. The took a holistic approach to treatment planning. They considered all areas of a patient’s lifestyle and took a targeted and proactive approach to health promotion. The nurse consultant was empowered to give informed consent. Staff discussed treatment options in detail and patients were given time to consider the information and their options.

This service scored 88 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

All patient feedback was positive. Patients reported they felt the service went over and above to provide the best quality treatment to manage their gender dysphoria. Patients reported the care and treatment they received significantly improved their quality of life. Patients were given information and advice about their health, care and support to enable them to be as well as possible, physically, mentally and emotionally. There was a mental health nurse available at every face-to-face appointment and further appointments could be requested if required. Patients told us this was going “above and beyond” and felt they took patients mental health seriously and specialist support was available for both them and their families.

Staff told us in detail about the comprehensive approach to assessing the needs of the patients. They were passionate about providing the best and most up to date evidence-based practice in line with national guidance to make sure patients had the best outcomes. Patient needs were assessed using a range of holistic assessment tools to ensure their needs were reflected and understood. All patients who were referred to the GPHC had a comprehensive psychological assessment and a diagnosis of gender dysphoria. All patients were discussed as part of an MDT and decisions were made by a range of experienced professionals about whether a patient was suitable for treatment. The nurse consultant recognised the importance of having sufficient time to assess the patient. They provided a 60-minute initial face to face appointment to ensure the patient understood all the treatment options, side effects, risks, and gave time to answer their questions. The nurse understood the importance of discussing lifestyle aspects, such as nutrition, sexual function and smoking during the consultation. Staff had received specific training to support them to engage with patients with additional needs, such as patients with a learning disability and autistic people.

There was an interacting with people with learning disabilities and autism policy. The service worked hard to promote positive interactions with patients with learning disabilities and autism. The nurse consultant had received training on working with learning disabilities and patients with autism, and went out of their way to ensure these patients were accommodated within the clinic.

Patients and their families felt informed about their pathway and that it was in line with national guidance.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. Policies seen contained current national guidelines and were in line with evidence-based practice. Policies, processes, and other supporting documentation were based upon national guidance and standards including the international Endocrine Society guidelines, World Professional Association for Transgender Health and BAGIS. All clinical staff were members of BAGIS and attended an annual meeting to discuss new guidelines. Staff told us they were a very active organisation within BAGIS.

All new policies were highlighted to staff at team meetings. We observed a team meeting, and they discussed the accessible information policy and updating their detransition and reidentification policy. The service created a response and action plan to the Cass Review recommendations. The response detailed discussions around each recommendation from the report and how the service had delivered this or were working to deliver this. They had created an action plan to ensure all recommendations were delivered which had been completed at the time of the assessment. It included actions such as creating a detransition standard operating procedure, source a fertility expert to record an education video on fertility preservation and to develop the education resources for new hormone clinic patients. National legislation and associated guidance restricted the new prescribing of puberty suppressing hormones for the treatment of gender incongruence or gender dysphoria in children and young people who are under 18 years of age. The clinic had sought guidance from the government and a lawyer to ensure they were practising in line with the law and were able to use these medicines. In practice they only used it for feminising hormones however it was possible, and they checked this with the government, that they could use it alongside masculinising hormones too.

All patients we spoke to were very positive about the working relationships between the team and the team at Gender Plus. They felt they all really cared about them and worked well together to deliver and effective service.

Staff worked collaboratively to ensure patients received high levels of care. They recognised the importance of working closely with their partner service, Gender Plus. They had good links with external services and had tried to increase their links to ensure patients received joined up care. The nurse consultant contacted patients’ GPs to offer a shared care agreement. Patients gave examples of how staff had supported them to go back to their GP for treatment and reduce their costs. They liked the flexibility this gave them and appreciated staff working well with other professionals as it improved the service they received.

We observed an MDT and team meeting and found the teams were professional and used a detailed but simple process for patient referral between the services to ensure continuity of care. Staff were aware of how to appropriately refer to different services. The clinic worked alongside a pharmacy who did all their prescribing. They told us they had a good working relationship with GPHC, and they liaised with them well. The clinic had an independent mental health nurse who attended clinic alongside the nurse consultant to ensure patients had their mental health assessed if required.

There were pathways that staff followed to ensure patients received the care they required. Once a patient had been accepted for treatment at the GHPC they could still be seen at Gender Plus for further psychological support if required. The services worked well together and discussed patients together in an MDT. The nurse consultant had contacted NHSE and started the process of putting a pathway into place for a streamlined referral process back into the NHS for continued care for patients. They had also started to reach out to sexual health clinics within different locations to perform injections where GP surgeries did not offer shared care so that patients did not have to travel far for their injections.

Patients told us the nurse was very thorough with their advice about the changes that they would experience and how to lead a healthy life as a transgender person. We observed 3 patient consultations where the patients were given advice and supported with information on how to maintain a healthy lifestyle.

Staff assessed each patient’s health and provided support and advice to help patients lead healthier lives. Staff asked patients a series of questions about their lifestyle, such as smoking and their diet. The advised patients that smoking and a high body mass index could increase the risk of co-morbidities. Patients were given advice about smoking cessation and a healthy diet when required. Transgender males who were commenced on hormones were advised this could increase their risk of stroke and heart disease and were counselled on this and maintaining a healthy lifestyle. Staff discussed sexual health and libido with the patients to ensure they had considered contraception alongside their hormone treatment and any changes they would see to their genitals. Patients were also made aware that they still needed to attend cancer checks. They were made aware that if they changed their sex on their GP records, they would not be reminded of routine checks such as smear tests.

There were processes in place to ensure patients lived healthily when discharged. Discharge plans were created which included a care plan which gave advice about how to maintain healthy lifestyle as a transperson.

Patients were aware of the changes and outcomes to expect when taking hormones. Patients told us the nurse had given them a lot of information in different formats to ensure they fully understood their treatment.

Managers and staff carried out a programme of repeated audits to check improvement over time. Managers told us they used information from the audits to improve care and treatment. We saw that audits were discussed with staff at team meetings and actions were created. Patient outcomes were collected using questionnaires following each appointment. These were analysed for outcome measures. They looked at whether patients were functioning in society and whether this had improved their mental health, quality of life, and how they felt on the hormone treatment. All patients on continued treatment were discharged when they were safely on an adult dose of the hormone, with no associated comorbidities and with a plan in place for their continued care with the GP. All patients would be discharged after 2 years or when able, with a care plan advising the GP of monitoring for these patients.

The service had an effective system to regularly assess and monitor the quality of its services to ensure patient outcomes were monitored and measured. The audit programme ensured different aspects of care and treatment within the service were checked during each audit. Audits included medical records, infection prevention and control, health and safety, safeguarding audits and controlled drugs audits. Audit results were discussed at managers meetings and team meetings. The clinic had only been open since January 2024 and most outcomes were measured long term over 2 years and 5 years. However, the outcomes for patients that had been collected were positive. The service had commenced work on a 5-year follow-up research project to look at long-term outcomes for those on a hormone pathway at Gender Plus. It has been working to submit an ethics committee for approval and patients are given the opportunity to consent to take part in research at the clinic when attending their initial appointments.

Everyone we spoke with was very positive about the consent process. All patients and family members felt it was robust, they felt well informed and felt prepared to consent to the treatment. One parent told us they felt consent was a strong point of GPHC, they felt expectations were expertly managed and the information was pitched at the right level for them all to understand as a family. Patients told us they were offered more time to make decisions, and they were not rushed into consenting for treatment.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff made sure patients consented to treatment based on all the information available. Patients were given information about their proposed treatment both verbally and written, to enable them to make an informed decision about their procedure. They were sent bespoke videos explaining the treatment options, risks and side effects prior to their initial consultation. We looked at 10 sets of patient notes and saw consent was recorded in all these records. Staff had the appropriate skills and knowledge to seek verbal and written informed consent before providing care and treatment to their patients. Staff were aware of the legal requirements of the MCA. Data showed 100% of staff had completed consent training and 100% had completed MCA training.

We observed 3 consultations where consent took place. We found the nurse engaging with the patients and their families, provided appropriate information, answered questions and completed the consent alongside the patient checking their understanding.

There was an up-to-date consent policy which staff followed when gaining consent from patients. Staff clearly recorded consent in the patients’ records. There were different consent forms for different treatments. The consent forms were comprehensive and required the patient to initial next to each risk of the treatment to show they had read and understood each risk. The most recent audit showed they were 100% compliant. The consent policy detailed consent for 16- and 17-year-olds who were presumed to be capable of consent. There was also a Looked After Children policy which detailed how consent would be obtained in line with the MCA. The policies stated when a young person is 16 years old their capacity for decision making can be assumed, unless a person is deemed to lack capacity. All patients are referred to GPHC via an MDT and if a patient lacked capacity, they would not be accepted for treatment at GPHC. All patients between the ages of 16 and 17-years-old had a parent with them at their initial appointment and parental consent was gained as well, even though not required. We spoke to staff at Gender Plus clinic who told us the nurse at GPHC had turned down a patient as they wanted the clinician at Gender Plus to try harder to engage a non-residential parent in the decision-making process about hormones (the residential parent agreed).