Gender Plus Hormone Clinic Also known as Gender Plus Healthcare Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The service was very well managed. The managers used leadership, governance, and culture to drive and improve the delivery of high-quality person-centred care. They were passionate, inclusive, and demonstrated high levels of experience and capability to deliver excellent care and treatment. Staff felt respected, supported and valued. The service engaged with patients, their families and the community and were continuously striving for improving the services.

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Senior management ensured there was a shared vision and strategy and staff in all areas knew, understood and supported the service’s vision and values. Staff and leaders ensured the service’s vision and values were developed in collaboration with people who used the service, staff and external partners. Staff felt respected, supported, and valued. They were focused on the needs of patients receiving treatment and worked well together to ensure they achieved good outcomes for patients. Staff were positive and proud to work in the organisation. The culture was centred on the needs and experience of patients and their families who used services. Staff told us that the leaders created culture of mutual respect and appreciation for each professional in the service; this was for all staff who worked at GPHC and Gender Plus. Staff told us they felt involved in decisions and felt happy at work. We observed the staff and leaders embody a positive, compassionate, and listening culture. We saw that this culture promoted trust and understanding between staff, leaders and patients using the service.

The managers had a vision and involved their teams to plan the business. They wanted to be the leading expert in their field providing safe care for transgender patients. They had collaborated with a communications consultancy which specialised in transgender and non-binary inclusion and awareness. The managers wanted to promote the provision of healthcare to the transgender community. Activity was focused on building the organisation’s reputation through regular communications with trans support groups and charities, politicians and medical professionals with an interest in trans healthcare. Staff were involved in creating the values and vision for the service. They had an away day twice a year where they developed vision and values together. They wanted it to be led by the team and not just the leaders. Their vision was to improve accessibility by offering a comprehensive holistic service which was accessible to more people. They were working with 3rd sector partners to create a subsidise or fully fund a pathway for patients who met a criteria. They were working in line with the recommendations from the Cass Review 2024 to have a footprint that was more localised and have more locations for patients to access across the country. Managers also told us they wanted to be leaders in research in this field. Contributing to research was very important to them and they contributed to and looked at research information as a team monthly and discussed this within their team meetings. For example, there was a research paper produced in August 2024 which discussed the clinical considerations and endocrinological implications in the detransition process and they discussed this as a team and used the research to inform their detransition pathway.

Leaders were inclusive and understood the context in which they delivered care, treatment, and embodied the culture and values of their organisations. They were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them. They were actively seeking solutions to problems and to ensure the service was accessible for all. We saw evidence that the managers were engaged in current and future development of the clinic at a national level to ensure they were accessible to all patients. For example, there were plans to open a further clinic in the north of England and they were creating relationships with local sexual health clinics across the country to assist with administration of injections, so patients did not have to travel long distances. Partners from the gender plus team told us “There is good communication between and from the leadership team and they create a great working environment modelling respect and ethically minded leadership.”

There was a leadership meeting weekly between the leaders from the GPHC and Gender Plus. There was an agenda and a working action plan. They created actions for improvements needed and worked as a team to ensure these were done promptly. The leadership team met with a leadership consultant monthly. They told us this brought an alternative perspective and allows them to be responsive to the team and clients.

Leaders fostered a positive culture where most patients and their families felt they could speak up and their voice would be heard. Staff and leaders acted with openness, honesty, and transparency. Staff were encouraged to raise concerns with their managers. Managers had a meeting twice a month to ensure staff had a place to discuss any concerns. There was also an encrypted social media group where staff could have discussions.

There was a detailed whistleblowing policy in place. All staff we spoke to felt able to raise concerns with their managers and told us they were approachable and listened. All staff had an employee handbook which detailed whistleblowing policy, grievance procedure, equal opportunities, and about joining their organisation.

The service promoted equality and diversity in daily work. ‘The managers were looking to recruit into the administrator position and were actively looking for someone who had lived experience of gender affirming care as they felt this would be beneficial to the patients.

There was an equality and diversity policy in place. Equality and diversity training was part of staff’s mandatory training programme; all staff had completed this.

Throughout this assessment, the managers consistently demonstrated that they had the skills and knowledge to provider a well-led service. They had a clear understanding of their responsibilities and were familiar with guidance for providers on meeting the regulations. They used national guidelines to inform their practice and continuously ensured they were working ethically. Managers described some of the audits that were completed on a regular basis, such as health and safety, infection control, safeguarding and ensuring equipment was safe and well maintained. All levels of governance and management functioned effectively and interacted with each other. We saw standard agenda items for discussion included clinical incidents, complaints, audits and risks. There was evidence of action taken to address compliance within the service. The service had a business continuity plan in place to deal with emergencies and major incidents.

There was a clear management structure. Leaders monitored quality and operational processes and had systems to identify where action should be taken. There were a range of other systems which supported the delivery of safe and high-quality care. There was a governance policy in place. We saw the service had clear and effective governance, management and accountability arrangements in place. We were assured that staff understood their roles and responsibilities. We saw there were effective quality assurance processes in place. These included feedback from patients which was used to help continue driving improvement within the service. We saw the management reporting structure was transparent, and the manager made themselves available for support to the patients using the service, relatives, and staff. We saw that care records were kept securely. We reviewed 5 sets of minutes which showed action plans were discussed and improvements were made. Learning was shared with staff and team meeting minutes which showed staff were kept informed. There were arrangements for identifying, recording, and managing risks, issues, and mitigating actions. There were 11 risks on the risk register, and all showed mitigations in place. They had 1 high risk on their risk register which was the pharmacy provider stopping allowing prescriptions for 16–17-year-olds following changes in legislation. They had mitigations in place for this with assurances to the pharmacy provider around their procedures and they had sought government and legal advice which allowed for the hormone clinic to continue to prescribe these medicines in certain circumstances.

The service used local Lesbian, Gay, Bisexual, and Transgender+ (LGBT+) networks, partners and people to identify new or innovative ideas that could lead to better outcomes for patients. For example, they had started a patient and parent involvement group. All patients and parents are asked if they want to partake and are given a voucher for their time. The parent group was working well. We saw minutes for this and saw discussions were had and suggestions were made to improve the journey and support for parents and guardians including a welcome pack.

Staff and leaders were open and transparent, and they collaborated with relevant external agencies where necessary. Staff and leaders worked in partnership with people, communities and partners to share learning with each other that resulted in continuous improvements to the service.

Staff engaged with partners to share learning with each other which resulted in continuous improvements to the service. They held joint meetings every Wednesday with their partner organisation, Gender Plus, and had a joint management team. Partners told us “I think we work extremely well together and there is clear reciprocal communication” and “I think we are all working towards a joint purpose which is to support the trans and gender diverse people and their families in a holistic, safe and responsive way.”

Leaders actively engaged with local communities. The managers met with LGBT+ charities and groups on a quarterly basis within the area. The managers attended their support groups where required and gave information to patients about what to expect with the service and were able to offer advice as professionals.

All staff were committed to continually learning and improving services. Leaders encouraged staff to speak up with ideas for improvement and actively invested time to listen and engage. They contributed to safe, effective practice and research. There were processes to ensure that learning happened when things went wrong, and leaders encouraged reflection and collective problem-solving. The service used innovation to gather information to improve the service. They had a patient and parent involvement group, they reached out to charities, they had created links with another gender affirming service to consider peer reviews, and they used social media to create a voice within the community. They had a public relations team, who specialised in transgender awareness, actively engaged with the media and service users to ensure the messages being delivered on social media were in line with their values. The service was explorative and looked at ways to creatively explore and develop social skills of young patients. Alongside Gender Plus, they were in the process of setting up a project called “Gender Plus Heroes Guild”. Its aim was to create a safe, inclusive, and supportive environment for transgender young people through the engaging and imaginative world of Dungeons and Dragons. This group will provide a space for young people to explore their identities, build community engagement, and develop social skills in a fun and creative setting. It was a 3-month project which aimed to foster a sense of community, enhance social skills, and promote self-expression among participants. Evaluating the pilot project would indicate whether the project would be a useful addition to the service on an ongoing basis.

GPHC showed innovation in their referral process. They ensured every patient went through a multidisciplinary meeting. This meant there was a joined-up approach where experienced professionals made the decisions together about a patients care to ensure it was safe; this was a best practice model. There was a focus on continuously learning. The leadership team arranged training for staff on topics of their choice. Staff felt they could ask for extra learning if they needed more support in a certain area. The managers were in the process of arranging a gender identity skills conference for professionals to attend to share their knowledge and encourage positive conversations about gender affirming care. The service was contributing to research regarding the long term effects of hormone treatment on adolescents. The leaders commissioned an independent mock assessment of the service in June 2024, by the previous director of nursing in gender identity services. They highlighted several changes the service needed to make and all actions had been completed at the time of our assessment. We saw they were committed to making continuous improvements to the service for the patients. They had an innovation plan which involved a subsidised pathway for the future. This would increase the accessibility of the clinic to more patients. There was a mental health nurse available at each consultation. One parent told us this created a discussion which they would not have had due to them being in clinic and accessible. They felt it was “positive and would not normally happen”. The nurse consultant was a contributor to the Cass Review 2024 and wanted to be an active contributor to developing gender services across the country. They wanted to contribute to public discourse in a positive way about gender healthcare and ensure they were leading the research. Managers told us that contributing to research was very important to them to help shape the future of gender affirming care.