Would you ask a gardener to cut your hair? It is still cutting after all.
Would you ask a rapper to lead an orchestra? It still music after all.
Would you ask a gastric (stomach) surgeon to operate on your brain? It still surgery after all.

For the sane individuals out there the answer would be no to all of the above.
So when GPs are being told to take on work outside of their expertise it wouldn’t be a far cry to suggest that an organisation that mandates such a change would be insane.

Insane. Frankly it the only word suitable to describe NHS England’s recent plan to make prescribing and maintenance of gender transformation medications a GP’s responsibility.

These medications are routinely prescribed by specialist consultants who are experts in their field, often using medications out of licence (intended use) .

Some would ask ‘why is this an issue?’ Many drugs are used out of licence ie in children and pregnancy (as no drug company would get ethical approval for testing drugs in these groups).

The issue comes from what can be safely and confidently prescribed to a patient, giving them an informed choice in the matter. The BMA, GPC and I would argue that most GPs would see a handful of patients needing help in this area; and so prescribing potentially harmful medication would be clearly out of an average GP’s scope of knowledge. As an example working in a practice with a registered population just under 10 000 patients, there are currently two patients on the register undergoing gender transformation treatment. That is 0.0002%. Hardly enough to keep safely up to date in a specialist treatment area.

The relevant point here, is that to prescribe such medications, therefore directly contradicts GMC guidance of practicing within your clinical limits and risks the medical licence of any GP that was to engage with this ludicrous policy. This would have significant repercussions with regards to a GP’s probity.

I will correct myself. There is another word for the actions of NHS England – in my view they are acting dangerously.

To push forward with this policy shows the NHS England is putting the cost of patient care ahead of what is safe and in the best interests of patients. As a result I would call upon the GMC and other bodies to intervene before this policy puts patients at risk of inappropriate prescribing.