Respect, confidentiality and the law

 

From Medical practice

 

  1. 46. You must be polite and considerate.
  2. 47. You must treat patients as individuals and respect their dignity and privacy.12
  3. 48. You must treat patients fairly and with respect whatever their life choices and beliefs.
  4. 54. You must not express your personal beliefs to patients in ways which exploit their vulnerability or may cause distress.
  5. 50. You must treat patient information confidential.
  6. 59. You must not allow your views about a patient to adversely affect your professional relationships or the treatment you provide or arrange.

These principles in GMP are fundamental to providing a good standard of care. For trans and non-binary people you may sometimes need to take extra care with the issues below in order to comply with the guidance and provide effective care and a positive patient experience.

Show respect by using the right name and title

The way you address patients who are transitioning or have transitioned is extremely important and taking care to use the right (ie the patient’s preferred) name and title shows that you are treating them with respect.

If you are not sure how you should address someone, ask them, “how do you like to be addressed?” and also “what pronouns do you prefer people to use when talking about you?”

Medical records: changing name, title, NHS number

Both electronic and paper medical records should clearly indicate your patient’s preferred name and title.

"I called the GP's surgery to make an appointment. The receptionist asked me to repeat my name twice. I said Angela - twice. The receptionist sort of sniggered and turned to the other receptionist and said, quietly, but loud enough for me to hear: 'he says he's Angela - what do I do?'

I did get my appointment, but my stomach was churning. I felt terrible. That feeling comes back every time I need to make an appointment"

Employers have a responsibility to ensure that all staff are trained to understand trans issues. Trans women's voices can sound masculine on the phone. Sometimes misgendering a person is a genuine mistake for which the person making the mistake should apologise, and move on. Receptionists, practice nurses as well as doctors need to consider the long-term effects on mental health and wellbeing of trans people, if those they turn to for help don’t treat them with respect. It may even prevent them from seeking healthcare at all.

A patient’s request to change the sex indicated on their medical records should be respected; they do not have to have been granted a Gender Recognition Certificate or have acquired an updated birth certificate for this to be changed. The process for changing name and NHS number can be found at  and information for  (pdf).

If your patient is to be issued with a new NHS number which has no reference to their sex at birth, you should explain to them that they will not automatically be contacted regarding current or future screening programmes associated with their sex at birth, and discuss the implications of this. Decisions about screening should be made with patients in the same way as any other decisions about their health (see our Consent guidance for more information).

Confidentiality – gender history and the law

From Confidentiality:
  1.  

  2. 12. You must make sure that any personal information about patients that you hold or control is effectively protected at all times against improper disclosure.
  3. 24. Seeking a patient’s consent to disclosure of information shows respect, and is part of good communication between doctors and patients.
  4. 27. You must respect the wishes of any patient who objects to particular personal information being shared within the healthcare team or with others providing care, unless disclosure would be justified in the public interest. If a patient objects to a disclosure that you consider essential to the provision of safe care, you should explain that you cannot refer them or otherwise arrange for their treatment without also disclosing that information.
  5. 28. You must make sure that anyone you disclose personal information to understands that you are giving it to them in confidence, which they must respect. All staff members receiving personal information in order to provide or support care are bound by a legal duty of confidence, whether or not they have contractual or professional obligations to protect confidentiality.

The gender status or history of trans and non-binary people should be treated with the same level of confidentiality as any other sensitive personal information.

It is unlawful to disclose a patient’s gender history without their consent. When communicating with other health professionals, gender history need not be revealed unless it is directly relevant to the condition or its likely treatment.

There will be circumstances where it is appropriate to disclose this information – with your patient’s consent – so that the service you are referring to is aware that your patient may have specific needs. For example, if you are referring a trans man for treatment to a gynaecology service, letting the clinic know in advance should allow them to make sure that clinical, administrative and support staff respond appropriately to your patient and care for them in a manner that respects their dignity.

The Law

The Equality Act 2010 and Gender Recognition Act 2004 give trans people legal protection against discrimination and harassment; and legal right to privacy.

Equality Act 2010 (and parallel legislation in Northern Ireland)

The Equality Act and parallel legislation prohibit direct or indirect discrimination or harassment of patients on the basis of a protected characteristic. The protected characteristics are: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.

Direct discrimination occurs where a person treats another person less favourably than he or she treats, or would treat, others because of a protected characteristic.

Indirect discrimination occurs when a person (A) applies a provision, criterion or practice to another person (B) that appears neutral on its face but which disadvantages B and other people with whom B shares a protected characteristic, and which cannot be shown to be justified.

Harassment occurs where a person’s conduct has the purpose or effect of violating another person’s dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that person (section 26). For further detail on the application of protected characteristics and discrimination in providing health services, check the Equality Act or seek legal advice.

Gender Recognition Act 2004

The Gender Recognition Act 2004 imposes certain responsibilities to maintain confidentiality. Section 22 of the Act makes it a criminal offence for any individual who has obtained information in an official capacity to divulge that a person has a gender recognition certificate or do anything that would make such a disclosure. The Gender Recognition (Exceptions to Offence of Disclosure) Order 2005 creates an exception to Section 22 for healthcare professionals where:

  • The disclosure is made to a healthcare professional
  • The disclosure is made for medical purposes, and
  • The person making the disclosure reasonably believes that the subject has given consent to the disclosure or cannot give such consent.

It is also important to understand that ‘medical purposes’ means that disclosure must have direct relevance to the treatment involved or likely to be involved. GPs and others should not automatically disclose a patient’s gender history when referring a person, for instance, for carpal tunnel syndrome.

Gender Identity Clinics (GICs) in the UK

England

  • Gender identity clinics in London and the southeast
    West London Mental Health NHS Trust Gender Identity Clinic
    179-183 Fulham Palace Road, London, W6 8QZ
    Telephone: 020 8483 2801

The has an overview of information useful for anyone with gender identity needs, not just those in the area.

  • Gender identity clinics in the north
    Sheffield Health and Social Care NHS Foundation Trust Sexual and Relationship, Sexual Medicine and Transgender Services
    Porterbrook Clinic, Michael Carlisle Centre, Nether Edge Hospital,
    75 Osborne Road, Sheffield, S11 9BF
    Telephone: 0114 271 6671

The includes information about referrals, clinic opening hours, and links to eligibility criteria and the Porterbrook Clinic.

  • Leeds Gender Identity Clinic
    Management Suite, 1st floor, Newsam Centre, Seacroft Hospital, York Road, Leeds, LS14 6WB
    Telephone: 0113 855 6346

The covers referrals and commonly used medications.

  • Northumberland Gender Dysphoria Service
    Benfield House, Walkergate Park, Benfield Road, Newcastle, NE6 4QD
    Telephone: 0191 287 6130

The has a leaflet outlining eligibility and how to access services.

  • Gender identity clinics in the Midlands
    Northampton Gender Clinic
    Danetre Hospital, London Rd, Daventry, Northamptonshire NN11 4DY
    Telephone: 01327 707200
    Email: [email protected]

Visit the for more information.

  • Nottingham Centre for Gender Dysphoria
    3 Oxford Street, Nottingham, NG1 5BH
    Telephone: 0115 876 0160

Visit the for more information.

  • Gender identity clinics in the southwest
    The Laurels Gender Identity and Sexual Medicine service (Devon Partnership NHS Trust)
    The Laurels, 11-15 Dix's Field, Exeter, EX1 1QA
    Telephone: 01392 677077

has information about the types of services on offer and the help available during transition.

Northern Ireland


  • Shimna House
    Knockbracken Healthcare Park
    Saintfield Road
    Belfast. BT8 8BH
    Tel. (028) 9063 8854
    Email: [email protected]

Opening Hours for Telephone Contact
9.00am – 5.00pm Monday – Friday.

Scotland

There are 4 gender specialist clinics in NHS Scotland and referrals can be made to these clinics to explore with the patient the options available to them.

  • The main NHS Scotland Gender Identity Clinic is based at the Sandyford in Glasgow and accepts referrals from across Scotland. It is also possible to self-refer to the Sandyford clinic www.sandyford.org or 0141 211 8130.
  • The Sexual Problems Clinic within the Royal Infirmary of Edinburgh accepts patients from NHS Lothian Health Board area and also NHS Fife, NHS Borders, NHS Forth Valley, NHS Tayside and the North of England. The clinic can be contacted on 0131 242 2515.
  • NHS Grampian. Referrals are accepted from general practitioners of patients residing in Grampian, Orkney and Shetland. All referrals should be made to Dr John Callender, Royal Cornhill Hospital, Aberdeen AB25 7ZH.
  • NHS Highland Sexual Health Clinic based at Raigmore Hospital, Inverness accepts selfreferrals. The clinic can be contacted on 01463 704202. The clinic does not accept out of area referrals.

Wales

Wales does not currently have a gender identity clinic but in April 2015 Welsh Assembly members voted for an independent study to be carried out into the feasibility of opening a gender identity clinic in Wales.

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