Welsh Gender Identity Service

Powys Sexual Health Network met recently, marking its second birthday as a network, updating members on the Test and Post STI testing, pregnancy terminations and update about the Welsh Gender Identity Service. John Morgan, Transformation Manager for the PTHB told us more about the Welsh Gender Identity Service and how it works.

Welsh Gender Identity Service

Background

Previous to the establishment of the service in Wales adults aged 17.5 and over who presented as gender dysphoric were referred to their local Mental Health services via their GP, where they were then diagnosed and referred to a specialist clinic in London. This led to long waiting times for patients from Wales, as they were included in the English waiting lists. This idea for a Welsh Gender Identity service was proposed by Vaughan Gething in 2017 and became established in February 2019. Adults who now present as gender dysphoric can be referred by their GPs directly to the Welsh service, based in Cardiff. 

Current Service.

The service is commissioned by the Welsh Health Specialised Services (WHSSC) on an all Wales basis. Patients who are non complex are assessed by the Welsh service and if appropriate, are endorsed for hormone replacement therapy, they then are discharged back to the local gender teams. If the patient as part of the pathway requires surgery to change some of the physical attributes in relation to their gender, then they are referred through to the specialist clinic in London, where the surgery takes place. 

Umbrella Cymru.

The Welsh service is based in Cardiff at St David’s hospital, with a core team of nine staff. The first patients were seen in September 2019. The Welsh service is slightly different to some of the other gender identity services in England, as peer support is embedded into the service. People accessing the service are supported by a third sector provider Umbrella Cymru. Umbrella Cymru offers a range of support, from the first point of contact with the service, to when the transformation has been completed. There have been 42 referrals from Powys in the last year, which is close to what was predicted and in line with the population of Powys, representing approximately 4% of the total Welsh referrals. 

Third Sector support for the service. 

Changes. 

There have been some changes to staffing in Wales with Dr Sophie Quinney, one of the leading gender specialists for Wales joining the service this year. The impact of the COVID 19 pandemic has lead to the service  embracing new technology, with digital access and attend anywhere software. This allows virtual consultations to take place with the continuation of service provision. A new website with a new website platform is currently being adopted. The new website will include information about what an appointment with the service looks like, as well as general information about making a transition and what hormone surgery entails. There is quite a long waiting list for the service, due to the fact that WHSSC anticipated 365 referrals per year, but in the first year 400 people were transferred back to Wales from London, when the Welsh service was established. The service is currently in the process of developing a business case to seek funding from WHSSC in the hope that this will help to enhance the service and reduce the waiting time. 

Powys

The service in Powys is a virtual one. GP Jonathon Shaw is the clinical lead, based in Machynlleth, with support from the PTHB Sexual Health team and Speech and Language services. There has been some confusion and lack of clarity about the service in Powys, with primary care services and GPs unsure of how to refer to the service. The Sexual Health team as a result aim to send info to all the GP clusters in Powys with details about the Welsh Gender Identity service and how to refer to it.  This confusion is echoed with third sector organisations and whilst a lot of work was done last year to raise awareness of the service it’s clear that this needs to be reiterated and a continual promotion of the service to remind people of what is available. The Powys service will virtually link in to the All Wales service on a fortnightly basis to keep up to date with developments and help people link to the service, accessing the support they require.