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. 

Test and Post STI Sampling

Access to STI screening in Powys is about to get easier.

STI home testing is a convenient and discrete way of testing for sexually transmitted infections. Current test at home kits involve testing at home and getting the results at home. Proposed changes to STI home testing means that the test will still be taken in the privacy of your own home then sent to a lab for analysis. The results will then come from the PTHB with help and support on hand if required.

Trial Period

Hywel Dda health board began trials of TaP (Test and Post)  in 2018. TaP can be used to test for the two most commonly contracted STIs Chlamydia and Gonorrhoea. Test kits can be ordered via the website www.friskywales.org There’s an easy to find Testand Post page with details of the service. To receive a kit through the post you have to follow a simple link to answer a straightforward questionnaire with the option of answering in Welsh or in English. The questions help the selection process and also help to support people under the age of 16 and victims of domestic abuse who are then signposted to appropriate support.

Findings

By the end of Year 1 Hywel Dda had had 2000 responses with a 91% completion rate. The test results for Chlamydia were surprising with results coming back as 7.7 % positive with the national normal range for Wales at 4.6 % The majority of tests were from women at 85% with 15% returned from men. The majority of tests returned were in the 16-24 and 25-34 age ranges. The two most popular reasons for using the service were lack of time to go to a clinic and being too embarrassed to see someone in person.

Proposals

Welsh Government are considering the option of widening initial pilot to include Powys and Betsi Cadwalladr University Health Board. As of February 2020 PTHB have 50 trial test kits. There is a need to ensure that testing is supported by services in Powys and BCHUB and that effective pathways are in place. The anticipated number of requests for Powys in Year 1 is 1000. This would benefit Powys residents as current cross border services aren’t accessible to Powys residents. The aim is to be able to offer STI services in Powys rather than pay for an out of county provision. Current reasons for visiting out of county sexual health services are routine testing, contraception, IUDs, contraceptive implants and treatment for HPV and genital warts.

What Next?

Feedback from the Hywel Dda pilot has been positive,

“A very easy to use comprehensive service.” 

“This service is so much easier than waiting for hours at a clinic and is exactly what is needed in Wales. It allows people who struggle to find time in their working day to visit a clinic the opportunity to get a peace of mind in a quick and easy way,”

The PTHB are hoping to roll out the Test and Post service later this year in Powys.

We’ll keep you posted about all developments in the meantime!