Today, NHS England has published the independent review of NHS adult gender services, led by Dr David Levy. The review was commissioned by NHS England in June 2024 in response to a recommendation in the Cass review final report. The review has sought to pinpoint areas for improvement, drawing attention to where the quality of NHS adult gender dysphoria clinic services could be raised, and recognising the positive existing practice that can be shared across services.
To inform this review, Dr Levy visited all commissioned NHS adult GDCs from October to December 2024. The review included engagement with NHS clinicians, executive and management staff in the hosting trusts, current and former patients, and those on waiting lists.
Although the review acknowledges the positive signs of progress across GDCs, such as patients feeling heard and understood and a strong commitment by staff to patient care, it highlights the challenges faced by GDCs and recommends a co-ordinated system-wide approach for improvement. Key findings of the review are:
Poor productivity across many adult GDCs, coupled with increasing demand, has led to unacceptably long waiting times, signalling the urgent need for an expanded number of services and targeted improvement programmes to enhance efficiency and productivity.
Significant variation exists in the quality and productivity of clinics, pointing to the need for a standardised approach to care that incorporates holistic assessments and a complexity measure sensitive to individual patient circumstances.
The referral process into the GDCs would benefit from streamlining and it is recommended that the current system of self-referral is ended in favour of a single referral route via GPs.
GPs may not always have sufficient experience or confidence to fully support patients with gender dysphoria, particularly in relation to prescribing and monitoring hormone treatments. It calls for GDCs to take responsibility for initiating and managing hormone prescribing during the first year of treatment, prior to transferring care to primary services.
In response to the findings of this review, we and NHS England will take forward a set of immediate priorities:
Creating a new single, national waiting list for adult gender services to be implemented in April 2026.
Raising the referral threshold to 18 years to align with the age of discharge from the NHS children and young people’s service.
Bringing an end to self-referrals into the service and, in parallel, providing advice and guidance for those finding it difficult to secure a referral.
Establishing challenging but achievable productivity goals for every service that can then guide and inform the commissioning of additional services, underpinned by a clear understanding of the regional demand through the national waiting list.
We are making progress beyond this review. NHS England has increased the number of adult gender dysphoria clinics in England from seven to 12 since 2020, and has established a national quality improvement network for adult gender services. In order to support the wellbeing of patients awaiting their first appointment with a GDC, I previously announced the development of a “waiting well” pilot for patients on the waiting list for the GDC in the south-west.
I will place a copy of the review in the Library of both Houses. This Government have always made it clear that anyone accessing gender services deserves the highest quality of care and support, and to be treated with dignity and respect. The publication of this review marks a significant step forward in our commitment to ensuring safe, effective and evidence-based care for anyone accessing gender dysphoria services across the NHS.
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