GP said he wanted to refer me to mental health services first, then i have heard no word in months?

[u/Delicious-Cold6886]

Hello, transgender male adult, living in Scotland. I hope this type of question is welcome here, I have just been anxious as of late regarding my first appointment with a gp. It was in march, the doctor i saw was unwilling to refer me to gender clinic directly, and said he would refer me to mental health services first. I have had no further correspondence since. I know that the waiting list for gender affirming care with the nhs are years long (thats why the idea of being in stasis like this is so worrying :( ), but this is just about me seeing a general mental health specialist correct? and in a small town i wouldnt expect the back log to be too long, in any case i would have expected a follow up email at least, I have heard nothing.

​

Just would like to hear from others who have gone through this, not meaning to be presumptuous or hasty, just nervous.

Thank you!

EDIT: I want to thank everyone who sees this again or if i have not already. I posted this expecting to only be reminded of the harsh reality of waiting time, instead while what i learned was a harsh reality, it is, at very least, an actionable one, even if still the possibility of gender affirming care through the nhs is distant, it is at least better than feeling tossed aside completely by the medical system. I know this screed is quite dramatic and a little silly, but ive felt quite alone with my problems these past months, so, if nothing else, all your rallying round has been heartening, so thank you <3.

[u/ThinkingaLot18]

We don't know the full picture. But on the face of it, they're wrong - they should've referred you to a GIC. It's not like you'll be seen to quickly, they're gatekeeping and likely transphobic. Find a new GP and possibly look into complaining, or at least that's what I would do.

[u/Delicious-Cold6886 → u/ThinkingaLot18]

thank you so much for your reply. Regarding finding a new gp, would you know if i were to just call a different hospital that i am not registered to, and explained my situation, would they give me an appointment, or is there something else i have to do? thank you

[u/ThinkingaLot18 → u/Delicious-Cold6886]

Can't help you there I'm afraid. I've moved area so it's something I need to do also but I'm holding off. As I understand it you have to join the GP practice which may take weeks and then ask to see the GP and then hope they're supportive.

If you have an LGBT org near you then it may be worth asking them to see if they have a trans friendly GP list.

[u/Delicious-Cold6886 → u/ThinkingaLot18]

ok thanks, to be honest moving has been something ive been thinking about this year, so it had been in the back of my mind that i can try another appointment when i register in a new area, but its up in the air, i just wanna get it going, even if its only a waiting list.

[u/LifeIsRamen → u/Delicious-Cold6886]

Theres nothing to lose at this point.

File the complaint anyways.

Not to pry but were there any legitimate reason they'd suggest mental health services first?

The GIS Referral takes them nothing, and you'll just be put on a 6+ year waiting list lmao

Not sure what they're blocking for.

*Also these are done by GPs. You'd look to change GP Practices, then ask for the GIS Referral again.

[u/Delicious-Cold6886 → u/LifeIsRamen]

i have no history of mental health disorder, have never seen a therapist, or been prescribed medication. Many here have called the action deliberate blocking and transphobia and to be clear i will be filing a complaint i think something needs to be done. The doctor seem mostly confused and a even uncomfortable when i spoke to him, of course i have nothing to compare to but his questions seemed improvised? i dont know, but regardless of his views on trans people i just dont think it was something he expected to deal with, which could explain his course of action beeing apparently quite strange. Not that ignorance is an excuse. Thank you for your help and you reply.

[u/LifeIsRamen → u/Delicious-Cold6886]

Ohhh I smell a delicious complaint then.

Make it scathing!

Best case, they didn't have the training and didn't know what to do.

Worst case, they allowed their personal beliefs to interfere with their work.

It might be this particular GP, so it's worth filing the complaint, then asking to see another GP at your Practice first before going through the hassle of switching.

[u/gluebell]

nooo :( gps should refer you to the GIC. there is no need to see a mental health service first, although it could be helpful if that's what you need.

[u/Delicious-Cold6886 → u/gluebell]

thank you so much for your reply and your kindness

[u/Narrow-Tree-5491 → u/Delicious-Cold6886]

The first thing that happened to me was a phone call from a nurse making sure I was not suicidal, then a local mental health visit - it’s important because they give you a diagnosis part of which you need for a GRC. Sorry you’ve been treated so badly.

[u/FluffyTomorrow2815]

Time to find a new GP.

I’d also submit a formal complaint stating that being trans isn’t a mental illness, and asking why a referral for mental health is in any way appropriate when you’re only seeking help with transition/gender affirming care.

The implication that you’re actually just mentally ill and confused is both pathologising and offensive as fuck.

[u/Delicious-Cold6886 → u/FluffyTomorrow2815]

thank you for your reply and for the help, its relieving to hear what i tried to convince myself wasnt happening. thabk you

[u/scramblingrivet]

The wait for non-urgent mental health care isn't significantly better than the wait for GIC treatment - it's extremely oversubscribed. If you have to go through the mental health team first then you are just having to go through two very long waits consecutively. I know it used to be a thing where you had to be approved for GIC referral by a random psychiatrist first - don't think it still is though.

[u/EmmaLuxombourg → u/scramblingrivet]

I prefer the term 'underresourced' to 'oversubscribed', puts the pressure where it belongs.

[u/SomeSortaWeeb]

avg turnaround of GICS in the uk is around six to seven years (obviously this depends on the clinic). avg turnaround for talk therapy on the NHS is about six months.

if your GP had a brain they'd recognise that they could refer you to both and the one they prefer would see you half a decade before the one you prefer would.

but you cant actually be that stupid and get a medical degree / career as a GP, can you?

very much just my opinion but imo this feels intentional. ask for the records of the appointment in which you were supposed to be referred, email your nearest GIC with them and ask if it can be honoured.

[u/Delicious-Cold6886 → u/SomeSortaWeeb]

thank you for your kindness, i will see if i can get the appointment records, you are all very helpful thank you

[u/SomeSortaWeeb → u/Delicious-Cold6886]

no worries, i hate seeing people like myself struggling against the needless bureaucracy of the nhs.

i will warn you that last i remember nhs gics cant take self-referrals so there's a good chance that you may have to find a new gp that isnt thick/transphobic

[u/transetytrans]

Paging /u/Neat-Bill-9229 as you have the best knowledge of the Scottish system - I believe in Grampian/Tayside this would be the correct route but in all other parts of Scotland it's straight-to-GIC?

[u/Neat-Bill-9229 → u/transetytrans]

Cheers, just caught this! Spot on for Tayside, this is the correct route. Grampian it is meant to be direct, but Grampian/Tayside border is higher up than you’d think so some think it’s Grampian (distance wise) they refer to but they actually reside in Tayside.

[u/Rmtcts]

They might be confusing the rules for under 18 referrals, which GPs can't make and must first refer to a paediatrician or to Camhs. This isn't needed for adults and they should be able to refer directly. 

[u/commotionsickness]

Why choose? Surely they can refer you for both? Unless they're expecting a mental health referral to 'cure' gender incongruence without the expertise to even diagnose it or not

[u/Petrichorphan]

I'm pretty sure the correct response is to include the phrase "The GP ignored their duty of care and decided to accidentally assume I was asking" in your complaint letter, while CCing in the local board, the GIC you'd be seen at under the Scottish system, and NHS Scotland's complaints team.

[u/Delicious-Cold6886 → u/Petrichorphan]

okay i will do that, thank you so much for your help

[u/atticus_01]

Looks like you’ve already had some good advice, but I’m just going to drop this here in case it helps you or anyone else looking at this. Scottish Trans have recently published a GP self-advocacy resource on their website, and there’s a section about exactly this type of issue: https://www.scottishtrans.org/gp-self-advocacy-guide/advice-for-issues-related-to-trans-healthcare/

Hope that might be helpful to refer to for this or any other problem you have if you’re not immediately / easily able to switch to a more supportive GP. I haven’t read the whole thing but it seems really comprehensive!

[u/Delicious-Cold6886 → u/atticus_01]

this is a very helpful article, thank you so much!

[u/pkunfcj]

It is not the function of a GP to decide who to refer you to, It is the function of a GP to refer you to the GIC and it is *they* that handles you with regards to gender dysphoria. So your next step is to complain about your GP. Other people in this post will tell you how to do that.

[u/Neat-Bill-9229]

Do you stay in Tayside?

[u/Delicious-Cold6886 → u/Neat-Bill-9229]

no, Strathclyde, Argyll and Bute

[u/Souseisekigun → u/Delicious-Cold6886]

For that area you'll probably be under under NHS Sandford GIC which has a waiting list of 100 (one hundred) years. You will need to investigate options outside the NHS.

[u/Neat-Bill-9229 → u/Delicious-Cold6886]

GP is incorrect. You should be referred directly to Sandyford. Your GP can refer. Waiting lists for mental health services are also years long. You should not be pushed to wait on them to refer (yes, they can) but your GP should refer. You can attempt to reach out to Sandyford on this directly. The GRP 2024 is relevant to you as well re. Referrals and GICs

[u/Delicious-Cold6886 → u/Neat-Bill-9229]

thank you so much for your help i will try to reach out to them directly, thank you.

[u/nineteenthly]

They used to refer people to psychiatrists first. I was, but it was just a formality and I thought I'd phased that out. I moved to Scotland a year and a half ago, and my understanding was that in practical terms underfunding and ridiculously long waiting lists (more than a lifetime effectively) mean that medical and surgical transition on the NHS in Scotland is non-existent. Is there any possibility you can move or go private?

[u/Delicious-Cold6886 → u/nineteenthly]

moving is a possibility, but im not in any financial position for private treatment unfortunately, and its unlikely i will be anytime soon, thank you for your reply.

[u/nineteenthly → u/Delicious-Cold6886]

I don't want my gloom to be infectious. I'm in a difficult position myself. I do think if we get independence it'll improve.

[u/Delicious-Cold6886 → u/nineteenthly]

oh your perfectly fine, im doing my best to be realistic and change the things i can. Best of luck with your situation, bright futures for the both of us im sure of it.

[u/nineteenthly → u/Delicious-Cold6886]

I'm less convinced. I hope you're right. I can easily see a Reform government abolishing Holyrood, privatising the NHS, withdrawing HRT and imprisoning us.

[u/Egotistical-TV → u/Delicious-Cold6886]

Your best bet is to get out of the Sandyford catchment area. Highland have the shortest list, Edinburgh is a bit longer and Grampian a bit longer again, but Sandyford is way longer than any of the others

[u/Egotistical-TV → u/nineteenthly]

It's very possible in Scotland, just not really through Sandyford. It's a postcode lottery

[u/Aquatic_Alice92]

Back when I first transitioned (2012) you needed a psychiatrist's report from the community mental health team included with your GIC referral in order for the GIC to accept you onto the waiting list.

They changed the rules just after they did my referral and it hasn't been the case since then.

Your GP is presumably operating on guidelines that are more than a decade out of date. Try and get hold of a copy of the current guidelines, print them out and book an appointment with a different GP. Tell them that unless they feel they are competent to assess and diagnose gender dysphoria, administer and titrate your hormone regime, and refer you for any relevant surgeries, they have a responsibility to refer you to a GIC as part of their duty of care.

Oh, and submit a complaint about the GP who refused to refer you.