Patients aged under 18 years
Following publication of the Sullivan Review which looked at data, statistics and research on sex and gender, the Secretary of State directed that the formerly existing PCSE process for changing NHS numbers and gender markers for children and young people under the age if 18 should cease immediately. Such patients can still change their name and title.
This means practices should not initiate this process for patients under 18; if this process has already occurred, no further changes should be made to the medical records. This was a prospective decision. Since this may cause concern amongst affected patients, it is important for practices to explain this is not an optional process for practices: practices can note preferred names/pronouns/titles in the context of patient consultations and communications, and patients can change these, but the NHS demographic data, (that is gender marker and NHS number) cannot be altered.
Patients aged over 18 years
This direction only applies to patients under the age of 18. For older patients, practices should use the process described on the PCSE website.
In summary, for patients over the age of 18 years, the practice can submit a gender reassignment request. There is no requirement to hold a Gender Recognition Certificate to initiate this process. This normally results in the patient receiving a new NHS Number. However, patients can opt to change their gender marker without changing their NHS Number. In both cases this decision should be confirmed and documented with the patient.
If a patient receives a new NHS Number, they are registered at their GP practice as a new patient. Relevant previous medical information needs to be transferred into the newly created medical record. Patients need to understand that having made this change, they cannot revert to their previous NHS Number. Receiving a new NHS Number may create a risk of loss of some of the original medical record held under the old NHS Number, and loss of their place on current NHS waiting lists. Changing recorded gender data may also affect screening invitations.
Registration of Gender
Patients can be registered as either male or female; or they can (if aged over 18 years) be registered as Intermediate or ‘I’ which will appear as ‘Not specified’ on PDS.
Changing registered name
PCSE does not require confirmation that a practice has seen evidence of a name change, although it is good practice (but not a legal requirement) to do so. It would be for individual practices to decide their policy in terms of such requests, although PCSE may contact the practice to confirm this information.
Colleagues should note that NHS England is currently reviewing these arrangements, and they may therefore change in the future.
Screening Programmes
Patients who change their gender marker may not be invited to an appropriate national screening appointment or may receive invitations that are no longer appropriate. There is a comprehensive description of the NHS screening programme in the context of trans and non-binary people.
In summary, the following will apply:
Trans women and non-binary people assigned male at birth who are registered with a GP as female:
- are invited for breast screening
- are invited for bowel cancer screening
- do not need cervical screening as they do not have a cervix, but may still get invited
- are not routinely invited for abdominal aortic aneurysm (AAA) screening but can request screening
Trans women and non-binary people assigned male at birth who are registered with a GP as male:
- are not routinely invited for breast screening but can request screening
- are invited for bowel cancer screening
- do not need cervical screening as they do not have a cervix
- are invited for abdominal aortic aneurysm (AAA) screening
Trans men and non-binary people assigned female at birth who are registered with a GP as female:
- are invited for breast screening
- are invited for bowel cancer screening
- are invited for cervical screening
- are not invited for abdominal aortic aneurysm (AAA) screening
Trans men and non-binary people assigned female at birth who are registered with a GP as male:
- are not routinely invited for breast screening but can request screening if they still have breast tissue that needs screening
- are invited for bowel cancer screening
- can ‘opt in’ to receive routine cervical screening invitations by contacting their cervical screening provider, for example their GP or practice nurse, sexual health clinic or transgender health clinic
- are invited for abdominal aortic aneurysm (AAA) screening but do not have a high risk of AAA
Cervical Screening Programme
In the case of the cervical screening programme, an opt-in form relating to patients whose NHS gender marker would mean they will not be routinely called/recalled for screening is now available at:
GP practices and primary care – NHS Cervical Screening Administration Service
Breast Screening Programme
In the case of the NHS breast screening programme, patients registered as male will not receive an invitation for mammographic screening; however, patients can discuss their risks, and the need for a direct referral for mammography, with their GP.
Abdominal Aortic Aneurysm (AAA) Screening
AAA is far more common amongst males over 65 than in females and younger men, and so the screening programme only invites those patients registered as male at birth who will have this risk. Patients only have one screening ultrasound, subsequent investigations depend on risk either at screening or in any subsequent clinical assessment.
Patients who are registered as female with a GP but who were assigned male at birth can contact their local AAA screening service to request a screening invitation at:
Find abdominal aortic aneurysm screening services – NHS
or their GP can do so on their behalf.
Bowel Cancer Screening Service
This is offered to both men and women routinely and without any differences in the programme parameters and so any patient registered as such will automatically be invited. The invitation occurs every two years and whilst currently the screened ages are between 60 -74, this is gradually being reduced to 50. Any patient aged 75 or over can request a test kit every two years by calling the free programme helpline on 0800 707 6060.