Facilitating a referral

If you have any questions on how to make a referral, contact agem.cyp-gnrss@nhs.net or call 01522 857799 with any queries

Please do not contact The Tavistock and Portman NHS Foundation Trust or the new providers for any queries about previous or new referrals

Who to refer?
Children and young people up to and including 16 years of age with features of gender incongruence as described in NHS England’s service specification can be referred into this service by the appropriate professionals. Self-referrals cannot be accepted under any circumstances

For young people aged 17 and older, you may wish to consider whether a referral into an Adult Gender Dysphoria Clinic is appropriate. The adult service accepts referrals from 17 years of age, though waiting times into the adult service are also currently long. Anyone who wants to transfer their referral to adult services will have their original referral date honoured. Referrals to an adult clinic should be made directly to the relevant provider

Advice for referrers (not suitable for Primary Care}
Please carefully consider the appropriateness of a referral using the guidance below and on the form before making a referral. Not everyone who identifies with a gender other than their natal sex, or whose gender expression is different from what others might expect of them, will need to be seen by a gender specialist

There is a high demand for these specialist services and long waiting times for a first appointment

Referring professionals must discuss the referral with the family / carer of the child / young person to provide detailed referral information and seek their agreement

Clinical responsibility remains with the referrer and the local professional network until the patient is seen by Children and Young People’s Gender Incongruence Services

Advice on completing the form
The referral form requests details about different aspects of the child or young person’s life. Referrers should provide as much information as possible at the earliest opportunity. The most common reasons for requesting further information from the referrer are:

• Clarifying what the young person/family is seeking from Children and Young People’s Gender Incongruence Services
• Understanding detailed gender history: when incongruence was first noticed, how it has been responded to, any social transition (e.g., changes in pronouns, name, appearance), length of time living in role, etc.
• Ensuring appropriate family/carer/guardian consent
• Identifying which other services, and who from those services are also involved
• Clarifying family and developmental history
• Understanding who will be providing input with this young person and family while they wait to be seen by Children and Young People’s Gender Incongruence Services (e.g., care plan)
• Risk has been identified without a care plan
• Risk is unclear

To help us deal efficiently and effectively with referrals, the following referrals will not be accepted:

• Primary Care referrals
• Hand-written referrals
• Referrals made without use of the referral form
• With referrals for under 16s where parental consent is not present it is advisable that clinicians explore with the young person the reasons as to why they do not wish their parents/guardian to be involved in the referral to a specialist service. They should try to build a therapeutic relationship with the young person to explore this. It is important that young people have adult support for a referral to a gender incongruence service and to attend any future appointments. As with any other referral to a clinical service, when the patient is under the legal age of presumed capacity to consent, if they still want to go ahead without their parents’ or carers’ knowledge or consent, GPs and clinicians are advised to consider the Gillick and Fraser guidelines
• The following information looks at how this can be applied in practice
• Referrals where it has been indicated the young person is the only person to be contacted, but the contact provided is the parent’s/carer’s postal address
• Self-referrals from young people or families

Referrers may find the referral form itself a useful resource, when considering how to approach your conversations with children and young people about their gender

Risk and safety
Children and young people experiencing gender incongruence or gender dysphoria are a vulnerable group and may experience a higher incidence of co-occurring mental health issues. It is important to be aware that at present there are long waiting times for Children and Young People’s Gender Incongruence Services, and young people may require additional support with gender distress and other issues during the wait. It is strongly recommended that plans are drawn up by the referrer and local professional network to ensure the needs of the young person are being met in the interim

Children, young people and their families are strongly discouraged from sourcing puberty suppressing or gender affirming hormones from unregulated sources or from on-line providers that are not regulated by UK regulatory bodies. In such cases, GPs and local health professionals are advised to consider what safeguarding protocols may be appropriate for the individual child or young person’s wider circumstances including the extent to which the parents / carers are able to protect or safeguard the child or young person. Safeguarding procedures may be necessary regardless of the endeavours and best intentions of the parents / carers in reducing risk of harm. Safeguarding protocols should be initiated immediately where the child or young person is at risk of immediate, serious harm. It would also be important for the GP or local health professional to explore what regulatory bodies may need to be informed if healthcare professionals registered with a UK professional body are prescribing medication contrary to NHS protocols

The referral form and risk assessment form for appropriate professionals (not Primary Care)
Please save a local copy of the referral form before completing. You can save this form and come back to it later to complete if you need to gather further information.

For all referrals, please also complete the separate risk assessment form and send both to the above email address.

Download the referral form (DOCX format, 138Kb)

Download the risk assessment form (DOCX format, 120Kb)

Further guidance for healthcare professionals

• RCGP: Transgender Care
• RCPsych: Supporting transgender and gender-diverse people
• BPS: Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity
• NSPCC: Gender identity; Advice to help you understand what gender identity is and how to support a child
• MindEd: Catalogue of resources.