NHS England proposed Service for Children and Young People with Gender Incongruence: Referral Pathway - consultation response

In January 2024, NHS England (NHSE) published a public consultation on proposals for the referral process for children and young people experiencing gender incongruence, including who can make the initial referral, specifics around both upper and lower age limits for referrals, the process for transition for adult services and expectations placed on paediatricians.

Our response

In March 2024, RCPCH responded to the NHSE consultation, highlighting where further guidance is needed and concerns about children who are below the age of 7 and over the age of 17 and the importance of high quality care for this group of children and young people.

Our summary

  • RCPCH accepts a recommendation that paediatricians and mental health practitioners can make referrals into the Gender Identity Service (GIS), but highlights a need for further guidance to be provided to paediatricians both on the referral process and in supporting children and young people in distress while on the waiting list.
  • We raise concerns about the decision to exclude children under 7 years from the referral criteria, with regard for the evidence basis for this cut-off point and also the lack of alternative support for families of young children who are experiencing gender dysphoria.
  • We highlight the importance of ensuring continuity of care for 17-year-olds, and seek clarity as to the proposed pathway for this group, and concerns around the proposal for young people not to be transferred to the adult waiting list automatically.
  • Our response highlights concerns with proposals surrounding the pre-referral consultation service. We highlight the importance of ensuring clinical decisions made by paediatricians and mental health practitioners referring a child or young person to GIS are followed.
  • We suggest that the Equality and Health Inequalities Impact Assessment does not adequately address our concerns about healthcare for children below 7 and aged 17.

Download and read the response in full below.

We respond to a wide range of consultations to ensure that the College’s position, and ultimately children’s health, is represented. Members can get involved in current consultations by contacting the Health Policy team at health.policy@rcpch.ac.uk.