Young people described their experiences with doctors and staff at GP surgeries. They also described the relationships they had with their GP and the positive models of care that they valued. You can read more about GP’s knowledge of trans healthcare here.
Our participants described the following:
- Positive models of care
- Experiences with nurses and staff
- Changing names and GP systems
- Cultivating positive relationships
- Feeling valued and heard
Positive models of care in GP surgeries
Young people highlighted the positive experiences that had made a difference to them at GP surgeries. These included things such as the GP surgery making their support for trans patients visible and obvious with dedicated support staff and information readily available. Patrick talked about how his GP practice had allocated ‘a gender champion’. Their role is ‘checking in with the openly trans patients on their registry and making sure that we’re getting the support that we need and whether we’re being seen by the gender services’. He said it ‘was really affirming that actually my GP practice is putting stuff in place to support their trans service users.’ Jack said the staff at his practice ‘have been respectful and they have said, “honestly I’m not sure, how shall I refer to you? What do you want me to say? Is there anything I can do to make you feel more comfortable?’ that kind of stuff.’
At the same time, participants described areas for improvement. Some wanted to see more trans healthcare information in their GP surgeries. Ezio would like to see ‘more stuff in GP waiting rooms’. He said ‘there’s loads of stuff about, [getting your] prostate checked, cancer screenings and stuff but,I didn’t see a single thing about being trans, it’s not advertised’. He added ‘you’re not gonna know a lot about it unless you research it yourself’. Jack said his GP practice has ‘a little poster’ for a ‘trans helpline hanging up in the GP surgery’.
Bay talks about the administration systems at their GP practice and how it impacts their experience.
H talks about his ‘excellent’ and ‘clued up’ current GP service and a previous GP where ‘I had to give him all the information’
Experiences with nurses
A few participants talked about their experiences with nurses at their GP practice. Alistair said ‘one of the nurses that I’ve seen that has been administering my injections have been really nice and really friendly and respectful.’ H shared that originally when he asked his GP surgery to help administer the injections the staff said ‘No I can’t do it cos I’m not trained in this.’ He said ‘I had to speak to the practice manager and pester her and then finally a nurse came forward and said she’d done a similar injection before, she knows what to do so she’s happy to do that.’
Bay talks about making a smear test appointment with their GP reception and the difficulties with this.
Rahul talks about his experience with a nurse who claimed that people could not be allowed to do [testosterone injections] themselves.
Jack talks about a really fantastic’ nurse who was considerate with names and pronouns and tried to learn more.
Changing names and GP systems
Changing names at the GP practice was an important part of our young people’s transition. Our participants described how they went about this with their GP surgery. Some found it an easy process. Ari said their GP has ‘been fantastic. He’s helped me change my gender marker in the NHS system.’ They said ‘I made an offhand comment about it being frustrating that I was still marked as female in the NHS system and he suggested the solution to that, there was the marking as F or M, [there’s] N for non-determined [which Ari went for], there’s [also] I for Indeterminate.’ Ari was grateful their GP asked what would suit them and then put that into place immediately.
Jack talks about his experience of changing his name on the system with his GP surgery.
Beth talks about having an Mx title on their GP surgery’s admin system it’s a nice thing to see.
Others described having difficulty getting the GP practice to change their names and pronouns on the admin systems. Jay said,’The first appointment with my doctor, she changed my name and my title in the system. But every time I go back to the GP they had changed my title to Mx without asking me. I’ve handed in my Deed Poll which clearly has Mr on it and every time they keep changing it and I don’t understand why.. they keep just giving me gender-neutral pronouns because I guess they’ve decided that that’s what I should have.’
Sophie said, ‘I haven’t been able to legally change my name on the forms, but they have put a note saying [preferred name]’. She talked about a time where she occasionally had to use her dead name when she introduces herself to receptionists which she finds ‘demeaning’. Declan said, ‘I got a letter from the Tavistock telling everyone to change my gender and everything.’ He said ‘we had to fight with the GP to change my name on their system and my gender, that was quite a struggle. I would have to come out every time I went to see the GP to begin with.’
Safia talks about not being able to have Mx as a title and the impact this has on them.
Alistair describes his worst experience with the NHS’ having his dead name come up on the admin system was really embarrassing.
The trans and gender diverse young people we spoke talked about the positive difference it made when GPs and staff at the practice used the correct names and pronouns. A talked about mentioning their gender identity to the GP surgery and then visiting their regular GP and ‘as soon as I went in, I think the first thing she asked me was, ‘if I’ve, preferred a different name or something?’ which was yeah really lovely.’ Theo said his GP was ‘really understanding. He said, ‘Is there another name you want me to call you by and what pronouns do you use?’ He was probably one of the best GPs I’ve ever had.’
In contrast, some of the young people described their uncomfortable and upsetting experiences being misgendered by staff at their GP practice. June said, ‘All the medical receptionists would always misgender me and the GP would often misgender me.’ Jacob spoke about visiting the GP surgery and having to ‘book in [with] my dead name.’ So [the GP] welcomed me with my dead name and then I had to explain, Actually, thats not my name any more, it was rough [and] difficult for me to explain.’ Cassie said her GP surgery ‘took me at face value when I told them I was trans and despite [getting] the pronouns [and] the title wrong for a little bit, they have been responsive when I have pressured them in terms of name changes’.
Theo talks about the problems with misgendering by receptions and staff and his GP surgery.
Reuben describes his experience being misgendered by his GP [it] was a pretty horrible experience.
Cultivating positive relationships
Young people had many examples of positive as well as negative experiences with their GP. Our interviewees appreciated it when GPs didn’t make a big deal out of their trans identity. Loges said his GP is ‘really good, she doesn’t speak to me like I’m different she just speaks to me like any other patient and she’s really good with it.’ H said, ‘The GP service that I have here is absolutely brilliant,.the way that they treat me, I actually feel like a person’. He said, ‘they ask me about my life, how are things? What’s going on with my transition now?
Shash says that finding a good GP is one of the hardest things.
Erion says that trans patients should know their rights about what they can expect from a GP.
N talks about how they have never come out to a GP’ and explains their reasons why.
Our young people also appreciated clear and direct communication and efficient responses to queries. Cas said his GP was ‘really sweet.’ and said things like ‘yes okay, we understand, this has happened before, do not worry we will refer you, we will get this sorted.’ Tyra remembered ‘an appointment with this [GP] and he was just so kind and understanding, and friendly, and he did his research’. She said ‘when I was speaking about the issues that I was having like with my identity, he actually took time to go and research other alternatives and organisations that could be useful’.
Bailey said his GP acted as an advocate for them and made the effort to follow up: ‘he does whatever he can to sort things out and make things faster and all that. He chases things up a lot.’ One young person would have liked different forms of support from their GP. Alistair felt that it would have been useful if his GP ‘[had] given me a lot more support with like resources, local groups,[and] pointed me in the direction of websites’.
CJ said I had the incredible privilege of having a GP who was smart and actively cared.
Ari talks about the positive relationship they have with their GP he always takes me as the expert in what’s going on in my own body.
Feeling valued and heard
An important part of our young people’s experiences with GPs was not feeling valued or heard in healthcare settings. Patrick talked about ‘being shut down the first time I went to my GP and just them being like ‘No that’s not gonna happen, We can’t do that’,they were so dismissive’. He felt ‘I don’t know how to argue with this if you’re just telling me that categorically no it can’t happen. How am I meant to challenge this? A 15 year old like person who’s newly come out who’s so uncomfortable with my own like self. It was really disheartening to be so like categorically shot down.’
Some of the people we interviewed felt it was necessary for others to advocate for their healthcare needs on their behalf because of feeling intimidated by the setting. This was often a family member or a friend. Cas talked about visiting health professionals with his mum ‘she did basically all of the talking. I was terrified,I didnt know what to say or do,it was quite intimidating.’
People spoke about how language (such as medical language) could be a barrier. N felt that ‘there’s the need for self-advocacy within a public healthcare system,many of the resources that exist where you [can] find information that’s useful are written in medicalised or university level language.’ They added ‘self-advocacy is not a neutral skill. It is something you learn through having access to resources’.
Bee says even though the are confident in their healthcare needs I still find that it can be really intimidating’ with doctors.
June talks about bringing along his smart talking’ partner who acted as his advocate with his GP who completely changed her tune.
Henry says its exhausting’ always having to assert your own power in order to get the support that you need.