Transgender healthcare is a highly specialised area of clinical practice. Initiation, prescribing, and ongoing monitoring of treatment should only be undertaken by clinicians with the appropriate expertise, training, and experience.
The General Medical Council (GMC) requires that doctors must work within the limits of their competence. This applies equally to prescribing and the interpretation of investigations and monitoring results. Clinicians must have sufficient knowledge to safely manage treatment, including understanding the implications of test results and when to act on them.
NHS England is clear that the clinician who signs a prescription carries full clinical and legal responsibility. This responsibility extends to ensuring appropriate monitoring is in place and acted upon safely.
In a recorded response on 3 September 2025, Stephen Kinnock confirmed that GPs are fully entitled to decline shared care arrangements on the basis of clinical judgement or capacity. There is no contractual obligation for GPs to participate.
Key Principles for Practice
- GPs are not obliged to prescribe medications recommended by specialist or external providers.
- GPs are not obliged to undertake or act on monitoring (e.g. blood tests) where they do not have the competence to interpret results or manage the treatment safely.
- Monitoring is an integral part of treatment and should remain the responsibility of the initiating specialist service unless a formal, agreed shared care arrangement is in place.
- GPs should decline both prescribing and monitoring where they do not feel competent, confident, or adequately supported.
- Any involvement in prescribing or monitoring carries full personal clinical and legal accountability.
- Pressure from patients or external providers must not override clinical judgement or professional standards.
- Practices may also decline on the basis of capacity, workload, or safety concerns.
Position Statement
GPs should feel confident and supported in saying no to requests for prescribing and/or monitoring in transgender care where they lack the required expertise or where safe shared care arrangements are not in place.
Accepting responsibility for monitoring without the necessary expertise places both the patient and the clinician at risk. Declining in these circumstances is appropriate, justified, and fully aligned with GMC guidance, and supports safe, high-quality care.
TEMPLATES FOR PRACTICE TO USE
Template 1
Thank you for your request regarding prescribing and/or monitoring for this patient’s transgender care.
After careful consideration, I do not feel that I have the appropriate specialist knowledge or experience to safely prescribe or interpret the required monitoring for this treatment. In line with General Medical Council guidance, I must work within the limits of my competence and ensure patient safety.
As prescribing and monitoring are integral parts of a single treatment pathway, these responsibilities should remain with the initiating specialist service unless a formal shared care agreement is in place and I am confident to participate.
I am therefore unable to take on prescribing or monitoring in this case. I would be happy to continue providing general medical care and support the patient in accessing appropriate specialist services.
Template 2
I have reviewed the request for prescribing and/or monitoring in relation to this patient’s transgender care.
This is a specialised area of practice, and I do not have the necessary expertise to safely prescribe or interpret the associated monitoring. The General Medical Council is clear that doctors must practise within their competence, and the responsibility for prescribing and monitoring cannot be separated.
I am not contractually obliged to enter into shared care arrangements and, on clinical and capacity grounds, I am declining this request.
Ongoing prescribing and monitoring should remain the responsibility of the specialist service. I will continue to provide all appropriate general medical care.
Short EMIS/System Note Version
Writing
Declined request for prescribing/monitoring related to transgender care. This is a specialist area and I do not feel competent to prescribe or interpret monitoring safely. In line with GMC guidance, prescribing and monitoring should remain with the specialist service. Will continue routine GP care.
Any further questions, please dont hesitate to contact the LMC office.