Gender Plus Hormone Clinic Also known as Gender Plus Healthcare Limited

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Leaders and staff proactively sought ways to address barriers to improve people’s experience, acted on information and created opportunities to achieve equity. They provided a service which offered choice, flexibility and continuity of care. The staff empowered patients and their families to give their views and ensured they were listened to.

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

During our onsite assessment, we spoke with patients who all told us they had been involved in their treatment and decision making. Patients and their families where overwhelmingly positive about the care they had received, felt the staff really got to know them and understand their preferences. A parent told us their child had autism and the nurse “thoughtfully and carefully provided additional communication channels for them”.

The clinic was designed to meet the needs of patients who were at the centre of their treatment choices. They ensured patients had the most appropriate treatment for them and made reasonable adjustments where necessary. After a consultation, patients were able to take time to consider all their options before deciding on any treatment. The nurse took an integrated approach to treatment and ensured patients had relevant information about healthy living including smoking cessation and exercise, and sexual safety and function to support the treatment provided. The nurse ensured all patients were fully informed about the effects of the treatment on fertility and signposted patients to services for further information where required.

We observed 3 consultations and at numerous times the nurse consultant checked the patient’s reasons for wanting the treatment, their understanding of the treatment and what they were wanting to achieve. They checked the patient’s knowledge first before giving them the answers to ensure they were fully understanding of the process. It was a very person-centred approach.

There were reasonable adjustments made so that patients with a disability could access and use services on an equal basis to others. There was ground floor access for wheelchair users and the provider supplied items, such as fidget toys and drawing equipment for service users. The provider had access to the creation of large font leaflets, online information and language line.

Patients and their families told us their care was well co-ordinated and everyone worked well together and with them. They felt in control of planning their own care and support. They told us they could contact the clinic if they needed further support, and this would be provided at no extra cost. One patient told us “Everything feels very joined up and focussed on the goal of delivering the best and safest outcome for me”.

The service worked well to understand the needs of patients, their families, and their local communities. They ensured care was joined-up, flexible and supported choice and continuity. Patients were transferred between 2 integrated services, GPHC and Gender Plus, and this meant they had continuity of care when moving from a psychological service to the endocrine service.

Partners told us there was continuity of care. We spoke with Clinical psychologists who worked at Gender Plus and referred patients to the GPHC. Patients remained under their care whilst at GPHC to ensure their psychosocial needs were also met. For example, we were told they had assessed a young person who struggled with change and took a long time for them to open up and trust clinicians. After they were referred to the GPHC, they asked for psychosocial appointments to continue; they were able to offer this, and it was included in the cost for the patient.

The leaders understood the needs of the transgender community and worked hard to ensure the service provided a high standard of care. The leaders were setting up a charity which would partially or fully fund eligible patients who were unable to afford the service; this was in the process of being set up at the time of assessment.

Patients told us they were given information in different formats, both written and verbal. They were given the time to take the information away, read it, digest it and ask about anything they were unsure about.

Staff ensured patients who used the service were provided with information that was accessible and supported their choices. Information was tailored to the individual need. Patient identifiable information was protected. The nurse had created information videos for patients which detailed risks and treatment options. There was a video within the waiting room which displayed information about the staff, service, feedback and changes that had been made and treatment options.

Information needed to deliver effective care and treatment was available to relevant staff in a timely and accessible way. The service used an online system for records. Staff were aware of how to use and store confidential information. There was an accessible information standard policy in place. All staff had to complete information governance training; all staff had completed this. Managers audited patient notes on a quarterly basis. We reviewed the audits for May and August 2024. There were minor issues with data entry but compliance with documentation standards was good. There was an action plan for each audit and clear recommendations for improvements.

Patients we spoke to felt listened to and felt involved in their care. They were in control of planning their care and support. One patient told us “I felt that the team all worked very well and had my best interests at heart and really wanted to help me. They listened to what I needed and made me feel very reassured and informed.” They were encouraged to feedback about their care and were assured that it would be acted on.

It was easy for patients and their families to share feedback and ideas or raise complaints about their care, treatment or support. Patients knew how to give feedback about their experiences. They felt confident that if they complained, they would be taken seriously and listened to. Staff could give examples of how they used patient feedback to improve daily practice. There was a feedback survey, and patients were encouraged to fill this in. In September 2024, the clinic evaluated the previous 6 months questionnaires. Where patients made suggestions for improvements, the clinic did this. They created “you said, we did” changes following the feedback from patients. For example, a patient with neurodiversity told them their pathway was difficult for them to navigate so they created a step-by-step infographic to simplify the approach

We saw discussions were had about patient experience in the team meetings. For example, in August 2024, the nurse discussed that parents found the prescription process confusing and would like to know prior to the first appointment what might happen. An action was created for the nurse to do a video explaining this.

The service had a clear policy for complaints management and staff followed this. There was a bi-weekly team meeting where complaints were discussed, and this was a standing agenda item. However, there had been no formal complaints within the last 8 months since the clinic opened. There was a process whereby an independent manager investigated any formal complaints as the service recognised, they only had 1 clinician and needed the ensure the complaint process was robust. The service had received some informal verbal feedback about availability of appointments; there had been an increase in appointment times offered. The service had a second nurse starting in October 2024 which would mean further appointments would be available.

Patients we spoke with felt there was limited appointment availability due to there being only 1 nurse and had to travel far for their appointments. A few patients said it would be helpful to have other clinics across the country but despite this, they were all happy to travel for the service provided. Patients told us they were mostly able to access appointments quickly and could always speak to a clinician when needed. They were offered face-to-face and virtual appointments which improved the accessibility.

Patients were able to access the service when they needed it and received the right care in line with national standards. Patients could only access the service once they had been discussed in an MDT meeting and it was agreed by all professionals present that they were suitable for treatment. We listened to an MDT and found staff had detailed, holistic discussions about each patient and allowed professional questioning. For example, they discussed patients self-esteem, parental support, mental health, physical health, risk assessments including neurodiversity and social environment. It enabled the nurse consultant to understand the patients’ needs prior to accepting them into the service and ensure it was appropriate. The service was open Monday to Friday between 9am and 5pm, and there was usually 1 face-to-face clinic per week. Virtual appointments for reviews and psychosocial or mental health support were readily available. Staff told us numbers of patients were increasing and they would increase the number of appointments available as needed. Psychosocial reviews were costed into the pathway meaning gender-related therapy was available at any point throughout the service at no extra cost. This meant patients were aware of all the costs up front with no extra charges if further support is required.

Staff from Gender Plus told us they could easily refer a patient into the GPHC and an MDT meeting would be held promptly about their suitability and agreed as a team for them to progress into the GPHC.

The staff worked to try and ensure they had a good link with the NHS to enable better access of treatment to patients. The nurse consultant had started the process with NHSE to set up a pathway for patients to be referred seamlessly back into the NHS once they had completed their 2-year pathway at the hormone clinic. The service accepted transferred care patients. They were offered a lower subscription rate as they would not need to use the 2-year pathway if they had already been taking hormones.

Patients and their families felt empowered by providers and staff to give their views and understand their rights, including their rights to equality and their human rights. Patients told us they “felt listened to for the first time” and “staff really understood them”.

The service were looking at reducing health inequalities where possible. They they had, alongside 3rd party sector stakeholders, started the process of establishing a subsidised pathway for patient treatment. They recognised there were patients waiting a long time in the NHS for gender affirming services and wanted to be able to provide an affordable option for those who could not afford the monthly GPHC subscription charge. The service was contributing to research and had started to collect data to look at long term outcomes for patients undergoing hormone treatment. All patients were asked for their consent to contribute to the research. They wanted to be on of the first UK based gender services to publish research on the long-term outcomes of hormone therapy for adolescents.

All patients had a 6-month review whilst on treatment and had reviews in between if required. Patient outcomes were measured through questionnaires and how they were functioning in society.

Patients and their families we spoke to were supported to plan for important changes in their life and could anticipate these changes. Patients told us that staff went through in detail the changes that would happen when they underwent hormone therapy. Patients all felt fully informed about their future and how it would look for them. They told us “Expectations were expertly managed alongside all risks and long-term impacts on future fertility”. One patient told us their expectations were well managed and were aware they would see a slow transition once they had started their hormones. We listened to a consultation where the nurse consultant was actively encouraging the patient to find a GP who would want to pursue shared care as it would be easier to transfer their care back into the NHS when they were ready to.

Staff worked well together as an effective MDT throughout the patient journey from the initial enquiry to the assessment and throughout the patient’s pathway to plan for the patients futures. There was input from pharmacists, psychologists, endocrinologists, nurse specialists including a mental health nurse, to ensure patients were fully supported in their gender affirming care in line with national guidance.

Patients were supported to make informed choices about their care and plan for the future. Patients all had personalised care and treatment plans to suit their needs.