Leaked NHS guidelines on trans healthcare suggest GPs should avoid shared care agreements with private clinics for trans youth.

Details regarding NHS guidance on shared care agreements between private clinics and GPs were shared by Good Law Project Jo Maugham on Thursday (10 April).

The newly updated guidance, key points of which were shared by Maugham in the thread, advises GPs on how to manage shared care agreements with “non NHS-commissioned” gender clinics which provide care to trans adolescents.

A shared care agreement is a formal agreement between a patient, a GP, and a private or NHS specialist clinic which enables GPs to prescribe medication under advice from experts.

The new policy clearly stated that GPs “must refuse” to support shared care agreements and private prescriptions of gender-affirming medication for trans under-18s, including physically reversible puberty blockers, which are currently banned in England.

In a footnote on the report, which Maugham shared in a screenshot, the guidance states that while the advice does “not extend” to adult patients, “unregulated healthcare services pose a potential risk to patient safety across all ranges.”

“NHS England will address the management of adults who source medications outside of the NHS-commissioned gender dysphoria service, including the management of those who are using atypical levels of medications, within its current work to establish a clinical commissioning policy for exogenous hormones in 2025/26,” it continues.

The leaked guidance comes as several GPs across the country have, without prior warning, refused to oversee the use of hormones by trans patients of all ages through shared care agreements. In England, shared care agreements are essentially the only way that Gender Identity Clinics (GICs) can prescribe hormones.

Several GPs across Sheffield, the East Midlands, and the North have argued that the practice is “outside of our expertise,” leaving many patients unable to access gender affirming care without resorting to “DIY” methods.

Several patients affected by these decisions have told PinkNews they are “terrified of the implications and have considered self-medicating if nothing is done to reverse the decision.

Wes Streeting stands by puberty blockers ban despite apology

The guidance appears to be a recommitment by the NHS and the Department of Health to enforce a ban on private puberty blocker prescriptions, despite health secretary Wes Streeting claiming earlier this week he was “sorry” for the “anxiety” it has caused.

The Ilford North MP, who claimed during last summer’s election campaign that he no longer stands by the statement that ‘trans women are women’ said he was “genuinely sorry” for the “fear and anxiety” that the Labour Government had caused by extending a Conservative government’s ban on the medication.

In December 2024, the Health Department announced an indefinite extension of the ban after it was introduced by Conservative health secretary Victoria Atkins.

In a statement, the government claimed that an “unacceptable safety risk” was behind the decision, despite there being numerous studies that not only prove risks are negligible, but that puberty blockers can be “life-saving.“

During a Wednesday (9 April) Health Service conference, Streeting said his decision was “solely about the clinical advice” he had been provided, excusing the decision by arguing he did “what I think any health secretary would do.”

“I am very conscious that for lots of people, not just in the trans community, but across the LGBT community – in fact, across wide society – there is a real anxiety about the decision that I took,” he said. “I know people disagree with that decision. I know it’s caused real fear and anxiety in our community, and that certainly doesn’t sit easy with me.”

Streeting previously told a member of the public who challenged him over the puberty blockers ban and other rollbacks of trans rights to “get a grip“.

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