Essential Level

Domain 1 - About People 

1.1 Gender identity can be expressed and described in different ways.

Gender identity describes a person's deeply held sense of their own gender, be it female, male or non-binary or something else.

For most people it matches their sex recorded at birth. For trans people their identity does not match their sex recorded at birth and this is known as gender incongruence.

Treat and compassionately respond to everyone with respect and dignity.

Reflect on their values and beliefs and how this may influence their behaviour, actions and words.

1.3 Trans people may avoid seeking care because of experienced stigma and / or fears about possible prejudice and discrimination. 

Some trans people may experience poorer health outcomes because of inequality, access and socio-economic status.

Recognise and respond to situations where someone’s rights associated with their protected characteristics may be affected or they are at risk of poorer health outcomes.

Seek the person’s consent and agreement in all situations when disclosing gender identity.

Only ask questions that are directly relevant to someone's care.

Explain the rationale before asking personal questions about transition or where it may appear unconnected to providing someone's care.

Use gender-neutral language where appropriate.

Have confidence in rectifying situations where mistakes are made with names, gender or pronouns.

Know how to use a range of common pronouns including gender-neutral pronouns.

Confidently ask someone which name and pronouns they go by.

3.1 Understand how stigma can lead to negative effects on mental health and emotional wellbeing.

Understand the positive and protective impact of a welcoming and inclusive approach to someone.

3.2 Know the signs of discomfort, anxiety or distress and ways to respond.

Appreciate that trans people may be at higher risk of negative effects from distress, which may include self-harm and suicide.

4.1 Gender incongruence is not a mental health condition.

Trans people should access mainstream healthcare services for conditions unrelated to their gender identity.

Where trans people experience suboptimal health, they may experience greater distress.

Ensure that trans people are appropriately signposted or referred to relevant gender-identity services where this relates to their gender incongruence.

Refer someone to mainstream services for conditions unrelated to gender identity.

Where staff scope of practice involves safety planning for someone who is experiencing elevated levels of distress, consider all relevant factors when assessing risk.

4.2 Recognise situations relevant to own clinical area where it may be important to be aware of a person’s anatomy or hormone treatment, and that this or their trans status may not be apparent from their medical records.

(Applies where staff are working in a clinical role)

Undertake assessments related to these situations that ensure safe clinical decision making.

Explain why this information is needed and ask about it in a sensitive manner.

Apply this information appropriately to the care delivered.

4.3 Understand that laboratory results and other tests might be different for trans people as male and female reference ranges can differ and these may be dependent on the person's anatomy and transition-related treatment.

Appreciate critical situations where results for trans people require additional interpretation (for example, blood transfusion O+, troponin).

(Applies only if this is within staff scope of practice)

Recognise situations where results may need further interpretation and seek advice where needed.

Discuss with the person including the possible impact of results from key population calculators (for example QRISK or ASSIGN where relevant.

4.5 Know about local, national and regulatory guidance and understand clinical circumstances for prescribing hormone and related treatment for trans people.

(Applies only if this is within staff scope of practice)

Can provide continuity for endocrine and related treatments by prescribing where this has been recommended by an NHS clinician (within prescriber competence). This could also be on a harm-reduction basis.

Seek specialist support where needed and can act on that advice.

Arrange local investigations, taking account of specialist advice or other local or national guidance, and can act appropriately on those results.

4.6 Consider the relevance of disclosing a person's gender identity when making a referral to another service.

Are aware of the importance of respecting confidentiality around someone’s gender identity, including relevant legal requirements.

Identify situations where it may be clinically helpful to disclose gender identity when making a referral.

Seek the person’s consent and agreement in all situations when disclosing gender identity.

Where someone is unwilling to disclose their gender identity, consider whether this is clinically critical information, and if so seek appropriate support and legal advice.