Expert Level (Adult Services)
Expert Level
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Difference between enhanced and expert levels We expect that all clinical staff who oversee gender identity healthcare are likely to be working at or towards the enchanced level. Staff are working at the expert level will be providing similar care, but in situations where there may be greater complexity. |
| What staff know (knowledge) |
| What staff are able to do (skills) |
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Domain 16 - Complex Assessment |
| 16.1 Have an understanding of multiple or significant comorbidities where these relate to someone’s decision to access treatment or achieve their expected outcomes. |
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Undertake a history where there is uncertainty or complexity that someone relates to their gender identity. Take a more complex history and facilitate discussion where someone’s decision to access treatment may be affected by significant comorbidities or concerns. |
| 16.2 Understand formulation as a joint effort to explore someone’s challenges, explaining why they may be happening and to be able to make sense of these. |
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Work with someone where there is complexity to help them formulate their situation and explore their options, including readiness to access treatments under the gender protocol. Offer someone a way to take ownership and responsibility for aspects of their care provision. |
| 16.3 Understand the benefits and principles of individual and group clinical supervision. |
| Offer clinical supervision to other colleagues at an enhanced level. |
| 16.4 Awareness of the skill composition of the multi-disciplinary team (MDT), its strengths and limitations, and sources of further clinical support |
| Engage with members of the local and broader MDT to seek specialist advice as needed and can share this and its implications with someone. |
| 16.5 Understand practical and legal issues regarding someone’s capacity. |
| Identify situations where there may need to be further assessment regarding capacity and provide or arrange provision of this. |
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Domain 17 - Surgery |
| 17.1 Have a detailed understanding of the procedure including its risks and benefits and the possible effect on someone’s gender dysphoria. |
| Lead a meaningful and individualised discussion, helping inform someone about the risks and benefits of the proposed procedure. |
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17.2 Understand the practical perspectives around the proposed procedures, need for care/support afterwards, and the importance of good recovery. Know about specific requirements, e.g., life-long dilation and lifespan of implants which require replacement. |
| Discuss the practical aspects surrounding the procedure, including postoperative support, longer term aftercare and potential travel implications such as expenses and logistics. |
| 17.3 Awareness of relevant sources of information and support that can influence someone’s decision, and understand the importance of them having an opportunity to reflect on these. |
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Help someone reflectively explore the proposed procedure and signpost to other sources of information that may be helpful. Include others where someone identifies this as significant, e.g., partners and people in their support network. |
| 17.4 Understand the effects of surgery on fertility and options that may be available. |
| Discuss the impact of the proposed procedure on someone’s fertility and help them explore available options. |
| 17.5 Appreciate the need for a comprehensive formulation linking someone’s needs and experiences to the proposed procedure and for this to be presented in the context of their individual situation to help inform a meaningful and collaborative discussion to support their decision making. |
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Facilitate a discussion that supports robust, informed and shared decision making by bringing together information from the assessment including someone’s:
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| 17.6 Know about referral pathways and any options regarding surgical providers. |
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Can support someone to explore any choices around surgical providers, and identify and initiate referrals. Identify situations where further assessments may be necessary and arrange these. |
Expert Level