Framework Introduction
Please note that we use trans people as an umbrella term for people whose gender identity does not fully correspond with their sex recorded at birth. This includes, but is not limited to, trans men, trans women and non-binary people.
Purpose of the Framework
This Framework sets out the knowledge and skills required by healthcare staff providing care for trans people. It works alongside other standards and frameworks, such as the NHS Knowledge and Skills Framework, the Healthcare Improvement Scotland Standards for Gender Identity Services and the National Gender Identity Healthcare Protocol (replacing the Gender Reassignment Protocol).
The Transgender Framework:
- sets out the knowledge and skills needed by all NHS Scotland staff;
- is future-focused, meaning it is not just a description of what we do now, but aspires to improve the experience and deliver better outcomes for trans people receiving care as outlined in the NHS Scotland Gender Identity Healthcare Protocol
- builds on existing frameworks that place the person at the centre of their care; and
- may be relevant for all staff in other sectors, such as social care and the independent sector.
Principles and Evidence
The Framework is informed by values and principles that reflect what trans people have said are most important to them and places a strong emphasis on needs-led and person-centred care.
The Framework was developed within a broad strategic context including Realistic Medicine and the human rights-based approach of the National Health and Wellbeing Outcomes Framework. Its development was informed by a number of activities including:
- evidence, best practice guidance and literature reviews;
- reviews of existing competency frameworks;
- engagement with a wide range of stakeholders including people with lived experience and subject-matter experts;
- links with wider UK transgender programmes.
How the Framework is organised, and recommendations for how it should be used
Levels of Knowledge and Skills
The four levels of the Framework are:
- essential - knowledge and skills that everyone needs
- skilled - for staff who have significant or regular contact with trans people
- enhanced - for staff providing specialist gender identity healthcare to trans people
- expert - for staff providing complex specialist gender identity healthcare to trans people.
Recent studies highlight the importance of supporting staff to develop knowledge and confidence in providing care to trans people. This Framework assumes that the more contact staff have with trans people, the more their need for education and training to support them effectively.
To support this, the Framework is structured in levels. Knowledge and skills are cumulative; meaning that someone at a higher level is also expected to have the knowledge and skills defined at previous levels. As all staff are likely to be involved in delivering care for trans people, we have considered our starting level to be “essential”. Those having more contact with trans people may wish to consider some of the elements of the “skilled” level where this falls within their scope of practice.
The two higher levels “enhanced” and “expert” apply to staff working in or attached to specialist gender identity services. We have deliberately avoided suggesting job roles as differentials between levels as they relate to the knowledge and skills of the clinician.
Domains are used within the levels to group the knowledge and skills by theme. There is mirroring between the “essential” and “skilled”, and “enhanced” and “expert” levels facilitating a pathway for staff considering advancement in this field.
Scope of Practice
It is important to note that some of the knowledge and skills are designated as specific to certain functions or roles. Staff working at a particular level require only to consider those parts of the Framework that are described as being within their scope of practice.
In most cases, for most healthcare workers, interactions with trans people will be no different from interactions with anyone else. Gender incongruence is a condition, not an illness, that may or may not involve medical interventions and the right approach is professional, needs led and person centred.
Children and Young People
The Framework is designed to support the education and development needs of all NHS Scotland staff. The principles of providing high-quality, person-centred care are universal and apply to staff working with everyone regardless of age or other demographic.
We acknowledge the specific and unique requirements of children and young people and their support networks. In this first release of the Framework please note:
- the enhanced and expert levels are applicable to staff working in adult gender identity services;
- we will bring forward an Annex to the Framework to support specialist services for children and young people;
- selectors that relate to or are dependent upon specialist gender identity healthcare at the essential or skilled level shall be considered to apply to adults.