Patients can ask for their gender to be changed on their medical record at any time. They do not need to have undergone any gender reassignment treatment in order to do so. When a patient asks for their gender to be changed, they will receive a new NHS number and their records will be transferred over. Information that identifies them by their previous gender will be redacted, but all medical information remains unchanged.
Under 18 Patients
Children and young people under the age of 18 cannot change their gender marker on their medical record. They can change their name or title (see questions related to these options for more information). An independent review has identified a serious safeguarding risk in the current process of re-assigning gender and sex identity in medical records for children and young people.
In response, the Secretary of State for Health and Social Care has directed that the process for changing gender markers and NHS Numbers in relation to gender amendments for children and young people under 18 is stopped.
Over 18 Patients
At Surrey Lodge Group Practice, a patient’s request to change their name, gender marker and title that is indicated on their medical records will be accepted. The patient does not need to have been issued with a Gender Recognition Certificate or have an updated birth certificate for their records to be amended.
It should be noted that trans patients have a legal right to change their name, gender marker and title on their healthcare records.
Name changes can be made without a gender marker change.
Title changes to Mx can be made without a gender marker change. However, the practice will not change a title to Mx unless this is what the patient requests. Some trans and nonbinary people may prefer Mx but others prefer Mr or Mrs/Miss.
Title changes without gender marker change
With the current IT system that is used by PCSE (NHAIS), it is not possible to have a perceived mismatch between title and gender marker. For example, on the system it is not possible to be a “Mrs” with a male gender marker. An unmatched notification will be sent if this is attempted as the NHAIS system regards this as being inconsistent. The procurement of a new system by PCSE that underpins its work will apparently have this functionality in the future.
Processing the request
When a patient changes their gender marker, i.e., male or female, they are given a new NHS number and must be registered as a new patient at the organisation. All previous medical information relating to the patient needs to be transferred into a newly created medical record.
When the patient informs the practice that they wish to change their gender marker, the patient will be informed that that this will involve a new NHS number being issued for them and the potential implications of this. Patients will be offered a consultation with a clinician to discuss the potential risks of incomplete medical records and the impact on screening recalls.
It is important to note that this process is not reversible. Should the patient wish to revert back to their original gender marker, they would then need to receive a third NHS number.
The process
- The practice notifies PCSE that a patient wishes to change gender via the enquiries form. The organisation should include the patient’s name and NHS number in the notification to PCSE.
- The practice accepts the deduction and registers the patient using the new details provided by PCSE. It is important that the patient’s original record is NOT updated with their new NHS number. If this happens, they will not be registered and will miss out on continuity of care.
- PCSE sends a new patient medical record envelope with the patient’s updated details to the practice.
- The practice creates a new patient record using the new details and transfers medical information from the original medical record. Any information relating to the patient’s previous name, title, gender identity or NHS number should not be included in the new record. This will need to be discussed between the patients and the clinician.
Recalling patients for screening
Transgender and non-binary patients should be offered organ specific cancer screening. If a patient is issued with a new NHS number, they will not automatically be recalled for certain sex-specific screening programmes, for example, a trans man with a cervix will not automatically be recalled for a smear test if he changes his gender marker from female to male.
Screenings that will be affected by a change of gender marker are breast, cervix and AAA. Bowel screening is unaffected. Public Health England has developed information for trans and non-binary patients regarding population screening – www.gov.uk/government/publications/nhs-population-screening-information-for-transgender-people/nhs-population-screening-information-for-trans-people
The practice will ensure that appropriate screening is offered to patients and individual arrangements for such patients will be conducted using the following process:
- It will be explained to the patient that they will not be recalled for some types of screening when changing their gender marker.
- The patient will be informed as to what screening would be appropriate for them and which types may be affected. They will be asked to work with the Practice to ensure that this happens.
- Screening conducted will be according to the organs/tissues present.
- Where relevant, confidentially and with the patient’s permission, the patient will be identified as trans gender on paperwork/forms accompanying the 10 samples. It is critical that the reason for this is explained and consent given.
- A copy of the results will be provided to the patient for future reference.
- Where possible, a reminder will be issued for future screening via the primary care clinical system or a confidential database. This can be done by placing a relevant alert or reminder on the medical record. However, the patient will also be advised to keep a note of when screening is due and to request this if they do not receive an automated reminder.
Ensuring that patients maintain regular screening is vitally important. The practice will invite the patient to an appointment to discuss these with the GP and the above steps advised.
If you would like to confirm a gender change on your medical record please complete the following form:
Declaration to Change the Gender Marker on Your Medical Records (word doc)