New NHS children’s gender clinic hit by disagreements and resignations

Photograph: Guy Smallman/Getty Images

A string of resignations from a team preparing for the launch of the new NHS children’s gender clinic has further complicated plans to open the services in April.

Disagreements over the text of a training module for medical recruits to the new gender service have prompted NHS England to remove the training materials project from a team at Great Ormond Street hospital and outsource it to the Academy of Medical Royal Colleges.

Great Ormond Street last year recruited a small team, including paediatricians and child psychologists, to write training guidance for new medical staff who will work in NHS England’s reshaped gender services for children and young people.

But at least four members of the team resigned late last year after disagreements over how children with gender dysphoria should be treated, according to sources close to the process.

The new NHS Children’s and Young People’s Gender Service for London is scheduled to open its doors to patients in early April, a year later than first scheduled and almost two years after NHS England announced the closure of the Gender Identity Development Service (Gids) for children at the Tavistock clinic in north London.

The Tavistock was set up three decades ago to help children and other young people struggling with their gender identity. But after a series of concerns and complaints from inspectors, whistleblowers, patients and families, the clinic is to close and be replaced by a number of hubs, including at Great Ormond Street.

Great Ormond Street is working with the Evelina children’s hospital and the South London and Maudsley NHS trust to pilot the first of several regional hubs that will take on the work previously conducted by the Tavistock clinic.

The team of experts recruited to write the training material included former Tavistock employees who left because they were uneasy about that service’s treatment of young people, plus other clinicians said to be opposed to the NHS’s new approach to handling children and young people with gender dysphoria.

Sources close to the discussions said there was “no consensus” within the team and that their work was incomplete when members resigned.

In 2022, Dr Hilary Cass, the paediatrician charged with reviewing the NHS’s care of children with gender dysphoria, said a “fundamentally different” approach was needed because of rising referrals and a significant change in the case mix, with a sharp rise in adolescent girls presenting with gender incongruence in their early teen years.

She also noted that many children displayed a wide range of other complexities, including mental health needs. Her independent review highlighted uncertainties surrounding the use of hormone treatments. Interim NHS service specifications say the new clinics will take a multidisciplinary approach, offering psychological support.

Some clinicians working on the new training materials are understood to have felt it important to affirm a patient’s gender identity and believed patients could benefit from medication. Others, some of whom resigned their posts, stressed the need to adhere to Cass’s recommendations and take a holistic, “exploratory” approach.

A spokesperson for the Academy of Medical Royal Colleges said the body had agreed to step in to write an interim training module, and was working to meet a six-week deadline, “because our members are keen to help ensure this service can go live as planned” [in April].

He added that because “time is tight”, the body would deliver induction training to let clinicians begin seeing patients, and a more in-depth programme would be commissioned at a later stage.

Great Ormond Street said the team recruited to develop the training and education programme had “now wrapped up its part of the process, having produced a range of high-quality materials. The programme has now been passed on to the Academy of Medical Royal Colleges, who will complete and deliver the induction programme.”

Some parents are turning to private healthcare, frustrated by the continuing turmoil and NHS waiting lists that can stretch to several years.

This week a private hormone clinic for transgender young people said it had become the first UK-based private provider to be registered by the health regulator, the Care Quality Commission, to prescribe cross-sex hormones for patients over 16.

The service is part of the Gender Plus group, run by several ex-NHS former Tavistock clinicians, which also offers psychological consultations, and for those over 18, referrals for gender-affirming surgery.