Long waiting times come under fire as NHS England publishes Levy Review into adult trans clinics

NHS England must prioritise improving wait times for adult gender dysphoria clinics, an independent ‘Cass-style’ review has said.

The operational review, headed by Dr David Levy, urged the UK’s public health service to create an action plan that would reduce wait times for a first appointment in its Adult Gender Identity Clinics (GICs).

Patients are reportedly waiting over 15 years to access care according to the review, which said operational issues would likely exacerbate the problem if nothing is done.

Published on Thursday (18 December), the document makes 20 recommendations across four key areas – access, quality, productive, and culture – that Dr Levy says would help minimise core issues facing each of England’s 13 GICs.

One recommendation urges NHS England to create a single national adult waiting list which emphasises transparency and sets a “clear trajectory” for minimising wait times over the next five years.

Another urges healthcare officials to work with the National Quality Improvement Programme for Adult Gender Services to develop a “standardised national support programme” to help support those waiting for their first appointment.

Dr Levy similarly criticised “inconsistent” reporting on quality outcomes for patients who had received care, making it “impossible” to understand where GICs can improve.

The lack of consistent data collection means that, according to a service specification detailed in the review, there is “no official data on the number of people in England who present with a degree of gender variance.”

Operational issues, Dr Levy says, also stem from problems around culture and leadership among adult GICs in England.

He noticed an inconsistent array of leadership styles during visits to each clinic, which ranged from psychology-led to psychiatric-led provisions.

The review recommended that NHS England improve the culture, leadership, and governance within each clinic, ensuring each hub creates a “compassionate, safe, positive culture” which benefits patients and staff alike.

NHS must help GPs provide trans healthcare

Dr Levy also acknowledged the wave of GPs abruptly withdrawing care from trans patients in recent months, saying that many healthcare professionals feel they lack the appropriate expertise to administer gender-affirming care such as hormone prescriptions.

This, he says, is only worsened by unnecessarily “complex” guidelines sent by GICs during shared care arrangements, which can run up to 10 pages or more.

It recommended that clinics and GPs work with various representative bodies, such as the Royal College of General Practitioners (RCGP) to create more comprehensive models of care.

Responding to the recommendations, NHS England directors John Stewart and Professor James Palmer said its immediate priorities involved minimising wait times and ensuring that GPs are confident enough to prescribe medication under shared care agreements.

“We thank you and your team for leading this important review,” they wrote in an open letter. “Your report will help us to improve both services and the lives of the patients who need them.”

Commissioned in July 2024, the review was commissioned shortly after the publication of the Cass Report, which analysed NHS services for trans youth.

Research published in October suggests trans people in the UK are waiting anywhere from three to a staggering 224 years to access care.

Claire Prosho, founder of Claire’s Trans Talks, said in October: “It is beyond time for the current failed ‘diagnostic’ service models to be replaced by a simple informed consent model, in line with international best-practice and consultation with the trans community.”