National gender Identity Healthcare Reference Group minutes - 28 August 2025

Attendees and apologies

• Prof Nicola Steedman (Co-chair), Deputy Chief Medical Officer, Scottish Government
• Dr Ewan Bell (Co-chair), Associate Medical Director, NHS Dumfries and Galloway
• Dr Amy Beadle, NHS Greater Glasgow and Clyde
• Kerry Cairns, Service Manager Mental Health & Learning Disabilities Inpatient and Specialist Services, NHS Grampian
• Dr Fiona Clunie, Consultant Psychiatrist/Medical Lead, NHS Lothian
• Dr Paul Connelly, Clinical Lecturer in Diabetes & Endocrinology, University of Glasgow
• Dr Moira Connolly, Clinical Lead for Gender, NHS Greater Glasgow and Clyde
• Dr Emilia Crighton, Director of Public Health, NHS Greater Glasgow and Clyde
• Hayley Fairgrieve, Gender Lead Nurse and Advanced Sexual Health Practitioner, NHS Lothian
• Neil Ferguson, Director, West of Scotland Regional Planning
• Janis Heaney, Associate Director, National Services Directorate, NHS National Services Scotland
• Jennifer Jamieson, Adult Sexual Health Services Manager, NHS Greater Glasgow and Clyde
• Dr Amber Keenan, Clinical Lead in Gender Identity, NHS Highland
• Jennifer Layden, Programme Manager, Healthcare Improvement Scotland
• Kimberley MacInnes, Service Manager and Lead Nurse, Highland Sexual Health, NHS Highland
• David Parker, Senior Educator, NHS Education for Scotland
• Dr Fiona Wardell, Standards and Indicators Team Lead, Healthcare Improvement Scotland
• Mairi Watson, Information Consultant, Public Health Scotland
• Dr Sarah Weldon, Consultant Clinical Psychologist and Psychology Lead, NHS Greater Glasgow and Clyde
• Dr Craig Wheelans, Associate Medical Director, NHS National Services Scotland
• Lived Experience Coordinator
• Representative, LGBT Health and Wellbeing
• Representative, Scottish Trans 
• Representative, TransParentSees
• Scottish Government secretariat

 Apologies

• Rhoda MacLeod, Head of Sexual Health, Prison and Police Services, NHS Greater Glasgow and Clyde
• Dr Ruth Pearce, Lecturer, University of Glasgow

Items and actions

Welcome and minutes of previous meeting

Nicola Steedman (NS) welcomed attendees to the meeting of the National Gender Identity Healthcare Reference Group (the Group). Apologies were noted. The minutes of the previous meeting of the Group were agreed.

NS explained to the Group that this would be the 22nd and final meeting of the Group, as the commitments in the 2021 strategic action framework for NHS gender identity services 2022-2024 have now all either been delivered, or are on course to be delivered in the near future. NS thanked members of the Group for their contributions to date.

Policy update

A Scottish Government representative provided an update on the progress of the workstreams upon which the Group advises. Of the seventeen commitments, 15 have now been completed, including the publication of nationally collated waiting times data by Public Health Scotland; the Transgender Care Knowledge and Skills Framework by NHS Education for Scotland; and national standards for gender identity services by Healthcare Improvement Scotland.

The Scottish Government representative recognised that work remains to be done to continue to improve NHS gender identity services and, in particular, to reduce waiting times, including work to embed the publications listed above.

One of the two remaining outstanding commitments is to formally re-establish the National Gender Identity Clinical Network for Scotland (NGICNS), to allow it to take ownership of ongoing service improvement and planning, in place of the Group. The Scottish Government representative explained that this commitment is still in progress and remains on track to be delivered, subject to final decisions on the future overarching model for networks (believed to be imminent).

The other outstanding action still in progress is the establishment of the newly reconfigured national young people’s gender identity service. A Task and Finish Group, convened in December 2024, is in the process of designing a Target Operating Model for these services, which is expected to be signed off in 2025.

Group members were invited to provide reflections on the work of the Group, and views were exchanged on what has been achieved, and what work remains to be done to continue to stabilise services and reduce waiting times. Third sector representatives acknowledged the great work progressed by the Group, while also expressing their strong concern of challenges still remaining as the Framework work concludes, including the waiting times increasing in some of these clinics, which also remain the only services providing this healthcare, and the impact of this on people waiting to access them.

NS emphasised that improving gender identity services will remain a priority for the Scottish Government.

Progress update from Health Boards

Representatives of Health Boards then delivered presentations on the progress of improvement work over the lifetime of the group, with current waiting lists and staffing numbers. There was follow-up discussion on remaining obstacles to reducing waiting times; staff training; work with the third sector; and referral arrangements between Boards.

Public Health Scotland Waiting Times Data

PHS then presented an update on the publication of nationally collated data on waiting times for NHS gender identity services, which began in November 2024. This included plans to publish these data on an annual basis going forward, and challenges with data quality. Group members discussed how these data could be enriched in future, including suggestions to include waiting times for young people’s services, or waiting times between appointments.

Target Operating Model for Young People’s Gender Identity Services

Janis Heaney (JH) then delivered a presentation on the progress of the Task and Finish Group designing a new Target Operating Model (TOM) for young people’s gender identity services, expected to be signed off in 2025.

JH described the outcomes of a Strategic Needs Assessment for these services conducted by NHS National Services Scotland (NSS), as well as a summary of the responses received by NSS to a public consultation on a draft TOM conducted in August 2025. JH described the structure currently proposed in the draft TOM, and invited questions and comments from Group members.

Discussion included the role of the third sector in the new model; the holistic nature of the model; and the model’s position on the prescription of masculinising and feminising hormones.

Feedback from NES development day

Amber Keenan (AK) and Sarah Weldon (SW) presented an item reflecting on feedback received during a development day for gender identity services hosted by NHS Education for Scotland earlier in the year, on how gender identity clinics in Scotland might move toward a more standardised approach.

AK and SW presented a number of possible actions suggested at the development day, including common shared care agreements, Scottish Intercollegiate Guidelines Network (SIGN) guidelines, and standard operating procedures.

There was discussion about which of these actions would sit within the remit of Health Boards, and those that would instead sit with the successor to the NGICNS or the Scottish Government.

Closing remarks

NS reiterated her sincere thanks to the Group, and stressed again that this work will continue to be a priority for the Scottish Government and Gender Identity Services themselves, and that engagement with stakeholders in the NHS and third sector will continue. No other business was raised. NS then adjourned the meeting.