National Gender Identity Healthcare Reference Group: terms of reference

Terms of reference for the National Gender Identity Healthcare Reference Group.


The National Gender Identity Healthcare Reference Group has been established to coordinate improvement in the provision of gender identity healthcare within NHS Scotland.

It will aim to achieve this through overseeing implementation of actions in the NHS gender identity services: strategic action framework 2022 – 2024 (“the Framework”).  


The Scottish Government’s Programme for Government 2021/2022 commits to improve access to, and delivery of, NHS gender identity services. This mirrored the September 2021 commitment in the Scottish Government/Scottish Green Party Bute House Agreement.

Over recent years the number of people referred to NHS gender identity clinics (GICs) in Scotland has increased. This increase in demand has contributed to longer waiting times to access clinical services, which have been further impacted by the COVID-19 pandemic and ongoing recruitment challenges. 

People referred to gender identity services in Scotland have described the distress they have experienced due to long waits to access clinical services. It is clear that waiting times must be improved. It is also clear that wider work is required to ensure services can best serve people accessing them.  

Key priorities and principles

The Framework contains 17 actions to improve gender identity service delivery and access in Scotland. Working with Scottish Government, the Group shall oversee the implementation of these.

The Group’s immediate priority will include consideration and publication of guidance and documentation for Health Boards to promote service improvement. These will set out key principles which will inform allocation of funding made available for gender identity service improvement from 2022.

Secondary priorities will include consideration of how funding may be allocated to best support research relevant to delivery of gender identity healthcare, and oversight of commissioning special health board action in this area. 

The Group will also act as a general national forum where matters relevant to delivering NHS Scotland gender identity services may be escalated for collective consideration and action, as appropriate and if required.

Notwithstanding the above, the Group will also approve and receive updates on a work plan outlining key deliverables on the commitments and timescales. This plan will include work to be taken forward by the reference group as well as NHS partners. 

The Group will seek to ensure that all work to improve gender identity healthcare provision in Scotland fully embeds the voices and experiences of those using services in line with best practice in developing public sector services. Work must also be informed by the best available evidence in this field. 


The Group will consider whether specific targets or measures should be set to evidence success in improving gender identity healthcare provision. 

The priorities of the Bute House Agreement should define any measures of success. The Agreement sets out that gender identity healthcare:

  • adopts a human rights based, person centred and multidisciplinary approach to improving trans healthcare provision
  • is brought within national waiting times standards
  • offers improved support to those waiting on a gender identity service appointment, including peer support
  • examining, in conjunction with the upcoming revised Gender Reassignment Protocol for Scotland, different models of delivering these services, with models to be adopted based on the principles of Realistic Medicine
  • ensures that the newly improved services are accessible to trans, including non-binary, people

Membership and member expectations

Meetings will be held every 6 weeks for the first 6 months, frequency to then be reviewed thereafter by the Group. 

Membership will be reviewed on establishment of the Group and after one year (March 2023). 

Members are expected to attend the majority of meetings and if they are not able to attend to provide a deputy in their place. Deputies should be suitably senior, informed of the work of the Group and able to make decisions/act on behalf of the substantive member.

Members should not share or release papers or information shared with the group without discussion with Secretariat.

Members will not act as representatives of the Group in response to media enquiries, and are expected to forward media enquiries on the work of the Group to the Secretariat.

The Group is time limited and will not continue beyond the end of 2024.  


The Reference Group will be accountable to Scottish Government’s Health and Social Care Management Board. An update on the Group’s work and progress of service improvement shall be provided to the Board at least twice every calendar year. 

As appropriate, the Group will escalate any strategic issues, obstacles or risks in relation to implementation of the Framework actions to the Board.


Secretariat will be provided by Scottish Government.

The agenda and associated papers will be circulated by email at least five working days in advance of the meeting date and meetings will be held virtually for the foreseeable future.


The Group may establish sub-groups to progress specific work activity. The Group will decide the frequency of those sub-group meetings along with membership, governance and reporting arrangements.


The Reference Group is committed to ensuring its work is inclusive. Membership will include participants with different roles, identities, experiences and backgrounds. Members and guests must respect each other’s names and pronouns at all times. Members should also try to avoid using jargon or acronyms which others may not understand.

The Group will seek to promote a safe and supportive environment for those participating in its work and will respect the privacy and confidentiality of any personal experiences and information shared by individuals. 

Conflict of interest 

There will be a wide range of interests on the Group and it is important that the Group operates openly and transparently to maintain integrity, the confidence of stakeholders and to fulfil its remit effectively. 

To ensure this, the members of the group are asked to make a declaration of conflict of interests by completing the form in Annex C. Members have to notify the Scottish Government of any changes and pay due regard to each meeting’s agenda for any specific items that may present conflict of interest. 

A conflict of interest is a set of circumstances that could be considered to a create a risk that an individual’s ability to apply judgement or act, or could be, impaired or influenced by another interest. 


The Terms of Reference, membership and minutes of meetings will be published on the Scottish Government website. 

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