Non-Binary Working Group - gender identity clinics sub-group minutes: 2 September 2021

Minutes from the meeting of the sub-group on 2 September 2021.

Attendees and apologies

Group members

  • Dr Ben Vincent, (chair)
  • Mhairi Crawford, LGBT Youth Scotland
  • Paul Daly, LGBT Youth Scotland
  • Oceana Maund, Scottish Trans
  • Vic Valentine, Scottish Trans
  • Megan Snedden, Stonewall Scotland
  • Katrina Mitchell, LGBT Health and Wellbeing
  • Dr Carolynn Gray, University of the West of Scotland
  • non-binary community members


  • Emily Green, Equality and Inclusion Division, Scottish Government
  • Laurie Donaldson, Equality and Inclusion Division , Scottish Government


  • Kirstin Leath, Gender Identity and Healthcare Access, Scottish Government
  • Ewan Walker, Gender Identity and Healthcare Access, Scottish Government

Items and actions

Note of key points and actions

Key discussion points

The group discussed:

SG update

  • SG wrote to the National Gender Identity Clinical Network for Scotland (NGICNS) requesting they review and update the Gender Reassignment Protocol (GRP)
  • the draft agreement between SG and the Scottish Green Party, including the shared policy commitment to improve Gender Identity Clinic (GIC) services
  • the Programme for Government commitment to publish a national plan for improving services by the end of 2021
  • the group would be sighted on, and included in, ongoing work to improve GICs

Gender identity clinics and the gender reassignment protocol (GRP)

  • framing recommendations around the relationship between the GRP, what GICs are delivering, and the role of health boards
  • GICs and health boards not always delivering everything in the GRP and the variation between health boards
  • the importance of building buy-in from health boards to ensure services are delivered
  • the elements of gender - or transition-related care - that should be the focus for progress and recommendations and the need to draw attention to the current system

Waiting and clinical pathways

  • the need to consider waiting times for GICs beyond the understanding that current waiting lists are long and damaging
  • within GICs, particular pathways becoming expected or assumed for non-binary people seeking treatment
  • complexity around an individual’s gender identity leading to delays in treatment
  • what is not covered by GRP terms and how the updated GRP should take account of recent medical evidence regarding testosterone and hysterectomies
  • post-discharge care and the significant challenges in accessing this
  • expecting that reviewing GRP would be an ongoing process of regular reviews
  • the importance of other protocols also taking an inclusive approach


  • the need to fund further research into trans healthcare, to strengthen evidence base for gender reassignment treatment and care provided by NHS Scotland

Care beyond GICs

  • the important role primary care plays and the need to improve training for staff
  • drop-in trans healthcare services

Equity of access and parity of care

  • introducing binding national standards and nationwide funding
  • creating Local Gender Teams (LGTs)
  • the lack of consistency within adult GIC provision in Scotland
  • barriers to care on the basis of BMI and barriers faced by neurodivergent people
  • creating a recommendation around equity of access to services
  • the need for respect and understanding specific issues for non-binary people
  • issues around decisions being hard-wired to gender markers (within CHI identifiers), and the need for a more patient-centred approach
  • barriers faced by young people when accessing care
  • sexist attitudes within healthcare settings

Action: Gender Identity and Healthcare Access team to circulate relevant links, and remain in contact with the Working Group about work to improve GICs.

LGBTI Equality Team

September 2021

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