gender reassignment new nhs number

Updating NHS records

What is updating nhs records.

Changing your name, title, or gender on your NHS records.

How long does updating NHS records last?

This is a permanent change but can be done more than once.

What do I need first?

You will normally need:

to be registered with a GP surgery

There is information on how to do this on the NHS England website and the NHS Scotland website . In Wales, you can use the NHS 111 Wales website to find a local GP surgery and use the instructions on the GP surgery website.

to have a deed poll or statutory declaration

If you are changing the name listed on your NHS records, you will also normally need a deed poll or statutory declaration .

You do not need:

• a Gender Recognition Certificate
• a formal diagnosis
• to have had surgery

How do I update my NHS records?

You can change your name, title, or gender with the NHS at any time you like by telling your GP surgery.

Most GP surgeries will be able to update your details if you ask at reception. However, some GP surgeries may be unsure of the procedure for how to do it. You may find it helpful to give them these links which explain how they can update your details:

• in England , on the PCSE website (search for “How should I advise PCSE of a patient gender re-assignment?” and “A transgender patient registered at our practice would like to change their registered name”)
• in Wales , on the Umbrella Cymru website
• in Scotland , on the NHS National Services Scotland website (you can find further information about your rights in this Freedom of Information disclosure and in this document for staff in Greater Glasgow and Clyde )

If your GP surgery is still unhappy to do this, or request a Gender Recognition Certificate before making a change, you may wish to show your GP the General Medical Council guidance on this issue .

If you are still experiencing issues, take a look at the advice on our page about common healthcare issues .

What happens next?

The NHS has multiple different systems that store details about patients. Most of these will be automatically updated when you tell your GP surgery, but you may find some hospitals or other NHS services are not automatically updated, and you may have to tell them as well.

Each NHS system is different and able to hold different information about titles (or lack of title) and about the gender of the patient.

In most NHS systems there are gender options for not only male and female, but often also a “not specified” marker which may be useful if you do not wish to have male or female recorded.

Usually, when you change your gender marker you will be assigned a new NHS number in England and Wales, or assigned a new CHI number in Scotland.

What should I be aware of?

Changing gender marker may affect whether you are invited to important medical screening tests that you still need. Read the whole of this page to ensure you still receive the correct tests.

During your life the NHS will invite you to a number of screening tests for common conditions. As the prevalence of these conditions is different for men and women, some tests only invite people who have “female” on their NHS record, and some tests only invite people who have “male” on their NHS record. This can mean people who have changed their gender marker can invited to the wrong tests for the body parts they have.

When you change your NHS gender marker, you should remember that you may not receive reminders for the tests you need, and may have to ask for them yourself. You can read more about screening tests and which tests you might need:

• on the UK Government website
• on the NHS Wales website
• and on the Cancer Research UK website

In Scotland , you will normally be invited to the correct tests automatically (unless the gender marker on your records was changed before 2016). You can read more about testing in Scotland on the NHS Inform website .

Where can I learn more?

You can read more detailed information about updating your NHS details on the DMC blog .

Errors and omissions

Is there something missing from this page? Have you spotted something that isn't correct? Please tweet us or message us on Facebook to let us know, or file an issue on GitHub .

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Patients can request a change to their gender marker at any time and do not need a Gender Recognition Certificate or have undergone any gender affirming medical treatment.

PCSE must be informed when a patient wishes to change their gender marker. The GP practice needs to include the patient’s name as it is currently registered and their NHS number. You must also confirm that you have discussed the change with the patient and they are aware this will involve the creation of the new NHS number. 

PCSE will then send the GP instructions of how to proceed as well as a deduction.

Once the GP has accepted the deduction, they will then register the patient’s new details provided by the PCSE.

PCSE will send the new medical record envelope with the patients updated details. Information from the patient’s previous record must then be included in the new record, although the patient’s previous identity should be redacted. A black mark pen can be used to adapt physical notes and electric records should be printed, redacted with a black marker, then scanned back into the system.

More details about the process can be found here on the Primary Care Support website.

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Information for Trans (transgender) Patients

Changing your name.

Simply complete a change of name request form and give it to reception. We will ask to see proof of a name change (such as a deed pole or marriage certificate) along with photographic evidence. If you can not provide this evidence, please call reception to discuss this further.

Changing Your Title

You can change your title from Mr to Mx, or Miss, Mrs, Ms to Mx without changing your gender

If you want to change your title from Miss, Mrs, Ms to Mr, or Mr to Miss, Mrs, Ms. You will have to change your gender on your NHS records too.

Changing Your Gender

You can do this at any time, by completing a gender change form and you do not have to have undergone any form of gender reassignment treatment. You must be aware that changing your gender will mean you will be allocated a new NHS number, and your pre-exisiting NHS number will no longer be accessible or be reversible. Your previous notes will be merged to your new notes, minus any previous identity information.

*unfortunately the NHS only accepts a male or female gender for registration and for gender change currently, if you wish to choose non binary or other, we can add an alert to your notes, so we as a practice know your preferred gender. Without a male or female gender we cannot register you or change your gender as Primary Care Services England (PCSE) will reject the application. Sadly, this is out of our hands, but we and others across the UK have raised this issue to get the system changed, when will this be, we do not know. We do understand your frustrations. 

We as a practice will ensure you get called in for your screening opportunities as long as you stay registered with us, but we do need to know your assigned gender at birth to ensure you get called in at the right time.  NHS screening Guidance for Trans Patients  further information can be found at  Information for trans and non binary people  and at  I’m trans or non-binary, does this affect my cancer screening?

A new NHS number can take over 4 weeks to come through to us, once we notify PCSE. Once we receive your new NHS number, we will create a new registration for you at the practice within 5 days, and will aim to merge your old records to your new records in a timely manner.  You should be informed of your new NHS number by PCSE. If you do not receive, please contact us and we can give it to you. You may need to inform any hospitals you are under of your new NHS number so they can update your records.

Adoption and Gender Reassignment Processes  10/02/2021

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How to get help and support - Gender dysphoria

You may have to wait some time for a referral for an assessment at a gender dysphoria clinic because of more people needing gender dysphoria services. However, there are things you can do to help.

For children and young people under 18

If your child or teenager is distressed, ask the GP to refer them to the local Children and Young People's Mental Health Service (CYPMHS). CYPMHS may be able to offer psychological support while they wait for their first appointment at the Gender Identity Development Service.

The school or college may be able to offer additional support.

You and your GP can find a wide range of information and support on the Gender Identity Development Service (GIDS) website.

While you're waiting for your first appointment at a gender dysphoria clinic (GDC), or waiting for treatment, there are several things you can do.

If you are struggling with your mental health, speak to your GP about getting support and treatment.

Quit smoking if you smoke

It's advisable to stop as smoking can increase the risks of side effects of hormone treatment and surgery. Get advice on stopping smoking .

Lose weight if you are overweight

Certain risks from cross-sex hormones are increased if you are overweight.

Do not self-medicate with hormones

You do not know what you're being sold and you could harm yourself without regular monitoring. Hormones may also affect your future fertility.

Use contraception if you are sexually active

Ask your GP or sexual health service for contraceptive methods to suit your needs.

The UK Faculty of Sexual and Reproductive Healthcare (FSRH) has a useful guide to contraception for transgender and non-binary people .

Live in your preferred gender (social transitioning)

For some, this is an important part of managing gender dysphoria at home, work and socially.

You would need to do this before you can have gender surgery. Gender dysphoria clinics need to know the changes you want to make in your social role will improve your life and be sustainable over time, so that they can help you with this process.

As part of social transitioning, most gender dysphoria clinics recommend you change your name by deed poll . You can do this for free and then use it to change your name on your passport and other personal documents, at your bank, work and at the GP surgery.

Once the GP has a copy of your deed poll, they should contact Primary Care Support England to change your name on medical records and issue you with a new NHS number.

Non-binary identities are not officially recognised, but the GP can make a note of your chosen name and preferred pronouns.

Page last reviewed: 28 May 2020 Next review due: 28 May 2023

Gender Re-Assignment PCSE advice for GP Practices

How should I advise PCSE of a patient gender re-assignment?

Gender re-assignment process

It is important that practices are aware of the steps that need to be taken when a patient changes gender. Following the process will ensure continued patient care and ensure there isn’t an impact on your practice payments.

Please note: Patients may request to change gender on their patient record at any time and do not need to have undergone any form of gender reassignment treatment in order to do so.

When a patient changes gender, they are given a new NHS number and must be registered as a new patient at your practice. All previous medical information relating to the patient needs to be transferred into a newly created medical record. When the patient informs the practice that they wish to change gender, the practice must inform the patient that this will involve a new NHS number being issued for the them, which is not reversible. To revert back to their original gender, they would receive a third NHS number. The practice should confirm this has been discussed with the patient when notifying PCSE.

The process is as follows:

· GP practice notifies PCSE that a patient wishes to change gender via the enquiries form. The practice should include the patient’s name and NHS number in the notification to PCSE, plus confirmation that they have discussed with the patient that this will involve the creation of a new NHS number

· PCSE sends the GP practice a deduction notification for the patient and emails the main contact we hold for the practice (if available) the new details for the patient

· GP practice accepts the deduction and registers the patient using the new details provided by PCSE. Important: Do not update the patient’s original record with their new NHS number. If this happens they will not be registered and will miss out on continuity of care

· PCSE sends a new patient medical record envelope with the patient’s updated details to the GP practice

· GP practice creates new patient record using new details, and transfers all previous medical information from the original medical record. Any information relating to the patient’s previous identity should not be included in the new record.

· If the gender is being re-assigned from male to female, the screening team will contact the practice for no cervix confirmation

· If the gender is being re-assigned from female to male, screening will become the responsibility of the practice.

It is important that practices complete the new registration for the patient within five working days to ensure no interruption to patient care.

Please note: When registering new patients please do not use Select ‘I’ (Indeterminate) as the sex category. Please only select either ‘M’ for Male or ‘F’ for Female. This ensures that the appropriate screening invitations go correctly to individuals.

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The care of transgender patients by GPs

Introduction

All practice staff should receive training in trans-awareness as part of their wider equality and diversity education. It must be made clear that any information relating to a patient’s existing or previous gender status is bound by a specific legal duty of confidence. Administrative staff must be prepared to deal sensitively with approaches from patients requesting changes to their name and title within their medical records. Change of pronouns Requests to change pronouns and gender-markers on communications should be respected. Written medical correspondence should be discreet, including the appearance of the patient’s name in the address window, and should not assume that others in the household are aware of the individual’s gender circumstances. It is advisable to have an early discussion with the patient about their preferences, for example, as part of a consultation, so that this can be managed appropriately. Change of gender Patients also have the right to request a change of gender, a move that would require the creation of a new medical record with a new NHS or CHI number. The patient does not require, or need to present, a Gender Recognition Certificate or updated birth certificate for this change to be made. If a patient wishes to make a legal change to their gender, a Gender Recognition Certificate would be required. A change of gender has implications for screening recall which is explained below. Practices should familiarise themselves with the relevant NHS guidance which sets out the current process for changing a patient’s registered gender (e.g. PSD in Scotland / PCSE in England). This includes requirements in relation to screening advice and managing the patient’s medical records. Medical Record Management In Scotland : Once medical records have been updated to reflect the patient’s changed gender, Practitioner Services Division (PSD) Registrations will write to the patient confirming the changes and asking them to speak to the GP practice about the implications for their future care.   Once gender is changed on the patient’s CHI number, a new CHI record is started which is linked to the previous one, then known as the ‘historic’ record. The GP records should be updated and moved to the new CHI number. Gender markers and any information related to the patient’s previous identity should be removed from all previous records by the practice. In England and Wales : The GP practice will notify their local Primary Care Services who will issue a new NHS number and deduct the old patient record. The patient must then be registered as a new patient at the practice. It is the practice’s responsibility to inform the patient that this process is ‘irreversible’ and that if they wish to revert back in future this will result in the creation of a third NHS number (and record). [4] Unlike in Scotland, NHS GP practices in England need to manually transfer the patient’s previous medical information into the newly created record. Any information relating to the patient’s previous identity (name/title/gender) should not be included without the patient’s consent. This process should be completed within five working days of receiving the new NHS number. Because a new NHS number is created and a new patient record is generated, it is important to discuss with the patient what this implies and that they understand which information from their previous records is not included in their new record. There should be a clear, documented discussion about the patient’s request to ensure they fully understand the consequences of the change, including the fact that they will have a new NHS number and record. Once this is made clear, the old patient records should be filed with Primary Care Support England (PCSE) or the Business Services Centre (BSC) in Wales. Alternatively, the patient may choose to retain their current record provided the practice changes their ‘administrative’ details. In Northern Ireland : The GP practice should contact Business Services Organisation (BSO) to request a new medical record and Health and Care Number for the patient. The practice must ensure that no reference to the patient’s previous identity or gender is contained within the new records. At the present time, unless a patient has a formal Gender Recognition Certificate the final decision as to what is clinically relevant rests with the clinician. When discussing the transfer of information from the old medical record to the new one with the patient, GPs should make it clear which information should be copied over to ensure continuity of care and avoid clinical risk. If need be, additional reassurances should be given to the patient that any notes relating to gender transition will be treated confidentially. In our experience, most patients agree to previous notes being transferred to their new notes provided their record ‘administratively’ reflects their new personal information. GPs are also advised to seek consent to share the patient’s transgender status with the practice team, who may need to access their medical record in order to provide care. The patient should be reassured that no information about their gender history will be disclosed without their specific consent.If the patient expresses concern about access to their record, a practice could offer to limit this to clinicians only.Any restrictions should be realistic and should not be detrimental to patient care. Finally, the patient should be made aware that, if they register at another practice, these restrictions will no longer apply and the patient would be advised to discuss reinstating them with the new GP. Note-taking and referral Patients requesting treatment for gender dysphoria or gender incongruence should be referred to an appropriate specialist gender identity service. When writing records or making referrals regarding transgender patients, reference to their transgender status should only be made if clinically relevant. Express consent should also be obtained in order to share this information and it may be an offence to disclose it without consent. Any referral to other healthcare services made by a GP must not include reference to the patient’s gender transition/previous gender, unless:

• this has been discussed with the patient
• they have given consent to the disclosure, and
• the information provided is necessary for medical purposes.

There will be circumstances where it is appropriate to disclose gender information – with your patient’s consent – so that the service you are referring to is aware they may have specific needs. This allows the service to respond appropriately to the patient and care for them in a manner that supports their dignity. GPs using referral software must ensure that any referrals are checked before sending to avoid an inadvertent breach. GPs should continue to ensure that they follow GMC guidance in relation to recording their work clearly, accurately and legibly. Clinical records should include:

• relevant clinical findings
• the decisions made and actions agreed, and who is making the decisions and agreeing the actions
• the information given to patients
• any drugs prescribed or other investigation or treatment
• who is making the record and when.

As doctors may be involved in arranging blood tests and prescribing hormonal medications as part of the transitioning process, it is important to document all care and treatment provided. Screening If the patient is to be issued with a new NHS or CHI number which has no reference to their sex at birth, the GP should explain that they may not automatically be contacted regarding current or future screening programmes associated with their sex at birth, and discuss the implications of this. Decisions about screening should be made with patients in the same way as any other decisions about their health. The GP should discuss implications with the patient and, if they consent, contact the relevant NHS screening programmes to ensure they are invited for/referred to appropriate screening. The NHS has information available to help patients understand the implications across all screening programmes[5]. For smear testing, which is usually undertaken in the practice, the practice may be responsible for managing recalls, taking specimens and providing results. In this event, the practice should notify the laboratory that the results are to be forwarded to the practice and not the national call/recall service. It is the practice’s responsibility to ensure both that the patient understands the limitations of any national screening service and that the patient’s screening results are managed locally with appropriate confidentiality and consent. Prescribing The GMC acknowledges that trans patients are at an increased risk of self-harm or suicide and GPs should discuss access to mental health support services where appropriate. Their guidance also acknowledges the long waiting times to access specialist services. Good medical practice and the GMC’s prescribing guidance state that while doctors must recognise and work within the limits of their competence, they must work in partnership with patients and consider what treatment is likely to meet their needs, and must work with colleagues in the ways that best serve patients’ interests. ‘Bridging prescriptions’ GMC guidance states that “one way in which you might consider providing support to your patient is by issuing a ‘bridging prescription’”, which is “a temporary prescription of endocrine treatment that can be issued by a GP”. However, GPs must consider local policy requirements and obtain the advice of a specialist service provider or an experienced colleague before issuing a bridging prescription. The GMC seek to reassure doctors who wish to prescribe for their transgender and gender diverse patients that it would not be against their guidance to so issue a bridging prescription. Equally, they are clear that their guidance does not oblige doctors to do so if they do not feel that prescribing would be of overall benefit to a patient. Prescribing medicines outside their licence In relation to medicines unlicensed for this use, the GMC states that:

• GPs can prescribe unlicensed medicines following the steps set out in its Prescribing guidance.
• GPs must take care to discuss the risks and benefits of treatment with the patient.
• GPs should collaborate with experienced colleagues to provide care that best serves patient needs.

Prescribing on the recommendation of a specialist The GMC states that GPs must collaborate with a gender specialist service, and this may include prescribing medicines on their recommendation and/or following their recommendations for safety and treatment monitoring (taking into account local arrangements, such as Shared Care Agreements or Enhanced schemes). However, the GMC continue that it is reasonable for a GP to expect the specialist service provider to remain available to provide advice and support where necessary. The GMC confirms that doctors are not obliged to follow the recommendations of those working for a specialist service provider who are unable to demonstrate they are suitably qualified. However, in these circumstances, it is not acceptable simply to refuse to treat a patient, and doctors must communicate with the patient and more experienced colleagues or service leads to ensure they make the care of the patient their first concern and provide a good standard of practice and care. The future There are ongoing legal processes by the Scottish government to reform the Gender Recognition Act.

http://www.legislation.gov.uk/ukpga/2004/7/pdfs/ukpga_20040007_en.pdf

https://www.gov.uk/guidance/equality-act-2010-guidance

https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare

https://pcse.england.nhs.uk/help/registrations/adoption-and-gender-re-assignment-processes/

https://pcse.england.nhs.uk/media/1291/process-for-registering-a-patient-gender-re-assignment.pdf

• Screening guidance for transgender patients for England , Scotland , Wales and Northern Ireland .

This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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• Publications
• FOI – 000084 Requirements for Processing a Change of Gender and Title

FOI – 000084 Requirements for processing a change of gender and title (HTML)

Published on 06 June 2022

All information regarding the administrative requirements for processing a change of gender and title for a patient. Specifically:

• What evidence is required before a request for change of gender can be processed.
• What process must be followed by the GP in order to change the gender and title of a patient.
• Who can the patient contact if the GP is unwilling to change the gender and title.
• Any information related to the issuing of a new CHI number for patients who have changed gender and how this will be updated throughout the NHS.

This response is based on the based on how the Community Health Index (CHI) is updated and the link to NHS Screening systems which NHS National Services Scotland is responsible.

None of the following information is dependent on the patient changing their gender formally under the Gender Recognition Act 2004.

No evidence is required; the patient simply needs to advise either their GP practice or Practitioner Services (a business unit within NHS National Services Scotland) that they wish to change their gender. This is often accompanied by a change of name being requested by the patient.

The GP practice will amend their data held on their practice management computer system which will be received electronically by Practitioner Services. Whilst any name change can be processed automatically by CHI, a change of gender requires manual intervention by one of our trained staff to update CHI.

Most of our computer systems do not hold a title field rather it is the gender and marital status which determine title.

As GP practices are independent primary care contractors any dissatisfaction by a patient may be raised as a complaint and should be referred to the practice in the first instance and then the NHS Board in the area the practice is contracted to, if the complaint is not resolved by the practice.

In order to provide a better understanding of the context, it would be helpful to explain the current challenges within NHS National Services Scotland in relation to change of gender. Many of NHS Scotland's health screening programmes are gender specific e.g., breast and cervical for females and AAA (Abdominal Aortic Aneurysm) screening for male patients.

Whilst there is an enhancement to CHI which has been developed to allow for patients' CHI records to be marked to be included for screening if their gender does not match the gender usually associated with that particular programme e.g. a trans male who had previously had cervical screening in their former gender, the CHI record in the future will be able to record that the patient should be included in the screening programmes - the enhancement is not yet ready to be implemented.

When a patient asks Practitioner Services to change their gender, we alert them to the current clinical risks if they are undergoing a gender specific screening programme or follow-up treatment as a result of this we also advise the patient to discuss the clinical risks with their GP practice.

Practitioner Services will contact the patient to establish if they want a new CHI number and possibly a new NHS number. The new CHI number is communicated electronically to the registered GP practice.

All changes to CHI, including the issuing of a new CHI, number are notified to computer systems within NHS Boards who hold the previous CHI number for that patient to advise them to update - this previous medical records with reference to gender reassignment treatment and subsequent medication cannot be deleted.

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Poll: 75% of Americans Oppose Puberty Blockers for Transgender Children

A new poll finds most Americans disagree with providing gender-transitioning treatments to minors.

Only 22% support allowing puberty blockers or gender reassignment surgery for under-18s.

Similarly, just 10% support biological males competing in women’s sports.

The survey results come as England’s NHS banned puberty blockers for transgender-identifying youth due to lack of evidence for their safety and effectiveness.

“We have concluded that there is not enough evidence to support the safety or clinical effectiveness of puberty-suppressing hormones to make the treatment routinely available at this time,” an NHS England spokesperson said.

“Children, young people, and their families are strongly discouraged from getting puberty blockers or gender-affirming hormones from unregulated sources or online providers that are not regulated by U.K. regulatory bodies,” the NHS website states .

Catholic League president Bill Donohue praised this shift, saying future generations will view celebrating child abuse through gender treatments as a dark era.

He argued protecting children from ideological or financially-motivated exploitation by activists, professionals and influencers is the most urgent civil rights issue.

As views diverge sharply, even Supreme Court Justice Ketanji Brown Jackson said she cannot define “woman.”

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