Referral and waiting well.

For NHS gender services in England, the route is moving to GP referral only. Self-referral, which used to be available at several clinics, is being phased out. A useful referral letter from your GP usually includes a basic gender history, any relevant physical and mental health background, and a clear request for assessment at a Gender Identity Clinic.

If your GP is hesitant, "advice and guidance" routes, where the GP can ask a specialist a question before referring, are increasingly available. You can also ask politely about the practice's experience and, if needed, request to see a different GP at the same practice.

Once a referral is accepted, you join the waiting list. Where you are in the queue depends on when your referral was received and which clinic it went to. A single national waiting list is being introduced, which should make movement between clinics more transparent.

A bridging prescription is a short-term prescription, usually from a GP, intended to reduce harm for someone who is already self-medicating with hormones obtained outside the NHS, while they wait for specialist assessment. It is not a routine starting prescription. The General Medical Council describes it as a holding and harm-reduction approach. Whether your own GP can or will offer one is a clinical decision they make individually; provision varies a lot across the country.

Shared care is an arrangement where a specialist clinic recommends a treatment, and your GP takes over the day-to-day prescribing and monitoring. It is a voluntary agreement, GPs are not obliged to enter into one, and a small but real proportion decline. If shared care is declined, the specialist clinic should continue to prescribe.