If your GP stops or refuses care

There is no single official national dataset that tallies every instance of a GP halting or refusing Hormone Replacement Therapy (“HRT”).

Most available figures come from journalistic investigations, charity or advocacy surveys and local reviews. Examples of this include reports by the Bureau of Investigative Journalism and The Independent.

Community-led surveys and watchdog reports, including those from TransActual and Healthwatch, document hundreds of individual reports and measurable percentages of disrupted HRT prescriptions. Reports cite reasons given by GPs, including a perceived lack of expertise, contractual/funding issues, or administrative/record problems.

If you’re receiving gender-affirming care through an NHS GP and they have stopped providing care, or have refused to provide you with care at all, here are some practical steps and actions you may want to take.

Continuity of care: What should happen

Continuity of care

A GP should not suddenly stop prescribing essential medication, including gender-affirming hormones, if you have been stable on them and there’s no immediate clinical concern.

You could point to this RCGP statement, which explicitly states that if a patient has already been initiated and stabilised on hormone therapy, your prescription should not be abruptly stopped, as doing so may cause physical and mental health harm. Make it clear to your GP, ideally in writing, what you expect the impact will be of stopping your prescription and ask for a written response with reasons if they maintain their position.

Shared Care Agreements

A Shared Care Agreement is an arrangement between your GP and a specialist that allows your GP to continue prescribing medication recommended by that specialist.

Find out more in our guidance on bridging prescriptions.

Refusal to prescribe

A GP must not simply refuse treatment without discussion and reason. You have a right to fully understand why a decision to refuse has been made, and you can request that this be put in writing. A GP may refuse or stop prescribing only if there is a good clinical reason (for example, if blood tests show unsafe effects, or if continuing would be unsafe). However, they must:

1. Discuss it with you, the patient.
2. Explain their clinical reasoning.
3. Ensure that arrangements are made for ongoing safe care, ideally through referral or handover, rather than leaving the patient without medication.

Professional duties

The General Medical Council (GMC) makes it clear that doctors have a duty to act in the patient’s best interests, avoid discrimination, and not abruptly withdraw treatment without ensuring continuity of care.

If a GP stops prescribing without explanation, due support, or referral, it could be considered a breach of their professional obligations and possibly discriminatory.

What you can do

1. Request a written explanation

Ask your GP to explain in writing their reason for stopping your prescription.

2. Contact GMC or PALS

Notify GMC or PALS (Patient Advice and Liaison Service) if continuity of care has been denied without proper reasoning.

3. Advocate for yourself

You have both rights and options to ensure your care continues as needed.

Under the Equality Act 2010, you are protected from discrimination based on ‘gender reassignment’ from the moment you begin social transition, even before any medical or legal transition. GPs do have professional discretion, but this must be applied lawfully. They must justify their decision based on rational clinical reasons. You are entitled to understand their clinical reasons.

If you disagree with the reasons, you can, in the first instance, seek a second opinion and escalate if necessary. This is typically done by first complaining to the GP surgery and then to your local Integrated Care Board. Following that, if the practice does not remedy the situation to your satisfaction, you may refer a complaint to the Parliamentary and Health Service Ombudsman. The steps for following this process are detailed below.

Keeping records of your consultations with your GP

If you speak to the GP on the phone or in person, consider recording the conversation, as there will be a lot to remember. You may also have a friend accompany you to take notes.

You can inform your GP that you will be recording the call/visit if you want, for your records. They cannot use this as a justification to stop the call/visit or discharge you from their service.

You do not, however, need their permission to record. As noted by the Medical Defence Union, it’s your personal information, so GDPR doesn’t apply. Recordings (even if made secretly) can generally be used as evidence when dealing with these kinds of issues, either to show wrongdoing or to support your case.

What you can do if your GP continues to refuse ongoing care

Here are some things you can do if your GP refuses your transition-related care:

1. Understand why the GP refused

Sometimes it’s due to clinical judgement, safety concerns, interactions, or monitoring requirements.

At other times, it’s about practice policy; certain medications are only prescribed under a specialist’s care, or the practice may have a global refusal to support trans healthcare.

Ask the GP to explain their reasons clearly, in writing, with reference to any policy, guidance, rule or standard they seek to rely on.

You can also request a copy of your medical record, which should detail the GP’s reasoning.

2. Request a second opinion

You are entitled to request a second opinion from another GP within the practice.

Some surgeries allow you to book directly with a different GP if you’re unhappy with the first decision. You should be clear why you disagree with the first decision.

Remember, the second GP will be able to access your medical history and records.

3. Involve a specialist

If a GDC clinician initially recommended the medication, refer to this, along with copies of any correspondence you may have. You can ask your GP to liaise directly with the clinician to discuss your case.

Specialist input often carries significant weight and may override a GP’s hesitation.

Any further decision made should be documented in writing, and you can request a copy.

4. Follow the NHS complaints process

Things to know:

• Everyone who provides an NHS service in England must have their own complaints procedure in place.
• You can informally raise a concern with the GP practice manager first; they may be able to resolve the issue quickly.
• If unresolved, you can make a formal complaint to the GP surgery under the NHS complaints procedure. All healthcare providers have a complaint policy in place. You should request a copy and specific details on how to file a complaint, with confirmation of the timescales they will work to.
• If still unsatisfied, you are entitled to escalate matters to your local Integrated Care Board (ICB) (England). Find your local Integrated Care Board (ICB) using the NHS directory.
• If you are unsatisfied with the response to your formal complaint, you can contact the Parliamentary and Health Service Ombudsman (PHSO). The PHSO is an independent complaint-handling service for complaints that the NHS has not resolved in England. Note: the PHSO does not deal with complaints involving the private sector.

For help and support in making a complaint, you can contact the Patients Association Helpline, which covers all of health and social care.

5. Seek legal advice

Seek legal advice. Many law firms have regulatory, equality law, and medical experts who can consider your set of facts and determine whether you could successfully challenge the decision.

Remember that there are deadlines you must meet if you wish to challenge a decision via a formal, legal route. You should therefore not delay seeking an initial steer on whether there is merit in pursuing a legal challenge promptly to protect yourself on a ‘limitation’ front.

6. Consider medication continuity options

You can request that your GP provide a bridging prescription while the matter is reviewed, to avoid abrupt withdrawal.

Alternatively, you could check whether a private prescription is possible temporarily (you’d have to pay, but it ensures continuity).

7. Look for another GP

Some GPs are more knowledgeable and supportive of trans healthcare. This resource from Trans Healthcare Intelligence lists trans-friendly GPs based on real patient experiences.

If you’re in a rural area with fewer local options, consider an LGBTQ-inclusive online UK GMC-registered GP service.

If you’ve completed all these steps without success, please get in touch with us at community@anne.health.

Using our sample letter templates

These sample letter templates have been reviewed by solicitors at Russell-Cooke LLP prior to publication. Notes on using these templates:

• Always keep a copy of all messages for your records.
• Ensure that you read and review the template, making any necessary amendments to reflect your personal circumstances accurately. This is your letter, not ours, and it’s important that you are confident with the contents.
• Check that all changes have been made, all addresses and names are included, and that no brackets remain before sending the template.
• Try to include all relevant supporting documents before sending.