Introduction

Anne+ believes every trans+ person should have access to safe, gender-affirming care. Anne+ exists to help trans+ people get the medical care they need.

This toolkit is designed to give information and materials to help people navigate trans+ care pathways in England.

Because care differs for patients under and over 18, we have provided information on the specific needs of each group.

This toolkit:

• is for people aged 18 and over.
• considers both NHS and non-NHS care pathways.
  is intended for general information only and should not be relied upon as legal or medical advice.
• has been reviewed by solicitors at Russell-Cooke LLP prior to publication.

Some of the key authorities

Equality Act 2010

The Equality Act 2010 is a piece of UK legislation which applies in England, Wales, and Scotland. Northern Ireland continues to have its own equality legislation.

The Equality Act 2010 outlines the personal characteristics protected by law and the behaviour that is unlawful. The Equality Act protects individuals from “discrimination” in a variety of situations, such as:

• at work
• in education
• the provision of services and public functions
• clubs and associations
• the management and disposal of premises
• and in relation to transport.

The Equality Act 2010 means that healthcare providers (both public and private) must not unlawfully discriminate, harass, or victimise people based on the Act’s nine ‘protected characteristics’, including trans+ people who fall under the definition of the characteristic, “gender reassignment”.

NHS England constitution

The NHS England Constitution outlines the core values of the NHS in England.

The Constitution is important because it outlines the fundamental legal rights that everyone who uses the NHS is entitled to. This includes the right to access treatment based on clinical need rather than ability to pay, high standards of professional care, and patient involvement in decisions. As stated on the Government website, “All NHS bodies and private and third sector providers supplying NHS services are required by law to take account of the constitution in their decisions and actions.”

For many trans+ people, the NHS is falling short on various commitments in the following ways:

• Long waiting times: NHS gender dysphoria clinics (“GDCs”, (formerly GICs) waiting lists are among the longest in the NHS. The average waiting period for a trans+ person waiting for their first GDC appointment is stated as being 4 to 8 years; however, there are reports of waiting times exceeding several decades in some cases.
• Inequality of access: Many people pay privately or travel abroad for their gender-affirming care due to the long NHS waits, creating a two-tier system where access depends on financial means. This disproportionately affects those who are of low socio-economic status.
• Limited support in primary care: GPs and local services may feel undertrained or unsupported, leading to inconsistent access to routine care, with many deeming help to be a ‘postcode lottery.’
• Mental health impact: Delays and fragmented care directly contribute to poor mental health and higher suicide risk.
• Representation gaps: Trans+ people report trans+ voices being absent from service planning and reviews. This leads to a service provision (or lack thereof) that has not been informed by direct, patient-centred information.

How does NHS England work?

• NHS England runs the NHS in England. Its role is to provide leadership, oversight and to allocate funding.
• NHS England is funded by the UK Government’s Department of Health and Social Care.
• Currently, there are 42 ‘Integrated Care Systems’ (ICS), and each ICS has an ‘Integrated Care Board’ (ICB), which is responsible for NHS functions and budgets, and ‘Integrated Care Partnerships’ (ICP), which bring together the NHS, local authority, and the voluntary sector.
• ICBs are responsible for funding local primary care services, including GP practices.
• The primary commissioning responsibility for adult gender identity services lies with NHS England, specifically via its “Specialised Commissioning” arm. These are classed as “specialised services”.
• At the local level, place-based partnerships and Primary Care Networks (groups of GP practices) coordinate with community, mental health, hospital and social care providers to deliver joined-up services.

Your right to be involved in decision-making

The GMC’s updated guidelines on decision-making and consent emphasise that patients have the right to be involved in decisions about their care and to receive support to make informed choices:

“All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.” 

Quality control

This toolkit will be kept under review and updated as promptly as possible when necessary.

The most recent review occurred in October 2025.

If you think this toolkit is missing something you’d find helpful or you think something might be incorrect, please let us know at community@anne.health