Can a GP refuse a bridging prescription?

Can a GP refuse a bridging prescription? A GP can decline a bridging prescription, but refusal is not automatic or required. Both the GMC and RCGP recognise that GPs may prescribe hormones to trans people waiting for a gender clinic, to reduce the real harm of self-sourcing. If your GP refuses, there are practical next steps worth knowing. What is a bridging prescription? A bridging prescription is a short-term prescription for gender-affirming hormones, usually oestrogen or testosterone, written by a GP to cover the period while someone waits for an appointment at a gender clinic. The name captures exactly what it does: it bridges a gap that has, for many people, stretched into years rather than months. The gap it bridges is not trivial. NHS gender clinic waiting lists in the UK have run to several years in some cases. During that time, a trans person without hormone access faces a choice between waiting and watching unwanted puberty changes accumulate, or sourcing medication themselves from outside the regulated system. A bridging prescription is the third option, and for many people it is the one that keeps them safe. What do the GMC and RCGP actually say? This is where the confusion often starts. Many GPs believe they are not permitted to prescribe bridging hormones, or that doing so exposes them to professional risk. That is not what the guidance says. The General Medical Council's (GMC) position is that prescribing decisions should be based on the clinical needs of the individual patient, using the prescriber's own professional judgement. A GP who decides, on clinical grounds, that prescribing bridging hormones is in a patient's best interests is acting within that framework. The GMC does not prohibit bridging prescribing. The Royal College of General Practitioners (RCGP) has also acknowledged that GPs may be asked to prescribe bridging hormones and that this is a legitimate clinical request. Their position recognises the reality of waiting lists and the harm that unmonitored self-sourcing causes. The RCGP does not instruct GPs to refuse. Neither body has issued guidance requiring refusal. What GPs are asked to exercise is clinical judgement, which means they can say yes as well as no. Why do some GPs refuse? Refusal tends to come from one of three places, and it helps to know which one you are dealing with. The first is genuine unfamiliarity. Many GPs trained at a time when gender-affirming care was not part of the curriculum, and they feel unconfident about hormone doses, monitoring requirements, and drug interactions. That is understandable, but it is also solvable: the information is available, and a GP who wants to prescribe can find the support they need. The second is a misreading of the guidance. Some GPs have been told, or have come to believe, that bridging prescribing is outside their scope or carries regulatory risk. As the GMC position makes clear, that is not correct. A GP who is genuinely willing but uncertain can contact their medical defence organisation or refer to the RCGP's position for reassurance. The third is a conscious refusal based on personal values. A GP has the right to decline a clinical intervention on grounds of conscience, but the GMC is clear that any GP who does so must refer the patient promptly to someone who can help. A refusal that leaves a person with no route forward does not meet that standard. What harm does refusal cause? The harm is real and it is not always named clearly enough in clinical conversations. When a trans person is refused a bridging prescription and cannot access hormones through a regulated route, many of them source from online pharmacies, grey-market suppliers, or peer networks. I hear this constantly from people who have shared their experiences with me. They are not doing it recklessly; they are doing it because the alternative, watching their body move further from who they are while a waiting list ticks over, is worse. Self-sourcing without monitoring carries genuine risks: incorrect dosing, drug interactions that go unnoticed, and no baseline blood tests to catch problems early. These are risks that a bridging prescription, with appropriate monitoring, removes. Refusal is not a neutral act: it does not protect the patient from hormones, it pushes them towards unmonitored hormones instead. There is also the question of mental health. The research base consistently links access to gender-affirming care with improved wellbeing, and links prolonged delay with worsening distress. A refusal that adds months or years to that delay has consequences. What should a GP do if they feel unsure? A GP who wants to prescribe but is uncertain about the clinical detail has several routes available. They can write to a gender clinic for shared care advice, even if a formal shared care agreement is not yet in place. They can contact their local primary care lead or clinical pharmacist. They can use the information published by the RCGP and the Gender Identity Research and Education Society (GIRES) as a clinical reference. They can speak to a specialist private provider, such as GenderGP, whose clinicians are experienced in this area and routinely support GPs who want to prescribe but need clinical backing. None of this requires the GP to become a gender specialist. It requires them to treat a trans patient with the same willingness to find an answer that they would bring to any unfamiliar clinical question. Practical steps if your GP refuses If you have been refused a bridging prescription, here is what I would suggest. Ask your GP to explain the clinical reason for the refusal, in writing if necessary. A refusal that rests on unfamiliarity rather than a specific clinical contraindication is worth challenging, and having the reason documented helps if you decide to escalate. Ask whether they can refer you to a colleague within the practice who is willing to prescribe, or make a referral to a GP with a special interest in trans healthcare. You are entitled to a second opinion. If the refusal is on grounds of conscience, the GMC standard requires your GP to refer you promptly to someone who can help. If they have not done that, you can raise a complaint with the practice manager, and if that does not resolve it, with NHS England or your equivalent body. Consider a specialist private provider. GenderGP at gendergp.com works with people who have been refused through public routes and can provide both the clinical oversight and, in many cases, prescriptions that your own GP may then be willing to continue under a shared care arrangement. Document everything. Dates, what was said, what was refused, and what reason was given. If you need to make a formal complaint later, that record matters. The bigger picture A GP refusing a bridging prescription is not following a rule that requires them to refuse. They are making a clinical or personal decision, and that decision has consequences for a real person's health. The GMC and RCGP positions both create space for GPs to prescribe, and many do. The gap between what guidance permits and what trans people actually experience at the GP surgery is one of the most frustrating features of navigating this system. You deserve a GP who will engage with your healthcare needs as seriously as they would anyone else's. When that does not happen, knowing your options is the most useful thing I can offer you. If there is a topic that you would like me to cover, just let Sammy know. Dr Helen Webberley is a Gender Specialist and founder of GenderGP. She writes and advocates for trans-inclusive healthcare and equality.

What should I do if my GP refuses hormones? › Is it safe to self-source hormones without a prescription? ›