The rules about missing an appointment at England's new regional Young People's Gender Services are not fully transparent and are still being established. What is publicly known suggests services have some discretion, but families should contact the service directly and quickly to explain any missed appointment and ask explicitly whether waiting time is affected.
Why this question matters so much right now
If you or your child has been waiting years for a gender service appointment, the idea of losing that place to a single missed visit is genuinely frightening. And given how long waits currently are, it is not an unreasonable fear. Many families tell me they feel they are walking a tightrope: one wrong step and years of waiting could count for nothing.
That fear deserves a straight answer. The trouble is that the straight answer, at the moment, is that we do not fully know, because the services themselves are new and their policies are not yet fully published or standardised. That is not a satisfying thing to say, but pretending otherwise would not help you.
How England's new regional Young People's Gender Services work
The old Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust closed in 2023, following the Cass Review. In its place, NHS England commissioned a new model: a network of regional Young People's Gender Services (YPGS), based at children's hospitals around the country. These services began seeing patients from 2024 onwards.
The model is structured around a multi-step assessment process. A young person is typically referred to the regional service by their GP or local mental health team. Once accepted onto the waiting list, they wait for an initial appointment. The assessment itself usually involves several contacts rather than a single visit: an initial assessment, potentially one or more follow-up appointments with a multidisciplinary team, and then onward recommendations that might include psychology support, social transition guidance, or, in some cases, a referral for physical interventions.
Because the pathway is multi-step, the question of what happens if you miss one of those steps is a real and practical one, not a theoretical worry.
What the services have said publicly about missed appointments
The limits of what is publicly known are real. As of mid-2026, the individual regional services have not published detailed, standardised policies on what happens when a young person misses an assessment appointment. Some individual trust websites carry general NHS missed-appointment guidance, which typically states that missing appointments without notice may result in discharge from the service. That is standard NHS language and it is worth taking seriously, but it is not specific to gender services and does not tell you whether there is discretion, what counts as adequate notice, or whether partial waiting time is preserved.
NHS England's overarching specification for the new services sets out the clinical model in some detail, but the operational specifics around attendance and re-referral sit with individual trusts. That means the answer to your question may differ depending on which regional service your child is under.
What I hear from families navigating this is that services have, in practice, shown some willingness to work with people when circumstances are explained clearly. But "in practice" is not the same as a written policy you can rely on, and I am not in a position to promise you that is universal or consistent.
What genuinely puts a place at risk
From what is known, the situations most likely to result in discharge or removal from the waiting list are: missing an appointment without any contact beforehand or afterwards, failing to respond to letters or communications from the service over a period of time, or repeatedly not attending once a course of appointments has begun. In other words, it is the pattern of non-engagement that tends to trigger administrative discharge, rather than a single missed appointment where the family has been in touch.
That distinction matters. An appointment missed because of illness, a family crisis, transport difficulties, or a young person's anxiety about attending is very different from a family that simply cannot be reached. Services generally understand that trans young people and their families are not always in a straightforward situation, and that anxiety about the process itself can get in the way of attendance. That does not mean anything goes, but it does mean that explanation and communication are your best tools.
What to do if you have missed an appointment
Contact the service immediately, by phone if you can, followed up in writing. Do not wait to see what happens. Explain clearly why the appointment was missed, and ask to reschedule. When you do, ask this question directly: has my child's position on the waiting list been affected by missing this appointment?
Get the answer in writing, or at least note down the name of the person you spoke to, the date, and what they said. If the service tells you the place has been lost or the waiting time forfeited, ask what the process is for re-referral and whether any credit is given for previous waiting time. That is a fair question and you are entitled to ask it.
If the appointment was missed for a reason that might count as a reasonable adjustment under the Equality Act 2010, for instance because of a disability or mental health condition that made attendance impossible, say so. Services have legal obligations around reasonable adjustments, and framing your circumstances in those terms is not confrontational: it is accurate.
If the service says the place has been lost
If you are told that your child has been discharged and must be re-referred, that is devastating news and I do not want to minimise it. But it is not the end of the road, even though it feels like it. The re-referral route via a GP remains open. Some families in this situation have also found it useful to ask their GP to write to the service directly, explaining the circumstances, which can sometimes influence whether the discharge decision is reconsidered.
It is also worth being aware that NHS England does have a formal complaints process, and if you believe the service acted unreasonably given your circumstances, you have the right to raise that through the NHS complaints procedure. The Patient Advice and Liaison Service (PALS) at the relevant trust can help you navigate that process without it becoming a formal complaint if you would rather start informally.
The bigger picture: policies that families deserve to see
The uncertainty here is not acceptable in the long run. Families who have waited years for a service have the right to know, in plain language, what the rules are. What counts as adequate notice for cancellation? Is there a maximum number of rescheduled appointments? What is the re-referral process and does prior waiting time count? These are not unreasonable questions and they should be answered in writing on every service's website.
The new regional services are still establishing themselves, and I understand that operational policies take time to develop and publish. But the cost of that delay is not abstract. It is real anxiety, in real families, at a moment that is already extraordinarily difficult. That is a cost worth naming.
If you are a family in this position and you find that a service cannot or will not give you clear answers about your child's place on the waiting list, that is itself useful information. Write down what you were told and when. Ask for clarification in writing. And if you need support thinking through what to say or how to approach the conversation, come back here and let Sammy know what is happening.
What questions to ask the service directly
If you are anxious about a missed appointment, or want to be prepared before one happens, here are the questions worth putting to the service:
- What is your policy if a young person misses an assessment appointment?
- Does missing an appointment affect their position on the waiting list?
- What notice do you require for a cancellation?
- If a place is lost, what is the re-referral process and does any previous waiting time carry over?
- Do you make reasonable adjustments for young people whose health or circumstances made attendance difficult?
You are entitled to clear answers to all of these. If the service cannot give them, ask who can, and ask for the response in writing.
If there is a topic that you would like me to cover, just let Sammy know.
Written by Dr Helen Webberley, Gender Specialist and founder of GenderGP, advocate for trans healthcare and the lives built around it.
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