NHS waiting times for trans young people currently run to several years, causing real harm through unwanted puberty changes and worsening distress. Practical solutions exist: integrated GP training, reformed funding models, and distributed care pathways that spread expertise beyond a handful of specialist centres. None of this requires new legislation.
Why delay is not a neutral option
When policymakers and commentators talk about slowing down access to care for trans young people, they often frame caution as the safe default. I want to push back on that directly, because the evidence does not support it. Delay carries its own harms: puberty changes that cannot later be undone, deepening distress as a young person watches their body develop in ways that feel profoundly wrong, social withdrawal, deteriorating mental health, and in some cases self-harm. These are not hypothetical risks. They are what young people and their families describe to me, again and again.
The question is never "treatment or no treatment." It is always "which risks are we prepared to accept." A system that imposes a multi-year wait has made a choice about that, whether or not it frames the choice in those terms. Honest policy has to start by acknowledging what is actually being weighed.
What the current NHS pathway looks like in practice
There is currently no functioning NHS specialist gender service for children and young people in England that can meet demand. Following the closure of the Gender Identity Development Service (GIDS) at the Tavistock, a regional hub model was announced, but implementation has been slow and waiting lists have transferred rather than shortened. Young people and their families are routinely waiting two to four years simply to reach an initial appointment, by which point many are well into a puberty they never wanted.
GPs, meanwhile, occupy an uncomfortable position. Many are willing to help and genuinely want to support their young patients, but they have received no training in gender-affirming care, no commissioning guidance that covers shared care arrangements, and no clinical framework within which to act. The result is that even GPs who want to do something constructive often cannot, because the system has not given them the tools.
GP training: the fastest lever to pull
The most immediate change the NHS could make costs relatively little and could begin within the existing medical education framework. Gender-affirming care needs to be integrated into GP training curricula, not as an optional module, but as a core competency. This means training around social transition support, mental health assessment in the context of gender distress, how to refer appropriately, and the basics of what shared-care prescribing in this area looks like.
This matters for two reasons. First, it means that a young person presenting to their GP gets something useful: a clinician who understands what they are describing, can begin supporting their wellbeing, and can make a timely and appropriate referral. Second, it creates the workforce base for shared-care models, where a specialist centre holds the diagnostic and prescribing oversight while the GP manages ongoing monitoring. That model already works in other complex areas of medicine, from epilepsy to rheumatology. There is no clinical reason it cannot work here.
The Royal College of General Practitioners and the RCPCH both have the frameworks to integrate this into existing curricula. What is missing is the commissioning signal from NHS England that this is a priority. That signal does not require primary legislation. It requires a decision.
Funding models that reward shared care
The current NHS funding model is a significant structural obstacle. Specialist centres are funded per-referral and per-appointment, which means there is no financial mechanism rewarding them for building capacity in primary care or for delegating ongoing care to GPs once a treatment plan is established. Everything flows to the centre, which is exactly why the centres are overwhelmed.
A reformed funding model would look different. Capitated funding, where a sum follows the young person across the pathway and can be split between specialist and primary care providers, creates an incentive to distribute work appropriately. A specialist centre that trains and supports ten GP practices to manage ongoing care for stable patients is doing far more to reduce the waiting list than one that simply adds appointments. The funding model needs to reward that.
This is not a novel concept. NHS England has used capitated and blended funding models in other long-term conditions, including diabetes and mental health. Applying the principle to gender care is a commissioning choice, not a legislative one.
Regional hub-and-spoke networks
The regional hub model that was announced following the GIDS closure is, in principle, the right structural direction. The problem is implementation: hubs that are under-resourced from the start, without the workforce or the commissioning framework to function as genuine centres of expertise that reach outward. A hub that simply replicates the old model on a smaller footprint has not solved anything.
A genuine hub-and-spoke model works like this. The hub holds specialist clinical expertise, provides diagnostic assessment, initiates treatment, and offers complex case oversight. The spokes, meaning GP practices, paediatric teams, school health services, and community mental health teams, manage ongoing support, monitoring, and wellbeing under a shared-care agreement with the hub. The hub trains the spokes, and the spokes extend the hub's reach without requiring every appointment to happen at the centre.
This model reduces travel burden on families, reduces per-appointment cost, spreads clinical expertise more efficiently, and means that more young people can be in active care at any one time. It also integrates trans young people's care into the same structures that support their other health needs, rather than siloing it in a distant specialist centre they see once a year.
Building this properly requires NHS England to commission hubs with an explicit mandate to develop spoke capacity, with funding attached to that mandate and accountability metrics that measure spoke reach, not only hub appointments.
What evidence-based care looks like in this context
The international standards that govern this area, including WPATH Standards of Care 8 and the Endocrine Society guidelines, support a care model that is responsive, multidisciplinary, and proportionate to the young person's needs and stage of development. They do not support a model where a young person waits two years before anyone qualified speaks to them.
Evidence-based care in this context means assessment and support that begins promptly, is grounded in the young person's own experience and goals, involves the family where appropriate, and escalates to medical intervention when the young person is ready and the clinical picture supports it. It does not mean an obstacle course designed to reduce the number of young people who access care. The professional bodies that endorse gender-affirming approaches, including the World Health Organisation, the American Academy of Pediatrics, the Endocrine Society, and WPATH, are clear that withholding appropriate care carries risks that proponents of "watchful waiting" frequently understate.
I am also aware that the Cass Review has been cited to justify restriction. That review has been widely criticised by gender medicine specialists internationally, and its methodology and citation practices have been challenged in detail by researchers across Europe and North America. It is not a basis on which to build NHS commissioning policy, and the harm it has already caused to trans young people in the UK is real and ongoing.
The role of mental health services
One of the most consistent themes I hear from families navigating this system is that their child has been told they must engage with CAMHS before a gender referral can proceed, only to find that CAMHS waiting lists are equally long and that the CAMHS clinicians they eventually see have no particular expertise in gender identity. The child ends up waiting for two queues simultaneously, neither of which is designed to help them efficiently.
Mental health support and gender-affirming care are not sequential. They are parallel. A young person with gender-related distress benefits from both, and evidence supports that gender-affirming steps tend to reduce, not worsen, mental health difficulties. Making mental health assessment a prerequisite gate, rather than an integrated component of care, is not evidence-based. It is a delay mechanism.
Commissioning guidance should make clear that mental health support runs alongside gender care, not before it, and that a mental health difficulty does not disqualify a young person from gender-affirming assessment.
What families can do while the system catches up
The NHS pathway as it exists today is failing trans young people, and the policy changes I have described above are achievable but not yet implemented. In the meantime, families are navigating a system that was not built for their children.
Social transition, which means using a young person's chosen name, pronouns, and presentation, requires no referral and no prescription. The evidence base consistently shows it supports wellbeing. It is something a family can begin any time, supported by school and community, without waiting for an NHS appointment.
For families who need to explore medical options and cannot wait for the NHS, private providers do exist. GenderGP at gendergp.com offers gender-affirming medical care with clinicians who specialise in this area, using current international standards. I founded GenderGP precisely because public waiting times were causing harm, and that reality has not changed.
The policy solutions I have outlined above are not aspirational theory. They are practical, costed, and compatible with existing NHS infrastructure. What they require is the political will to prioritise the health of trans young people as straightforwardly as the health of any other group of children. That is the argument I will keep making.
If there is a topic that you would like me to cover, just let Sammy know.
Dr Helen Webberley is a Gender Specialist, Medical Educator, writer, and advocate, and the founder of GenderGP. She writes about trans healthcare, gender identity, and the evidence behind gender-affirming care.
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