The British Medical Association has spoken clearly, and I am glad it has. In response to the EHRC's revised draft Code of Practice, published following April's Supreme Court ruling on the definition of sex under the Equality Act, the BMA has raised serious concerns about what this means for trans patients and for the doctors and nurses who care for them. This is not a political statement presented as clinical guidance. It is a medical organisation saying, plainly, that the people it represents are worried, and that the people those members care for could be harmed.
The EHRC's draft Code recommends that service providers offer a 'third space' to trans people rather than allow them to use facilities in line with their gender. The BMA's response to this is unambiguous: it describes the repercussions as potentially devastating. I think that is exactly the right word. Think about what healthcare actually involves. A ward admission. A changing room before a procedure. A shared bay. A consultation that requires physical examination. These are not abstract policy questions. They are moments of profound vulnerability, and trans patients deserve to move through them with the same dignity as anyone else.
What the BMA is actually saying
The BMA is not hedging. It states directly that the Supreme Court judgement and the Code of Practice do not reflect the reality of NHS services, many of which are already struggling to provide safe and dignified care for trans patients. It calls on NHS England and the devolved health bodies to publish specific guidance without delay, guidance that must set out explicitly how healthcare services should apply the updated Code while maintaining inclusion, safety, and dignity for trans and gender diverse patients and staff.
That call for explicit guidance matters in practice. In the absence of clear direction, individual providers will make individual decisions, and the result will be a patchwork: some trusts doing their best to protect trans patients, others defaulting to the most restrictive interpretation available. That inconsistency is itself a harm. A trans woman admitted to hospital in one city should not face a fundamentally different experience from one admitted two counties over.
The BMA is also clear that while the Code formally applies to services rather than workplaces, it will have a knock-on effect on trans healthcare workers too. Doctors and nurses who are trans need to be able to do their jobs, access facilities that match their gender, and feel that their employer is on their side. The BMA continues to call for that, and it is right to do so. A healthcare system that cannot look after its own trans staff is not going to look after its trans patients well either.
It is worth noting what the BMA has already done beyond publishing this statement. Following the Supreme Court ruling, it wrote directly to the EHRC and to NHS England to raise concerns and to call on both bodies to mitigate the potential harms. This statement is not the BMA discovering the issue: it is the BMA pushing again, more publicly, because the EHRC's draft Code has now made the stakes concrete.
What the Code gets wrong
The 'third space' proposal sounds neutral. It is not. It places the burden of managing exclusion onto trans people themselves and onto already stretched service providers, who are now expected to police identities and decide which individuals should use which facilities. That is an extraordinary ask of a ward nurse or a hospital administrator, and it creates a dynamic in which trans people are treated as a category requiring management rather than as patients requiring care.
It is also worth noting precisely what the Supreme Court actually decided. The Court interpreted the Equality Act as meaning that the terms 'woman' and 'man' refer to biological sex for the purposes of that Act. It did not define what a woman is in medicine, in society, or in everyday life. It did not remove protections from trans people: the Court confirmed that trans people remain protected under the characteristic of gender reassignment. The EHRC's Code, however, has run considerably further than the judgment itself, and the BMA is right to challenge that.
The BMA also notes that while the Code expands or clarifies protections in other areas, including breastfeeding, menopause, pregnancy, and same-sex marriage, it does so by embedding trans exclusion as the default. Protections for some, codified exclusion for others. That asymmetry should not pass without comment, and it does not.
What this means for doctors who want to care well
Many doctors are already quietly doing the right thing. They are treating trans patients with respect, using correct names and pronouns, and providing care that is responsive to the person in front of them. The uncertainty created by this Code puts those doctors in a difficult position: they know what good care looks like, and they are now operating in an environment where the guidance above them is in flux and potentially at odds with their own values and their patients' needs.
The BMA's statement is, in part, reassurance to those doctors. It has reaffirmed its own policy: fair and equitable access for all trans staff and patients to accommodation, services, and care according to their gender. For a doctor trying to do right by a trans patient, knowing that their professional body is behind them matters. The BMA also reminds members that it can offer support where discrimination or harassment occurs, and that its free 24-hour wellbeing service is available to all doctors and medical students, members or not.
What I hope comes next is that NHS England moves quickly. The BMA is right that delay is not neutral here. Every week without clear guidance is another week in which trans patients face uncertainty, anxiety, and the real possibility of being turned away from or humiliated in spaces they have every right to use. That is a clinical harm, not a political inconvenience, and it deserves to be treated as one.