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Inside the Inverness gender clinic: How has the service developed over recent years?

By Andrew Henderson

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The Inverness gender clinic has gone from strength to strength over recent years.

It was not that long ago that it would have been a stretch to call the service on offer at Raigmore Hospital a clinic.

There was just a single person working in gender-based treatments six years ago, but the department has gradually grown, with professionals in other departments coming on board to assist in the process.

The process for trans people medically transitioning includes regular check-ups, psychological assessments, prescribing hormones and referrals to other services.

The Inverness gender clinic has grown significantly over recent years.
The Inverness gender clinic has grown significantly over recent years.

That is a lot to ask of one person, so over the last few years the service has added a nurse, a GP, a Gender Identity Psychological Service, and support from the endocrinology department at Raigmore.

“A lot has gone on, and I think we’re in a really good position now,” a doctor at the Inverness gender clinic explained.

“As a team, we are delighted, because some of it has been a struggle. Nationally, the pool of people with actual clinical gender experience is small. Currently, there is no recognised pathway for training, so it’s all done on the job.

“The GP that joined us last year had been looking after her own cohort of trans people in her surgery. That varies between GPs – some do, and some don’t. She was interested in working with the clinic a day a week as part of her job.

“The exciting part for me was that after five years doing the job, I now had a colleague to speak to. This made a huge difference, because up until then I was the only doctor doing it.

“Two years ago the Scottish Government provided funding to improve gender services throughout Scotland. We had to set out a business case of what we wanted, what it would cost, and then they made a decision on whether to authorise it or not.

“That gave us the opportunity to think about how we could improve our local service, so after quite a bit of work and consultation with different people we got the NHS Highland head of psychology on board. Now, there are four psychologists in NHS Highland who did training with the gender psychologist in Aberdeen.

“Since February 1 this year, we no longer send our patients to Sandyford for psychological assessment. They are seen by professionals in Highland, which will inevitably reduce the waiting time to be seen.

“As part of the Sexual Health Strategy Group, we now have a gender identity sub-group that meets every four to six weeks and it is now a standing item on the strategy agenda.

“The sub-group comprises a variety of health professionals which include representatives from community mental health, public health, psychology, general practice, service and finance managers and me as the clinician locally.”

One of the big challenges gender clinics across the country face is waiting lists.

In other parts of Scotland, thousands of people are waiting for their first appointment after being referred to a gender clinic, but most of the time the resources are not in place to see them inside a couple of years.

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That situation has changed over the years with the Inverness clinic too. During Covid, the gender clinic was one of the few clinics that could keep working by embracing virtual, online consultations, so the entire Highland waiting list was cleared.

In recent years, that number has grown again, with 95 people on the Inverness waiting list as of mid-April.

That is something medical professionals are conscious of, making sure that patients on the waiting list are not left to completely fend for themselves until they are seen by the clinic, but positive steps are being taken that should see that number drop again in the future.

“The waiting list still might be around the same, but that would be because of more referrals coming in while we’ve been seeing more and more people with the extra support from staff,” the doctor added.

“The waiting list definitely won’t come down to zero in 2024, but we hope that we get to a stage where people are waiting for two or three months rather than 18 months. That’s where we’re at.

“Our service is more robust now, there are more resources going into it, so we can see more patients locally.

“Another improvement that we are trying to make is to ensure that patients are not left unsupported whilst on the waiting list. Good mental health support is crucial in that.

“Patients who are seen more quickly will often see their mental health improve. It’s not black and white – some will still need support, and some will never need help – but if we recognise that some people will need support while they wait, that’s a good step.”

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