Kamilla Kamaruddin is a GP in transgender health care and clinical lead for the East of England Gender Service, Cambridge.
The population of the UK is 67.1 million,1 and 61.8 million patients are registered at GP practices as of 1 September 2022.2 So, it makes sense that GPs are key to deliver assessment, treatment, continuing care, person-centred care, and preventive medicine to the general population.
Patient’s data are captured on our IT system in primary care. Primary care have information about demographics, ethnicity, gender identity, age, sexual orientation, population health, and ways to measure and address health inequalities. Our NHS services are free at the point of contact and GPs are often the first point of contact for most people accessing health care irrespective of race, colour, sexual orientation, gender identity, and economic background. Undocumented people are also able to register with a GP in the UK and there is no requirement to show proof of identity or immigration status.3
During the pandemic we faced huge challenges in delivering care to the public. We had to be creative, innovative, and adapt to new ways of working to protect our patients, colleagues, staff members, and family. We have proven that we could deliver good medical care under challenging circumstances and unexpected demands. In the worst of times, we have proven that we can shine and show leadership. We never stop working.
“Diversity in the boardroom is an important factor and should be reflective of service users.”
However, GPs are often overstretched, an issue exacerbated by the pandemic and limited resources in general practice. Trans people face multiple barriers to health care from various healthcare providers.4 Most trans patients have a good level of trust in their general practice, which can be further built on with the support of charitable organisations to encourage patients to engage with health care. GPs share their core values with charitable organisations in delivering care to trans people, so it makes logical sense to collaborate.
Many trans people have a good experience when engaging with charitable organisations who are able to provide a safe meeting space, host a trans-led support group, improve fitness and wellbeing, improve mental health by providing trans-specific counselling sessions, support trans people affected by cancer, support trans people in social transition, provide trans-specific sexual health clinics, give employment advice, and improve social cohesion by building self-confidence. Charitable organisations can reduce demand on GPs and have an enormous impact on long-term health benefits and facilitate key improvements in population health.
In this article I will demonstrate how GPs can help trans people in the community and deliver services in a friendly, safe, confidential, non-judgemental, and accessible space both in person and online. GPs and other healthcare professionals can work with charitable organisations in their capacity as a board member, trustee, volunteer, patron, or advisor. Most Board members in trans charitable organisations are people with lived experience. However, in my opinion it does not necessarily restrict to only people with lived in experience; allies can equally contribute effectively to the success of transgender charitable organisations.5
Diversity in the boardroom is an important factor and should be reflective of service users. Diverse groups make far superior and more reflective decisions — more creative and constructive decisions to improve their services. Without diversity the pressure to be collective and conform can be stifling and a barrier to progression. Board members can help to steer their organisations and give confidence to their service users. Their service users will find the organisations meet their needs and make them feel valued.
The message that charitable organisations should be able to shout loud and clear is: WE ARE HERE TO HELP YOU TO BE YOU!
What are the duties of a board member?:6
- duty of care — a board member has to be proactive, participate, communicate, and provide support to their chosen charity organisation;
- duty of loyalty — all activities are in the interest of the organisation and not for personal interest; and
- duty of obedience — to keep in line with governance within the organisation and steer organisation towards its goals.
What are the responsibilities of a board member?:
- to uphold the mission of the organisation;
- has an understanding of internal policies and comply with legal implications of the organisation;
- attend board meetings;
- overseeing hiring organisation staff;
- ensure resources are available to improve communication; and
- each board member has different skills and experience but work collaboratively to ensure success of the organisation.
I am a board member with Spectra-London, The Clare Project, and Live Through This, and a volunteer for Trans Actual. Spectra-London is a charitable organisation that helps trans and non-binary people in London, who are an underserved community, to reach their full potential by being empowered to make positive, informed life-choices.
Spectra-London emphasises cis allyship to improve the lives of trans people. Spectra’s history has shifted from HIV in men who have sex with men to trans health, and is developing trans services to be led by peers — the founding of the ‘Trans Learning Partnership’ (TLP) is a major breakthrough. TLP is a trans and non-binary research and development programme. Sharing knowledge, experience, and good practice to directly improve the lives of trans people, Spectra-London is encouraging GPs and health care to embrace trans-led futures.
Live Through This helps LGBTIQ+ people in the UK affected by cancer and we do this through three main actions:
- for patients, we provide peer support, advocacy, and connection;
- for professionals, we provide high-quality education, and support clinical and research networking; and
- we also produce bespoke campaigns and information, and work with key stakeholders in cancer care to update policy and best practice guidelines.
The Clare Project supports trans people across Sussex in South East England. The Clare Project provides community-led psychosocial support for trans adults and this compromises of: weekly drop-ins, online groups/workshops, a therapy-cooking group, a neurodivergent group, 1:1 support/coaching, small, short-term psychotherapy offering, regular socials, and adhoc advocacy.
The Clare Project also runs community upskilling and resourcing sessions, for example, support in applying for social benefits, self-advocating medical needs, information sessions on gender affirming surgeries, social transition, and navigating relationships. TCP chair several community steering groups, offer mentoring/support to smaller developing groups, are heavily involved in local NHS inclusion engagement work, co-run the Trans Health Hub, and deliver training aspects of the trans locally commissioned service. We are at present in discussions with Sussex NHS commissioners to help with the framework of delivering GP-led gender services.
Trans Actual UK is a charitable organisation run by the trans community, with the trans community, for the trans community. As a GP working in transgender health care, I volunteer to improve trans people’s experience with health care. Recently we have published the Trans Lives Survey 21,7 which reports trans people’s experience with daily life and health care — 14% reported that they were refused GP care on account of being trans on at least one occasion and 57% of trans people reported avoiding going to the doctor when unwell. We advocate, we inform, and we empower.
GPs are leaders in a community, and general practice plays an important role in community projects to make positive changes in their health. We can facilitate, collaborate, and innovate in decision making, empowering the participation of community members to improve their health. General practice has the passion, commitment, and a strong belief that however big or small your contribution is to society it can bring an enormous benefit to the wellbeing of patients in the community.
I acknowledge the contributions made to this article from Karen Skipper, CEO, Spectra-London; Stewart O’Callaghan, Founder, Live Through This; Chay Brown, Director of Operations, Trans Actual UK; and Gray Hutchins, Operations Manager, The Clare Project.
- UK Population Data. UK population 2022. 2022. https://populationdata.org.uk/uk-population (accessed 6 Oct 2022).
- NHS Digital. Patients registered at a GP practice. 2022. https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice (accessed 6 Oct 2022).
- Office for Health Improvement and Disparities. NHS entitlements: migrant health guide. 2022. https://www.gov.uk/guidance/nhs-entitlements-migrant-health-guide (accessed 6 Oct 2022).
- Mikulak M, Ryan S, Ma R, et al. Health professionals’ identified barriers to trans health care: a qualitative interview study. Br J Gen Pract 2021; DOI: https://doi.org/10.3399/BJGP.2021.0179.
- Theuer C. Diversity is strength in the corporate boardroom. Forbes 2022; 12 May: https://www.forbes.com/sites/forbesbooksauthors/2022/05/12/diversity-is-strength-in-the-corporate-boardroom (accessed 6 Oct 2022).
- Bodin S. What is a non-profit board? 2022. https://www.thecorporategovernanceinstitute.com/insights/lexicon/what-is-a-non-profit-board (accessed 6 Oct 2022).
- Trans Actual. Trans lives survey 2021: enduring the UK’s hostile environment. 2021. https://static1.squarespace.com/static/5e8a0a6bb02c73725b24dc9d/t/6152eac81e0b0109491dc518/1632824024793/Trans+Lives+Survey+2021.pdf (accessed 6 Oct 2022).