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Our response to the review carried our by Dr David Levy and published on 18th December.
Trans+ people have waited years for the NHS to acknowledge what they already knew: adult gender services are failing. Dr Levy’s review finally admits it, but stops short of real solutions.
Long waits, inconsistent care, and a system that cannot meet people’s needs. We welcome the review’s acknowledgement that change is needed. But it misses several important opportunities.
The report is clear: the current system isn’t working. Patients are waiting years for basic care. Services are understaffed and under-resourced. There’s no consistent approach to assessment or treatment across the country.
These are serious problems, and investment is essential.
The review calls for standardised biopsychosocial assessments, complexity measures, and multi-disciplinary team meetings for ‘complex’ cases. What’s missing is any serious consideration of informed consent.
Trans+ people understand their own needs and goals. What they need isn’t more assessments. It’s timely access to safe, evidence-based care that respects their autonomy. The move to end self-referrals risks more gatekeeping, based on the false assumption that more barriers equal better care.
The move to end self-referrals seems to suggest more gatekeeping. The review seems to assume that more gatekeeping equals better care. We disagree.
The review reinforces the idea that gender-affirming care sits outside everyday healthcare. By pushing responsibility away from GPs and toward distant GDCs, it allows primary care to disengage and leaves trans+ people waiting longer, travelling further, and feeling increasingly “othered” within the NHS.
In reality, GDCs are handling high volumes of routine, non-specialist work: hormone prescribing and blood monitoring that GPs already provide daily for cis patients. Better GP training would reduce wait times and allow specialist services to focus on genuinely complex cases.
Train more clinicians in gender-affirming healthcare. Integrate routine care into primary care settings through proper GP training. Increase capacity where it’s needed: in clinics that deliver care, not in assessment bureaucracy. End the postcode lottery with consistent, nationwide standards.
Trans+ people are experts in their own identities. They need comprehensive information and ongoing support, not lengthy assessments that delay care. Respecting autonomy isn’t just ethical, it leads to better outcomes.
Ban LGBT+ conversion practices in ways that protect trans+ people and gender-affirming care, rather than weaponising the law against them. Make Gender Recognition Certificates accessible, not an obstacle course.
In some Integrated Care Boards, we know that individual GPs are refusing routine care for trans+ patients, including blood tests, prescribing, and Shared Care Agreements. This is not about clinical complexity.
It reflects fearmongering and uncertainty around trans healthcare.
Reform must address this directly, so that everyday monitoring and prescribing are treated as routine care, not something exceptional or risky.
Put trans+ people at the centre of service design. Create governance structures that prioritise trans+ wellbeing. Support clinicians to facilitate care rather than gatekeep it. Offer active support to people waiting, not just signposting to overstretched mental health services.
Collect meaningful data on where care is failing and hold services accountable. Better integration between GPs, local services, and specialist clinics means better coordinated care and fewer people falling through gaps.
While the Levy Review correctly highlights just how broken the NHS system is for trans+ people, and suggests ways to improve, it still falls short of the radical changes required.
Trans+ healthcare can, and should, be better. We’re here until the NHS makes that happen.
Take the first step with Anne.
We’re here to guide and support you with inclusive, gender-affirming care built around you.