Prescriptions can still be issued for puberty blockers for some children and young people if the prescriber 'feels competent to do so’, NHS England (NHSE) has said in new advice.

It comes as the Government has recently extended the legal ban on private prescribing of puberty blockers, which was first introduced in May under the Conservatives, until 26 November.

Now, NHSE has written to GPs and primary care prescribers to set out guidance for dealing with patients under 18 who want to access puberty suppressing hormones, in light of the new regulations.

In the letter, seen by our sister publication Pulse, NHSE said that young people currently taking the medicines who are no longer able to access further prescriptions ‘are being advised they should speak to their GP’.

In this case, the GP team should ‘offer to see any young person’ and assess whether a referral to the Children and Young People Gender Service or for mental health support are required.

However, from 1 September, GPs will no longer be able to refer young people directly onto waiting lists for children gender services, with referrals only accepted from paediatric or mental health services.

‘The continuation of puberty suppressing hormones can be considered where the GP feels competent to do so, and where confirmation that treatment had been underway in the six-month period before 3 June 2024 is available,’ the letter added.

If a prescription of puberty blockers for gender incongruence is continued, the prescription ‘needs to be endorsed “SLS” to satisfy NHS Regulations’.

NHSE also told clinicians that they should advise patients not to buy ‘GnRH analogues (or any other medicines) from unregulated sources such as the internet, friends or from street dealers’.

If a child or young person is accessing puberty blockers from these sources, GPs should consider whether ‘safeguarding procedures’ need to be explored.

It advised that any patients stopping the medicines ‘may benefit from psychological and potentially psychiatric support’, due to the ‘incidence of mental health presentations’ for young people with gender dysphoria who seek ‘sex reassignment interventions’.

The letter, signed by NHSE primary care director Dr Amanda Doyle and specialist services director Professor James Palmer, also advised primary care prescribers to meet with patients to ensure the ‘risks of continuation/initiation are fully understood’, due to the ‘limited evidence base’ which is laid out in the Cass Review.

Prescribers must also ‘take due diligence’ to determine whether the patient had initially been issued the prescription in the six-month period before 3 June 2024, as per the regulations.

The letter said: ‘This would need to be in the form of documentary evidence. The form of the evidence (letters, prescriptions…) which a GP should rely on to decide whether a course of treatment has started has not been specified in legislation, but whether treatment has previously started is ultimately a question of fact.’

A version of this article first appeared in our sister publication Pulse.