In a couple of weeks I'll be off up to London again, this time to see the GIC counselor. For me that means about an hour on the train, followed by about an hour's walk across the park and through Kensington. I'll be back home by lunchtime, back in work for the afternoon.
Note, I'm not complaining about my journey. Because mildly annoying though it is, compared to some of the patients I'll be sharing the waiting room with it's quite short. For me the GIC is almost local by comparison, even though my train ticket has just cost me about thirty quid.
The NHS can be a little unexpected in its organisation at times. For most ailments that need more than a GP's input you'll be taken to a local general hospital for treatment. You'll be seeing a specialist in your condition, but in the same building there will be specialists in all conceivable medical disciplines. Oncologists, ENT specialists, heart specialists, urologists, the list is endless. Including unsurprisingly, psychiatrists like my local psych who referred me to the GIC and endocrinologists like the one who keeps a yearly eye on the blood of all my local trans friends.
Some ailments, gender dysphoria among them, are seen as specialist beyond the limits of what the general hospital can offer. For these you'll be referred to a specialist regional clinic like the GIC. Each local healthcare trust has a contract with a GIC, and sends its gender dysphoric patients to that GIC.
So far so good, you say. But here's where the unexpected part creeps in. There is nothing that dictates which GIC your healthcare trust has a contract with, so while you might expect to be sent to the nearest one in fact which one you are sent to depends on the postcode lottery of who your trust decided to contract. Thus while I only have to travel an hour for my appointment the lady sitting next to me in the waiting room might have come from the far north-west of Wales, and had to spend the night in London to make her appointment.
population data from the Guardian Datalog. It's not comprehensive as there are some small-scale single-practitioner operations I omitted, but it gives a pretty clear idea of the distribution of services for gender dysphoric people across the country. (Please tell me if there are any I have missed!)
Straight away you can see that the distribution of GICs is not even. Exeter, Glasgow and Norwich have clinics because they serve far-flung points of the country, but does the concentration of GICs from the north-east Midlands through Yorkshire to the north-east of England really represent an unusually high regional demand in those regions? That a huge swathe of territory including Birmingham, the Midlands, the north-west, the west of England, and Wales have no GIC services seems to go against the overwhelming evidence that there are just as many trans people in those parts as there are in the well-supplied north-east.
Does it really have to be this way? I sense this situation evolved because years ago there were relatively few of us who weren't suffering in the closet. The chances of a local psych or endo having any experience of us was nil, so it made sense to centralise the facilities. But is that still the case? I know my local psych and endo have both seen a large number of trans patients and I doubt my city is significantly different from any other of equivalent size. It makes sense for me to take an hour's train ride to the GIC, but for the patient from North Wales would they not be better served by seeing a more local trans-experienced psych or endo rather than spending a fortune and traveling hundreds of miles to see one in London? I can't help thinking someone's missing the rather obvious here.