Thursday, 23 February 2012

They say getting to a GIC is a long road...

    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.
    Just to satisfy my curiosity I created a map of the UK showing the location of the main GICs overlaid on 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.


  1. I never set foot in a GIC but only because I went private and saw only my psychiatrist and my GP although my psychiatrist was in London and I live in Merseyside. I can see though what a pain it must be for those who, under the NHS, are compelled to travel all over the place for their 'assessments'.

    Shirley Anne xxx

  2. I was lucky in that I got referred to Nottingham GIC. The bus stop into Nottingham is at the bottom of my cul de sac. An hour on the bus later and I used to get off on the stop opposite the GIC building, easy. Even Now that I drive it's only a 40 minute drive along one road.

  3. The situation in Scotland probably looks better than it is in reality. There is a single practitioner in Edinburgh with a 2 year waiting list and I believe that the situation is the same in Aberdeen. In practice, most of us go to Glasgow. I have a drive of about an hour and a half to get there, though what you get when you do, is well worth the journey.

    Private provision up here is limited and very expensive and most of the girls who I know travel to London for private treatment.

    Interesting to read what I take to be the norm in England where girls are refered to GIC by their GP. Here, most self-refer.

  4. Yes, Louise, you can't self-refer to a GIC in England- a referral comes only after assessment by a local mental health type.

    Bristol had a sort-of-GIC once- when the PCT was broke after paying out compensation over the baby deaths scandal, they organised something to avoid having to send people outside the area. It was all a bit mysterious, but meant I got to see Prof Levy, the endocrinologist, which was good. Also delayed my getting to CX by a couple of years. Not so good.

  5. It's surprisingly difficult to get past that first referral step in some cases, local psychs can be dinosaurs. I'm lucky mine's seen a hell of a lot of us through ours being a big regional teaching hospital.

    There have been one or two clinics offering services either in a small way or in the past that I've left out on purpose.

    I was trying to find a decent choropleth generator but none of them did what I wanted.

  6. Hmm, all too true :( As a girl from North West Wales who started out with a local GIC, then saw it axed by the trust, then complained and had to cobble together an ad hoc service together from practitioners who don't normally work together I have had my patience thoroughly tried by this geographical imbalance. My service is provided by a Psychosexual Therapist in one hospital, a Diabetic Endocrinologist in another and various Psychiatrists who have a passing interest in Gender issues. I sort out my own blood tests and take them down to Charing X! Need I say more?

  7. Ah, that would explain why I found reference to a Welsh GIC but couldn't find it. I've certainly encountered others from Wales who've found it very difficult to progress.