Legal Basis for “Bridging Prescriptions” in England

In England, the legal basis for “bridging prescriptions” largely falls under the general framework of medical prescribing practices and guidelines issued by relevant medical authorities. Bridging prescriptions are temporary prescriptions intended to provide continuity of care when there is an expected delay in accessing full clinical services.

Bridging Prescriptions in Sex Trait Modification

Specifically for sex trait modification (also known as “gender affirming care”), bridging prescriptions have been used to medicalise young people with transgender ideation before there has been any attempt at an holistic resolution of their delusion.

NHS Guidance: NHS England’s Service Specification for Gender Identity Services for Adults highlights the potential use of bridging prescriptions. Their use is given spurious justification by the long waiting times to access specialist gender identity services. The specification suggests that bridging prescriptions can be provided to mitigate the risk of self-harm or to prevent individuals from seeking medications from unregulated sources.

Ethical and Clinical Considerations

There has been significant discussion about the ethical and clinical implications of providing bridging prescriptions in gender affirming care:

  • Risk of Harm: Critics argue that without comprehensive assessment by specialists, bridging prescriptions may pose risks due to potential side effects or inappropriate use of hormone treatments.
  • Need for Specialist Involvement: There is a consensus that such prescriptions should ideally be managed by or in close consultation with specialists in gender identity services.

General Prescribing Principles

The General Medical Council (GMC) provides overarching guidance for all medical prescribing in the UK. According to the GMC’s Good Practice in Prescribing and Managing Medicines and Devices, doctors must:

  • Ensure they have adequate knowledge of the patient’s health.
  • Have sufficient information to prescribe safely.
  • Understand the medications they are prescribing, including side effects and interactions.

The GMC also emphasizes that doctors should work within their competence and seek advice when necessary.

The Royal College of General Practitioners (RCGP) issued a statement in which it says:

The RCGP recognises that some GPs have particular expertise, or an extended role, in the area of transgender care and supports them to act in their patient’s best interests, within the limits of their competence. For the majority of GPs, without this expertise or extended role, the RCGP considers that the role of the GP does not include the following:

  • Prescribing bridging prescriptions for those on the waiting list for a GIC.