Adoption and gender reassignment processes

Yes – this needs to be discussed with the patient, and preferably a form signed by patient and included in their medical records.

The PCSE system now allows 'conflicting' title and gender/sex, so a patient can be known as the title they wish while remaining with their current gender. For example, a gender listed as male with a title of “Miss”. You can also state in the free text why the change is occurring so the registration team do not mistake the change as an error.

A patient’s gender can be changed to indeterminate or “I”.

All clinical data should be retained with the pre adoptive details redacted.  If there are any documents that refer to the adoption these should be redacted from the record. This can vary from system to system, so it would be best to confirm with your system supplier how to action a merge of medical records. 

Usually the best time to merge the record will be once the registration under the patients new number has been accepted.

It is up to your GP practice to define its own procedures about whether or not you ask patients to provide evidence for a name change.

There is no legal requirement for your practice to request evidence, although it is considered best practice to do so.

PCSE does not require confirmation that evidence has been seen in order to change the name, although we may contact your practice by phone or email to confirm the changes made.

If you need to submit a query regarding Gender reassignment, please use our dedicated, secure Adoptions and Gender Reassignment online form. 

Adoption process

It is important that practices are aware of the steps that need to be taken when a patient is adopted. Following the process will ensure continued patient care and ensure there isn’t an impact on your practice payments.

When a patient is adopted, they are given a new NHS number and must be registered as a new patient at your practice. All previous medical information relating to the patient needs to be transferred into a newly created medical record.

The process is as follows:

• The National Back Office send the patient’s new NHS number and any other amended details (e.g. name, address) to PCSE
• PCSE sends the GP practice a deduction notification for the patient and emails the main contact we hold for the practice (if available) the new details for the patient  
• GP practice accepts the deduction and registers the patient using the new details provided by PCSE. Important: Do not update the patient’s original record with their new NHS number. If this happens they will not be registered and will miss out on continuity of care
• PCSE sends a new patient medical record envelope with the patient’s updated details to the GP practice
• GP practice creates new patient record using new details, and transfers all previous medical information from the original medical record. Any information relating to the identity or whereabouts of the birth parents should not be included in the new record.

It is important that practices complete the new registration for the patient within five working days to ensure no interruption to patient care.

If you need to submit a query regarding Adoption, please use our dedicated, secure Adoptions and Gender Reassignment online form.

For further information please see our guide for GP practices.

Gender re-assignment process

It is important that practices are aware of the steps that need to be taken when a patient changes gender. Following the process will ensure continued patient care and ensure there isn’t an impact on your practice payments.

Please note: Patients may request to change gender on their patient record at any time and do not need to have undergone any form of gender reassignment treatment in order to do so.

When a patient changes gender, they are given a new NHS number and must be registered as a new patient at your practice. All previous medical information relating to the patient needs to be transferred into a newly created medical record. When the patient informs the practice that they wish to change gender, the practice must inform the patient that this will involve a new NHS number being issued for the them, which is not reversible. To revert back to their original gender, they would receive a third NHS number. The practice should confirm this has been discussed with the patient when notifying PCSE.

The process is as follows:

• GP practice notifies PCSE that a patient wishes to change gender via the dedicated, secure Adoptions and Gender Reassignment online form. The practice should include the patient’s name and NHS number in the notification to PCSE, plus confirmation that they have discussed with the patient that this will involve the creation of a new NHS number

Please note: To submit an Adoption, Gender Reassignment or Sensitive Patient notification, you must be a verified contact. Please ask the main contact we hold for your organisation to register you on PCSE Online via the User Management section. Alternatively, the main contact can submit the Adoption, Gender Reassignment or Sensitive Patient notification.

Top tip: When entering the patient's details into the online form, enter only the first part of their postcode, then scroll to the bottom of the drop down menu and select Not Listed. The practice can then manually enter the postcode. 

• PCSE sends the GP practice a deduction notification for the patient and emails the main contact we hold for the practice (if available) the new details for the patient  
• GP practice accepts the deduction and registers the patient using the new details provided by PCSE. Important: Do not update the patient’s original record with their new NHS number. If this happens they will not be registered and will miss out on continuity of care
• PCSE sends a new patient medical record envelope with the patient’s updated details to the GP practice
• GP practice creates new patient record using new details, and transfers all previous medical information from the original medical record. Any information relating to the patient’s previous identity should not be included in the new record.
• If the gender is being re-assigned from male to female, the screening team will contact the practice for no cervix confirmation
• If the gender is being re-assigned from female to male, screening will become the responsibility of the practice.

It is important that practices complete the new registration for the patient within five working days to ensure no interruption to patient care.

Please note: Please only select either ‘M’ for Male or ‘F’ for Female. This ensures that the appropriate screening invitations go correctly to individuals.

Download our guide for GP Practices for further information on the process for registering a patient gender reassignment.