The care and treatment pathway for people with gender dysphoria and related conditions usually begins with the patient's referral by their general practitioner to a psychiatrist or psychologist for assessment. If the referral is to a consultant psychiatrist, national waiting targets will apply.
Mental health services are not currently required to offer a choice of provider at the point of referral. If, following an appropriate period of assessment, gender reassignment surgery is recommended, that is usually the subject of a consultant to consultant referral which is also outside the scope of the requirement to offer a choice of provider.
The Department recognises that transsexualism is a medical condition and that the availability of gender reassignment surgery should be dependent on the clinical need of the individual patient. Primary care trusts commission gender dysphoria and surgery services on the basis of their assessment of the needs of their populations and available service capacity.