‘Clarity needed’ on dispensing privately prescribed puberty suppressing hormones

Government and regulators must ‘clearly communicate’ the extent of community pharmacists’ responsibilities when asked to dispense privately prescribed puberty suppressing hormones to children and young people, an independent review has said.

The final report of the Cass review, published today, called for measures to reduce inappropriate overseas prescribing of puberty suppressing hormones.

It highlighted that pharmacists are responsible for ensuring that medications prescribed to patients ‘are suitable’, adding that the dispensing responsibilities of pharmacists with regards to private prescriptions ‘needs to be clearly communicated’.

This follows the review’s findings that ‘a number of young people’ had sought private provision while waiting for NHS services, and that families were ‘trying to balance the risks of obtaining unregulated and potentially dangerous hormone supplies over the internet with the ongoing trauma of prolonged waits for assessment’.

‘Feedback from the lived experience focus groups presents this as “a forced choice (because the NHS provision is not accessible in a timely way) rather than a preference,”’ the review noted.

The review said that it ‘understands and shares the concerns about the use of unregulated medications and of providers that are not regulated within the UK’.

And it said that 'any clinician who ascertains that a young person is being given drugs from an unregulated source should make the young person and their family aware of the risks of such treatment'.

Today’s report highlighted that ‘pharmacists are responsible for ensuring medications prescribed to patients are suitable'.

And it recommended: ‘The Department of Health and Social Care should work with the General Pharmaceutical Council [GPhC] to define the dispensing responsibilities of pharmacists of private prescriptions and consider other statutory solutions that would prevent inappropriate overseas prescribing.'

The pharmacy regulator last month issued guidance to community pharmacists following the publication of NHS England’s clinical policy on puberty supressing hormones.

The NHSE policy said puberty suppressing hormones should not be routinely prescribed in the treatment of children and young people who have gender incongruence or gender dysphoria.

In response, the GPhC guidance said that community pharmacists should ‘take account’ of relevant national policy, including the NHSE document.

And the regulator told pharmacies to take ‘active steps’ to assess whether prescribers, including those in private clinics based outside the UK, comply with latest policy on the drugs.

The GPhC told The Pharmacist today that it would 'carefully consider' this latest Cass report and 'identify any further communications or actions' that it may need to take in response.

And a DHSC spokesperson said that it welcomed Dr Cass's report 'which urges extreme caution in what is a complex area'.

The spokesperson added: 'In line with recommendations from the Cass Review interim report, NHS England has already banned the routine prescription of puberty blockers, helping to ensure care is based on evidence and is always in the best interests of the child.

'NHS England has also committed to review the gender affirming hormones policy and have established a national multi-disciplinary team that will review the recommendations for hormone intervention.'

The Cass review was commissioned by NHS England and NHS Improvement in 2020, to make recommendations on services provided to children and young people who are exploring their gender identity or experiencing gender incongruence.

It has been led by Dr Hilary Cass OBE, a consultant paediatrician and former President of the Royal College of Paediatrics and Child Health.