Gender affirming care (GAC) is an important and complex area of healthcare,especially as awareness and understanding of transgender identities grow.
In the UK, demand for GAC is increasing, driven by both societal shifts toward inclusivity and the extensive waiting times within the NHS for specialised care.
As consultants working with several private healthcare providers, we have witnessed how private providers can succeed by filling critical service gaps that the NHS cannot address effectively. This shows that private healthcare providers could also play a big role in providing gender affirming care.
The NHS commits to treating patients within 18 weeks, yet 94.4% of patients experience wait times exceeding this target, with many transgender individuals facing waiting times exceeding five years to get their first consultation. The current model of NHS care takes on a form of “gatekeeping” with a small number of specialised clinicians diagnosing and recommending treatment and a few new clinicians being trained. This “gatekeeping” approach of services is simultaneously creating both a crisis in terms of patient need and an opportunity for private healthcare providers to step in.
As a result, patients are increasingly seeking out private care, presenting a unique opportunity for private healthcare providers to bridge these critical gaps in service. However, the current landscape suggests that most UK private healthcare providers are not fully prepared to meet this need, despite the untapped market potential and patient demand.
The main private hospital groups in the UK have largely remained silent on the delivery of gender affirming care. This lack of visibility and transparency can create challenges for patients seeking specific services, as current messaging on most providers’ websites does not clarify the availability of trans healthcare options. As a result, potential patients may assume such care is unavailable, missing a crucial opportunity for providers to serve a growing, underserved community.
Our research found that 6 major private providers lacked information on their websites regarding trans health services, underscoring the gap between market demand and current offerings in private healthcare.
The NHS and challenges to access to gender affirming care
The NHS plays an essential role in providing healthcare for the transgender community in the UK.
However, its limitations are widely acknowledged. With only a handful of gender identity clinics nationwide, NHS patients often wait years to access hormone therapy, mental health services, and surgical consultations. The Tavistock and Portman Gender Identity Clinic in London, for instance, currently has a waiting list of nearly 16,000 people, with estimated waiting times of five years for the first consultation only. For patients needing timely, comprehensive care, private options can seem like the only viable alternative.
Given the significant barriers within NHS services, private healthcare could play a transformative role in addressing these gaps. Private providers have the flexibility to offer specialised, multidisciplinary care, including hormone replacement therapy (HRT), mental health support, speech and language therapy and access to gender confirming surgeries. Unfortunately, major private healthcare providers in the UK do not currently make it clear whether they offer gender affirming services, leaving an estimated 31,000 (NHS England) trans individuals on waiting lists with limited options for private healthcare.
Currently, major players in UK private healthcare have limited, if any, publicised GAC services. This lack of transparent and accessible information significantly limits potential patients' understanding of available options, often forcing them to seek smaller clinics or specialist online services which carries with it an element of risk. These services are also the exception rather than the rule among private healthcare providers.
Private medical insurance and employers stepping up for gender affirming care
While many trans individuals face challenges in accessing private healthcare due to limited service availability and high out-of-pocket expenses, private medical insurance (PMI) through employers has the potential to bridge these gaps. Some prominent UK employers, including HSBC, Amazon, and NatWest, have integrated gender affirming care options into their employee health benefits, addressing a growing need and aligning with their diversity, equity, and inclusion (DEI) commitments.
However, the impact of these trans-inclusive policies is limited by the lack of visible, accessible service offerings from major private healthcare providers. This disconnect makes it challenging for trans individuals to fully benefit from their inclusive corporate healthcare packages, as they struggle to find providers who openly offer the services their insurance is designed to cover. As employers increasingly emphasise DEI and comprehensive support for all employees, greater transparency and service availability from healthcare providers would ensure these inclusive policies can be fully realised.
Expanding gender affirming care could be a benefit for insurers and providers alike. By proactively offering gender affirming services, private healthcare providers can not only meet a vital healthcare need but also attract employers committed to DEI, thereby enhancing patient trust and industry reputation.
Our research found that 6 major private providers lacked information on their websites regarding trans health services, underscoring the gap between market demand and current offerings in private healthcare.
Barriers to expanding gender affirming care in private healthcare
Despite the potential benefits, several barriers hinder the expansion of GAC in private healthcare. Many private providers lack the necessary expertise to offer comprehensive GAC services. Building capacity requires training staff in trans healthcare needs and establishing partnerships with qualified professionals. Additionally, institutional biases and cultural resistance can contribute to a lack of prioritisation for gender affirming care within private healthcare organisations.
In terms of policy, insurance structures often categorise GAC as elective or cosmetic, making it difficult for patients to access necessary services through their standard plans.
Redefining these policies to include essential components of GAC would not only improve accessibility but could also pave the way for insurers to work with gender clinics and healthcare specialists to design comprehensive, sustainable care packages.
Recommendations for improving private healthcare's role in gender affirming care
Many of the core treatments involved in GAC, such as HRT, counselling, and routine health screenings, are services that private healthcare providers already offer to cisgender patients. By making small changes to how they offer these services, private providers can make these services accessible to transgender individuals. Providers can expand their patient base simply by offering these services in a manner that is inclusive of and tailored to the needs of trans patients. This adjustment would require minimal operational changes but could significantly increase provider visibility and appeal within a growing market.
Regardless of gender affirming care, trans people have the same basic healthcare needs as everyone else like routine checkups, mental health care, and treatment for common conditions. However, they often face barriers to accessing these everyday services due to a lack of welcoming environments and provider understanding. This presents an opportunity for private healthcare providers to offer holistic care that meets both general and trans specific needs in one place. By becoming known as inclusive providers who support the full health needs of trans patients, private healthcare providers can build trust and loyalty, positioning themselves as leaders in accessible, care for a much wider audience.
A more inclusive future
Private healthcare providers in the UK have a valuable opportunity to support underserved groups by making healthcare more accessible and inclusive. Many individuals from ethnic minorities and rural residents to LGBTQ+ communities face extra challenges in accessing care, especially with barriers to NHS care as well. Tailoring services with options like telehealth, culturally sensitive care, and language support would allow private providers to build trust and lasting relationships with a more diverse patient base.
By adopting an inclusive approach, private healthcare providers can set themselves apart as leaders in compassionate care, benefiting both patients and their own reputations for diversity and inclusion. Addressing the needs of underserved groups enables private providers to fill a critical gap in UK healthcare, creating a model that champions inclusivity, improves health outcomes, and fosters a reputation for comprehensive, community-centred care.
References
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