How CMAGIC was developed to give Trans people a say in their care

Friday, February 22, 2019


Tackling poor outcomes, health inequalities and patient safety

Trans people experience worse physical and mental health than the general population. This is likely to be substantially due to the direct and indirect effects of the inequality which trans people experience. This results in multiple admissions across health and wellbeing services. Whilst the numbers of trans patients is small they are rapidly increasing. Local engagement clearly highlighted poor patient experience in relation to the two to three year waiting lists to access national gender identity clinics and the lack of understanding of by health professionals in meeting the clinical and health and wellbeing needs of this population.   

Current health inequalities include:

  • Trans patients are disproportionality more likely to experience poor mental health in comparison to any other population cohort - 59 % of trans people under the age of 26 years have considered suicide and have self-harmed , compared to 8.9 % of all 16 to 24 year olds (Pace research – Brunel, Worcester and London South Bank Universities 2015).
  • Trans patients are disproportionality more likely to take their own life than any other population cohort. 48% of Trans patients under the age of 26 years have attempted suicide. (Patient safety issue).
  • Evidence also strongly indicates that poor patient experience and lack of confidence in GPs means it is more likely to delay in visiting their GP, meaning holistic health needs of trans patients are not being met effectively and routine screening not accessed

What people told us and how we responded

We responded by leading on the development of a safe grass roots approach to improving experience and quality of services and developed a clear pathway to support trans gender patients to access the right local services at the right time.

The work of this collaborative approach developed into ‘CMAGIC’, a multifaceted collaboration between clinicians and patients involved in the support and care of Trans people across the Merseyside area, established by us and our partner CCG in Sefton. The collaborative pulls together clinicians and activists working currently in the field of Trans health.

The collaborative aims to improve the care of Transgender people through:

  • Support and education of the clinicians who provide care for trans people
  • Distribution of information relating to transgender health care
  • Coordination of services and sharing of resources
  • Development of clinical pathways clinical evidence and best practice guidance
  • Develop and disseminate new ways of service provision, e.g. tele-consultation.
  • Assist commissioners in identification and support of clinicians willing to assist in the care of Trans patients across the area
  • Explore development of a provider network capable of being commissioned as gender identity Centre.

Current membership embraces a range of individuals drawn from across the NHS, with community, primary and secondary care all represented. Significantly the group contains individuals drawn from third sector organisations and volunteer groups, which ensure that co-production is a central feature of the collaborative, naturally, but perhaps unusually for the NHS, several of the collaborative members are transgender individuals.

The outcome

The outcome of the approach has resulted in an operational pathway in Sefton, which has since been adopted by CCGs in Merseyside. A bid is currently due to be considered by the Cheshire & Merseyside Health and Care Partnership to roll this out across the region.  This bid has been sponsored by the chief executive officers from all Merseyside CCGs, Mersey Care Foundation Trust and Wirral University Teaching Hospital.  A decision on the bid will be made in March 2019.

NHS England’s national specialised commissioning and transformation unit has highlighted the scheme as a best practice example and are keen to involve the pathway as part of a national pilot in September 2019.

Patient experience has improved as part of the unified approach and equality of opportunity has been advanced and health inequalities will be reduced.