Former British Health Secretary Andrew Lansley’s re-organisation of the country’s beloved National Health Service (NHS) is moving forwards, with many parts being implemented in only a few months time.

While for most of us the impact will be difficult to see, many trans people across England are highly concerned about the effects for them.

On the face of it, the movement of gender identity clinic services and genital surgery to be commissioned on a national basis should be a good thing – as it should remove the regional lottery that is often in effect. Some Primary Care Trusts have really good reputations for funding medical treatment of trans people, while others have created no-go areas for trans people due to the difficulty in gaining any funding whatsoever. National commissioning should smooth that out. Also, in theory, it may open the door to more providers – meaning different clinics and new surgeons.

But there is controversy over the specification of these services – what is covered and expected of the providers. Consultation over them with the Department of Health has been patchy – a meeting between them and representatives of various trans groups in May quickly descended into uproar. It did force the Department of Health to consult with service users (as trans people are grandly called in that context), but it was made clear that this government body could not actually tell the new National Commissioning Board what to commission or how.

This new National Commissioning Board has an advisory panel that is stuffed full of medics, and the draft policies all appear to have been drafted by them. A recent survey by the Scottish Transgender Alliance uncovered that 62% of respondents reported at least one issue or conflict with their gender identity clinic.

There is a very real fear that the voices of trans people are still being drowned out, and concerns with current services are not being addressed. An example is the on-going requirement for a trans person to be employed or in training in order to be eligible for surgery. It is a struggle to find any other NHS-provided medical procedure that is dependent upon your ability to earn money.

Another issue is the concern that best practice established in some Primary Care Trusts (PCTs), often after long fights by trans people, will be reduced to a common denominator. (PCTs are the NHS bodies which provide local doctors’ services and so-on.) While this will ensure that services in some areas will improve, others may well see deterioration – with little scope for the individual affected to change the situation. In an area already as contentious as medical care of trans people, this is causing some real concern.

PCTs are being replaced by CCGs (Clinical Commissioning Groups) – groups of doctors who are responsible for commissioning primary care. The ‘family doctor’, or General Practitioner, is very often the first port of call for a trans person wishing to access medical care. And here there are no national guidelines – CCGs are responsible for drafting their own.

There is real concern that some CCGs may decide to make access to the new national care pathways really difficult indeed. Bear in mind that a huge number of GPs don’t believe that gender dysphoria (the medical term for transsexualism) should be treated on the NHS. Trans people suddenly see many new areas of confrontation opening up, often at a point where people are most vulnerable and least able to fight bureaucracy.

Compare this situation to the one in NHS Scotland – where significant changes have recently been made to the service specifications, more accurately addressing the requirements of trans people. The difficulty in Scotland is actually the lack of a surgeon for genital surgery, but the protocols now appear to be more closely aligned to the new recommendations from WPATH – the international body which recommends what health care is appropriate for trans people.

Some trans groups are fighting hard for their voices to be heard, but is anybody actually listening?