Response to national review of adult gender dysphoria services led by Dr David Levy
Below is the Trust's response to the national review of adult gender dysphoria services led by Dr David Levy published by NHS England on 18 December 2025.
You can read the full report on the NHS England website.
You can also read NHS England’s initial response to Dr Levy’s Report on their website here.
This review was a recommendation from the previous Cass Review of the adult service specification. To respond to this, NHS England commissioned a review of the operation and delivery of the adult Gender Dysphoria Clinics (GDCs) across England.
The latest review examined the operating procedures in each service, including the Leeds Gender Identity Service. This included the appropriateness of the service model for the presenting population, areas of concern, and any action being taken to improve quality. It has identified good practice that can be shared with other clinics, areas for improvement in relation to service quality within clinics, and any support that should be made available to assist improvement. The key lines of enquiry were designed in collaboration with current and former patients, clinicians and other key stakeholders.
The review was led by Dr David Levy, Medical Director of Lancashire and South Cumbria Integrated Care Board, and previously NHS England’s North West Regional Medical Director. He was supported by an expert panel of patients, clinicians experienced in the delivery of gender-related care, independent regulators and members of relevant professional bodies.
Dr Chris Hosker (pictured), Medical Director of Leeds and York Partnership NHS Foundation Trust, which hosts the Leeds Gender Identity Service, said:
“We welcome this report and its focus on sharing best practice and improving quality across the country. To allay any fears, it’s important to highlight that the review does not recommend that any clinic should close.
“We expect to receive further correspondence from Dr Levy specific to our service in the coming weeks – which will highlight the good practice we should rightly be proud of, and the areas for improvement that we need to focus on. We look forward to collaborating with colleagues across the country on improving the service for everyone who needs it.”
Specific areas of known concern
Hormone prescribing
The report acknowledges that the lack of access to primary care NHS hormone prescribing services can cause distress to patients and staff working in both primary care and the GDCs. The report recommends that NHS England and Integrated Care Boards (ICBs) should work with adult gender clinics and GP representative bodies to set up sustainable local arrangements for hormone prescribing and access to longer-term health monitoring.
One specific recommendation is that GDCs manage hormone prescribing for patients for a minimum of one year, until levels are stable, before discharging patients to primary care.
These recommendations will take time to roll out, and no timescales on implementation are included in Dr Levy’s report. Therefore, it is important that we maintain current prescribing arrangements in the short term, until any change is rolled out safely and in the best interests of patients.
Access and waiting times
The review recognises that the current long waiting times have a significant impact on the operation and delivery of GDCs. Long wait times cause delays along the patient pathway and these delays affect patient flow and limit all gender clinics’ ability to discharge patients and see new ones.
The report states that “addressing the waiting lists at each GDC is therefore fundamental to achieving improvements for patients and services”. It recommends that all clinics must actively engage in the National Quality Improvement Programme for Adult Gender Services established by NHS England, who are also recommended to develop a national demand and capacity plan to support reductions in waiting times in the short term and ensure appropriate GDC capacity meets referral demand in the medium to long term.
Do you have any concerns about Dr Levy’s report?
We have published a short web form to capture any burning questions that our patients or their families and friends may have about Dr Levy’s report.
Once you have read the report, please submit your question via this web form.
Depending on the volume of enquiries we receive, it may take us a while to process them and respond.
Page last updated: 19th Dec 2025 10:14am