Career advice

A role in which building rapport and relationships is all the more important

Caring for trans* clients presents a particular challenge from a career perspective

The success of trans* patient clinics has shown how the NHS needs to improve its staff training

Establishing a rapport with a trans* patient is a vital aspect of health care. It encourages trust and helps build confidence, but for many nurses there is a fear of getting it wrong.

A recent report by the Commons Women and Equalities Committee found the NHS has a long way to go in its treatment of trans* people, and called for a review of the service.

‘Awareness can make a trans* person feel welcome, while its lack can put them off having the tests they need,’ says cliniQ co-founder and service development lead Michelle Ross.

cliniQ co-founder Michelle Ross stresses the importance of establishing a rapport with
trans* patients Picture credit: Tim George

Based in London’s Soho, cliniQ is the only weekly sexual health and wellbeing service for trans* people in the UK, although four clinics are to open in Brighton, Birmingham, Manchester and Blackpool.

Using the wrong pronoun for someone is among the topics covered by training provided by cliniQ. ‘Part of being aware of the cultural terminology is about building a relationship with the patient, whether it’s for five minutes or longer,’ says Ms Ross.

Training programmes are available for healthcare professionals, including nurses and doctors, and those working in other fields, such as charities. Recently, those receiving training have included staff at Centrepoint, the UK’s leading charity for homeless young people, and surveillance staff at Public Health England who collate figures about who is using which healthcare services. The aim is to make the healthcare statistics more trans* inclusive.

Training is interactive and begins by asking participants to examine their feelings about their own gender, and what it means for their identity and sexuality.

Next there is an exploration of the barriers to sexual health services for trans* communities and their partners. This includes increased vulnerability to HIV, with statistics showing that globally trans* women are 49 times more likely to become HIV positive than other adults.

Other topics include wellbeing and legal issues, including the implications of the Gender Recognition Act and Equality Acts, as well as confidentiality, transition, and an awareness of non-binary people – those who do not identify with exclusively male or female genders.

‘People can find non-binary pronouns difficult,’ says Ms Ross. For example, some prefer using the neutral pronoun ‘they’ rather than ‘he’ or ‘she’. ‘Sometimes people find it hard to grasp using “they” for a single person and they disagree with it,’ she says. ‘But we must use the right pronoun – it shapes the way we see people and shows that we respect who they are.’

Healthcare professionals will also look at issues related to genital surgery. This covers any problems to look out for, especially if some symptoms appear similar to those of sexually transmitted infections.

Ms Ross says everyone benefits from training. ‘All nurses need education around trans* issues as part of their core training. At the moment it’s not covered in depth and nurses who work in all settings need to be aware and able to respond appropriately.’

For example, a nurse working in an emergency department may have to remove someone’s clothes and see genitalia that have been surgically changed.

There is a lasting and positive effect on nurses who have had training, Ms Ross believes. ‘They become more informed and make fewer assumptions,’ she says. ‘If they do make an assumption – and we all do from time to time – then they are able to have a transparent conversation, apologise and correct the situation’.

‘We offer a safe space’

Richard Cameron is one of the nurses leading cliniQ’s work on sexual health – part of its holistic approach to patient care for trans* people, their partners and friends. ‘This group needs a safe place to progress,’ he says.

Mr Cameron sees five or six clients during a two-hour clinic held every Wednesday evening, giving him time to spend with each patient.

Picture credit: Neil O’connor

In practice, his role may involve doing an instant HIV test, screening someone who is asymptomatic, managing a patient’s sexual health symptoms, or assessing someone who has had recent significant risk of HIV for emergency post-exposure prophylaxis medication.

All staff receive trans* awareness training. ‘For me, hearing people’s experiences of health care in other settings had the most impact,’ says Mr Cameron. ‘I defy any nurse not to want to change their practice after hearing these poor experiences of care.’

He also appreciates the way care is delivered at cliniQ, with organisations such as the Terrence Higgins Trust and Stonewall on hand to offer support and advice. ‘It’s a great model of team-working and something that the NHS could learn from,’ says Mr Cameron.

Working at cliniQ has had a huge effect on his professional abilities. ‘I have a fuller understanding of the needs of the community and the behaviour they might consider disrespectful.’


Trans*[with an asterisk] is used by the team at cliniQ to indicate that the term is not exclusive, but includes people across the entire spectrum of trans*-identified presentations and behaviours


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