In a letter that the Minister of Health, Welfare and Sport sent to the House of Representatives on 9 May, he writes that hard work is being done with the Quartermaster Trans Healthcare (‘Kwartiermaker Transgenderzorg’) to make it possible for general practitioners who want to but are not yet officially allowed, because they have not had further training, to soon be able to help trans patients. This year and next year, a hundred GPs who have previously indicated that they want to follow a webinar, are expected to be updated in this area. After that webinar they can get started. The major advantage of healthcare at the general practitioner is that it makes healthcare more and better accessible.

The minister initially writes the following about it:

This mainly concerns support with the request for help and navigating through the healthcare landscape, support and guidance while waiting for healthcare, aftercare and follow-up care for hormone treatment.

This means that you could not yet go to your GP for the initial ‘measuring’ of hormone care. It is mainly to ensure that GPs understand where to go and how to navigate through the swamp of insurers. As far as the minister is concerned, diagnosis remains at a higher level, with specialists. Minister Kuiper does not seem to mind because the waiting times at the four university medical centers where hormone care is started, are only 45 people waiting with a waiting time of eight weeks. As far as Principle 17 is concerned, this is an optimistic count that seems to ignore the people who are still in the diagnostic phase of the inspection psychologist. This is the measurement behind the hall door. The large group of more than 3,000 people who are still waiting in the hall for the inspection psychologist to send on, have not been included. And how many people are still walking around outside, is not taken into account at all.

It is interesting that the minister is still calculating with an outdated model here. According to an advice from last year by the National Health Care Institute, which is concerned with the accessibility of healthcare, the adoption of the new international disease classification of the WHO in 2019 means that there is no longer any reason (link to Dutch report) to maintain the psychological gatekeeper. Because the ICD, as the classification is called, has taken gender incongruence – the new term for what is still called gender dysphoria in the Netherlands – out of the divisions of mental health problems or identity disorders. So you don’t need an inspection psychologist. This has not yet trickled down into policy and it will come as no surprise when Amsterdam UMC in particular wants to stick to this because of their research interests.

The minister also writes about experiments with triage: rapid inquiry into what the problem is, how serious it is and what to do about it. Perhaps people who know what they want, can quickly be referred to a doctor or a psychological therapist of their choice – who is therefore not a gatekeeper. This triage idea comes from a D66 motion from last year and is eagerly taken up as an option to not have to demolish inspection psychologists yet, at most to phase them out after years of unnecessary research. (Because a lot is already known internationally about the success of healthcare without a gatekeeper, see also our article on Barcelona.)

Meanwhile, developments are going forward. On the positive side, there is more and more room (link to Dutch report) for medical and psychological healthcare, there is a real official trans coach, emancipation continues, more and more people start working with themselves first and see medicine more and more as a useful partner in self-realisation, to mold their bodies so that it feels like a home instead of a burden. We are making progress, but things can be done much better and ultimately with far less costs for outage and shelter, if people simply respect our rights and do not cling to old-fashioned ideas.