The NHS is set to introduce a national waiting list and end self-referrals for adult gender services starting April 2026, following an independent review that exposed severe systemic failures.
An independent review of NHS Adult Gender Services has revealed critical deficiencies in the current system, prompting the UK government to announce significant reforms aimed at improving care quality and reducing waiting times.
Commissioned in response to the Cass Review Final Report and led by Dr. David Levy, the review was published on December 18, 2025, after extensive consultations with clinicians, patients, and NHS staff across all commissioned adult Gender Dysphoria Clinics (GDCs) in England.
1. Key Findings of the Levy Review
The Levy Review identified several systemic problems plaguing adult gender services across England. Poor productivity across many clinics, coupled with rising demand, has resulted in unacceptably long waiting times for patients seeking care.
The review also found significant variation in quality and productivity between different clinics, indicating a lack of standardized approaches to care. Dr. Levy's investigation, which involved visits to all commissioned NHS adult GDCs from October to December 2024, engaged with NHS clinicians, executive staff, and both current and former patients to gather comprehensive insights.
2. Government Response and Immediate Reforms
In response to the review's findings, the Department of Health and Social Care and NHS England have announced a set of immediate priorities for implementation.
The most significant change will be the creation of a single national waiting list for adult gender services to be implemented in April 2026, replacing the current fragmented system. This national list is expected to provide clearer understanding of regional demand and facilitate more equitable distribution of resources.
The government will also raise the referral age threshold to 18 years to align with the age of discharge from the NHS Children and Young People's Service, and end the current system of self-referral in favor of a single referral route through general practitioners (GPs).
3. Addressing Systemic Challenges
Beyond the immediate reforms, the review highlighted deeper issues requiring attention. It found that GPs often lack sufficient experience or confidence to adequately support patients with gender dysphoria, particularly regarding prescribing and monitoring hormone treatments.
To address this gap, the review recommends that GDCs take responsibility for initiating and managing hormone prescribing during the first year of treatment before transferring care to primary services.
The government has already made some progress, increasing the number of adult Gender Dysphoria Clinics in England from 7 to 12 since 2020 and establishing a national Quality Improvement Network for Adult Gender Services.
4. Ministerial Statement and Future Direction
In the formal statement, government officials emphasized their commitment to evidence-based care while acknowledging current shortcomings. "This government has always made clear that anyone accessing gender services deserves the highest quality of care and support, and to be treated with dignity and respect," the statement read.
The publication of the Levy Review marks what officials describe as "a significant step forward" in ensuring safe and effective care for those accessing gender dysphoria services across the NHS. A copy of the full review has been placed in the Library of both Houses of Parliament for public access.
To support patient well-being during the transition period, the government previously announced the development of a 'waiting well' pilot program for patients on waiting lists in the South West region, acknowledging that many individuals face extended delays before receiving care.
The planned reforms represent the most substantial restructuring of adult gender services in recent years, aiming to create a more standardized, efficient, and equitable system for all patients seeking gender dysphoria care through the NHS. Implementation of the national waiting list in April 2026 will be a critical milestone in this transformation process.
