Background
The claimant (ATN), a father, sought judicial review of the WellBN Partnership’s policy of prescribing gender-affirming hormones (spironolactone and oestrogen) to young people under 18 experiencing gender incongruence or gender dysphoria. The claimant’s child (ATT) was prescribed these hormones from October 2024 under a “bridging prescription” model pending referral to a specialist NHS gender service. The claimant objected to the treatment and simultaneously pursued proceedings in both the Administrative Court (for judicial review) and the Family Court (for a best-interests declaration).
The claimant raised two grounds of challenge: (1) that the policy was unlawful because gender-affirming hormones are not lawfully commissioned or funded when provided by a general practitioner under an NHS General Medical Services (GMS) Contract; and (2) that the policy unlawfully failed to take account of mandatory relevant factors, including professional duties regarding “extreme caution” in prescribing, and that the “informed consent” model was discredited compared to a gender assessment approach. Meanwhile, NHS England and the Integrated Care Board directed the Defendant to cease offering gender-affirming hormones to under-18s from 11 April 2025, in compliance with which the Defendant discontinued the practice.
The Court’s Holding
Mr Justice MacDonald refused permission for judicial review on two independent grounds, without reaching the merits of the claimant’s substantive legal challenges. First, the court found the claim to be time-barred. The time to bring judicial review began running on 19 October 2024, when the claimant discovered that his child had forged a parent’s signature on a consent form for “gender affirming hormone therapy.” The claim was not filed until 7 February 2025—over three months later—and the court found no good reason to extend the three-month limitation period set out in Civil Procedure Rules 54.5(4). The court noted that this was not a case of continuing breach, since the Defendant’s policy had already been suspended by regulatory direction, and that the claimant had not pursued alternative remedies (such as a complaints procedure with the practice).
Second, the court found the claim to be academic and not susceptible to judicial review. The child is now 18 years old with no suggestion of lacking capacity to consent to medical treatment, and is no longer being treated by the Defendant. The Defendant confirmed in sworn evidence that it no longer operates the challenged policy and will not restart it. The claimant’s submissions that other GPs might adopt similar practices or that the Defendant might secretly revert to the policy were rejected as speculative. The court declined to exercise its discretion to hear an academic claim absent compelling public interest reasons, finding none present.
Key Takeaways
- Gender-affirming hormone prescribing by GPs to minors does not fall within the scope of services commissioned under the NHS GMS Contract; such treatment is reserved for specialist NHS services.
- Judicial review of a challenged policy becomes academic and inappropriate where the defendant has ceased the practice, confirmed it will not resume, and circumstances of the original claimant have fundamentally changed.
- The three-month limitation period for judicial review claims runs from when the claimant first becomes affected by the challenged decision or policy, not from later confirmations of its continuation.
- A claimant’s failure to pursue alternative remedies (such as internal complaints procedures) or to seek prompt resolution weighs against extending time to bring judicial review.
Why It Matters
Although the court did not decide the substantive legal questions, this judgment clarifies the regulatory framework governing gender-affirming hormone treatment in primary care. NHS England’s direction that gender-affirming hormones should not be prescribed by GPs to under-18s—and the Defendant’s swift compliance—reflects an emerging consensus that such prescribing falls outside the scope of general practice commissioning and should be confined to specialist multidisciplinary NHS gender services with enhanced safeguarding and assessment protocols. The judgment also illustrates the operation of the Cass Review’s influence on NHS policy, though the court did not rule on its enforceability.
For litigants and practitioners, the judgment underscores the importance of prompt action in judicial review: delays in filing, even when motivated by pursuit of alternative remedies or pending developments, can prove fatal to permission. The court’s refusal to hear an academic claim despite the broader policy implications also reflects judicial restraint in the absence of concrete live issues affecting the parties.