This case established the fact that in deciding what to fund, the PCT may establish a hierachy of treatment (with exceptions).


A, D, and G were transgender patients seeking referral for gender reassignment surgeries. Their applications for extra contractual referral were denied.


Auld LJ held that the PCT may resort to a hierachy of treatment when deciding what to fund. But they may not place a blanket ban over certain treatments. His lordship decided in favour of A, D, and G requesting that the PCT change their policy in the following ways:

  1. Properly recognise Gender Identity Disorder as an illness;
  2. Provide adequate exceptions to the policy