NHS England nationally commissions Gender Identity Services. In April 2019, NHS England began a process of national procurement to determine which organisations are best able to deliver adult gender dysphoria services in the future. The process of procurement is open to organisations that currently host a gender dysphoria clinic as well as new market entrants. The outcome of the process is expected to be known by the autumn of 2019. Separately, NHS England has announced its intention to establish a number of pilot services across England from 2019/20 that will evaluate the extent to which gender dysphoria services can be delivered by trained clinical teams in local primary care or community health settings. If evaluated positively, NHS England will consider how to extend the new models to other parts of the country.