In 2012, NHS North West commissioned the Trans Resource and Empowerment Centre to undertake a research project with the ultimate aim of helping trans people get better access to health services. Trans people are often the last people to get the health care they need, and face considerable barriers in accessing services. Trans people are among the most stigmatised in the UK, suffering high levels of discrimination, harassment and violence. They also experience high levels of family breakdown and are at high risk of suicide, prior to transition. This report documents the findings of that project - which includes the obstacles the researchers encountered when trying to engage with GP practice staff. It highlights the low levels of awareness of trans issues, as well as openly transphobic attitudes.