It is normal practice for any Gender Identity Clinic or private Consultant Psychiatrist to require a 'Real Life Test' (RLT) in which the patient lives and works full-time in the new gender role, before genital surgery is performed.
The patient will change her name legally at the start of the RLT, and is expected to demonstrate her ability to work (this includes voluntary work, or higher education) and function socially as a woman. The early stages of RLT can be stressful to some patients: much re-learning is required, she may experience rejection from family, friends and others, as well as numerous practical problems.
It is important that the patient receives the maximum possible support during this time; her counsellor will probably be the main focus of support, but a co-operative and sensitive attitude on the part of GPs and practice staff is also important. Once legal name-change has occurred, the patient should be referred to by her new name, and treated as female. The NHS has a policy of issuing new patient numbers to transsexual patients (and amending their records to show the new gender), and assistance with this administrative issue should be given (at the time of writing, the PPSA is the body responsible).