Staff at an NHS trust must accept patients’ choice of pronouns and should not confront those who use single-sex facilities regardless of their appearance.

Bosses at Lewisham and Greenwich NHS Trust approved of the 18-page document that obliges staff to “comply or be damned”, campaigners have warned.

The guidance, which came into effect in February last year, told employees they should “commit to trying harder” if they make mistakes in front of patients.

Staff must also apologise to patients if they misgender them, according to the Daily Mail who saw the document.

Other sections of the document read: “'Patients may need to be screened for risks linked to their physiological needs… based on what organs are present rather than the patient's birth or acquired gender.

“Trans men and non-binary individuals can become pregnant and should be treated with dignity while using maternity services.

“[If] it is impossible to ask the view of the person because they are unconscious or incapacitated then, in the first instance, inferences should be drawn from presentation and mode of dress.”

Victoria Atkins, the Health Secretary, has condemned the document, stating that NHS staff must be able to carry out their duties without “tiptoeing around trans guidance”.

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She told The Telegraph: “I am crystal clear: biological sex matters, and the language used by the NHS needs to recognise the different biological needs of men and women.

“Illnesses and conditions that we know impact men and women differently should be communicated in a clear and accurate way.

“NHS staff must be allowed to get on with the job of caring for patients, not tiptoeing around trans guidance.”

She said that the Tories propose to update the NHS constitution to outline what patients can expect from health services, “including the biological needs of the sexes”.

“Under the Conservatives, the Government’s proposed update to the NHS constitution makes clear what patients can expect from NHS services in meeting their needs, including the biological needs of the sexes.”

Trans-critical campaigners have slammed the guidance, with Heather Binning of the Women’s Rights Network saying: “The policy incorrectly interprets UK law and places staff and patients in extraordinarily difficult positions.

“The coercion and bullying of NHS staff through these unlawful policies is clearly evident… Comply or be damned. Where's the dignity and respect for women who are uncomfortable accepting men in their spaces?”

A spokesperson for the trust told The Daily Mail that it “is committed to being an anti-discriminatory organisation, ensuring that we provide an inclusive, safe environment and equitable care for all our patients in line with the Equality Act 2010.

“We are proud of our trans policy, which ensures that we treat trans patients… with the same high level of dignity and respect offered to all patients.”