Transgender patients ‘less satisfied with GP care’

Less than half (47%) of transgender people believe their GP meets their needs, compared to 61% of cisgender people, a survey has found.

And 56% of LGBTQ+ people overall say their needs were met by their practice, down from 68% in 2018.

According to the LGBT Foundation – which published its annual survey yesterday (25 September) – transgender men were more likely than transgender women to say that their needs were being met by their GP, while non-binary people were the least likely.

Transgender patients reported incidents wherein they had been denied a referral to specialist Gender Identity Clinics (GICs), and of instances where GP practices had refused a shared care agreement where one was available, the LGBT Foundation said.

And many people reported their practice lacked knowledge regarding LGBTQ+ healthcare, particularly around contraceptive and screening advice and pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

The LGBT Foundation said: ‘While this may be down to a lack of education, knowledge, or training there are also examples of where inaccurate and transphobic narratives have a detrimental impact on patient outcomes and access to care.’

Aimee Linfield, programme manager for the LGBT Foundation’s primary care programme Pride in Practice, said: ‘We are seeing a downward trend [in satisfaction] across the NHS for all cohorts in all categories, post-Covid, as GPs are under more pressure and have less time, [but] for transgender and non-binary people we are seeing some of the largest disparities, particularly there has been an increase in transphobia.’

She added: ‘GPs are also being asked to do more [for trans patients] with bridging prescriptions and working with patients who have gone to a private clinic. There are guidelines in place for GPs to support transgender and non-binary patients but GP policies really vary on whether they would do a bridging prescription, or if they have a blanket policy that means they don’t follow private prescriptions from non-NHS clinics.

‘So what we are seeing here is long waiting lists for transgender healthcare on the NHS exacerbated. This is just a snapshot and there is more need for research.’

Additionally, the survey found that 17% of LGBTQ+ people between 25 and 34 are not registered with a GP practice.

And 17% of LGBTQ+ people said that they have experienced marginalisation or discrimination at a GP surgery. This rose to 25% among transgender people alone.

However the LGBT Foundation highlighted that 70% of people who shared their sexual orientation with their GP said their needs were being met compared to just 43% who had not, with Pride in Practice advising practices give their patients the opportunity to disclose their sexual or gender identity.

GP practices should also have an understanding of where to find further information where necessary as best practice, they said.

Survey respondents had linked positive experiences to the level of knowledge their GP had, adding that they did not expect GPs or other professionals to have all the information to hand but valued good signposting.

Ms Linfield said: ‘There’s an important role for social prescribers around signposting. The NHS only has so many resources. Social prescribers need to know that there are different options available, rather than pointing patients to one counselling service, they could point a patient to a specific bereavement service, for example. That role is going to become increasingly important, especially the more they get to know patients of a practice because a lot of people in need of signposting will likely continue to need it.’

A BMA survey last year revealed that less than half of LGBTQ+ doctors and medical students feel comfortable enough to come out to their colleagues.

And in June, NHS England walked back its plans to limit who can refer patients to its service for transgender children, after proposing to shift all responsibility for referring onto just GPs and healthcare professionals.