What are the primary care experiences and health and healthcare outcomes for transgender and non-binary adults in England? Analysis of data from the 2021 GP Patient Survey

Problem

During 2020 we carried out a research prioritisation exercise, working with an LGBTQ+ (Q+ here includes queer and other identities) patient and public involvement (PPI) panel to identify the most important areas for future research. The top three research themes prioritised by the panel were first, health service delivery (particularly primary care), second, prevention of ill-health, and third, research understanding the intersection of sexual orientation and gender identity with other disadvantage. However research to provide the evidence and insight needed to address these inequalities in health and healthcare outcomes has been limited in part by disproportionately poor recording of sexual orientation, and particularly gender identity, in routine data.One data resource that has been important to date is the GP Patient Survey. Data are collected annually to measure patient experience in primary care in England, to support the improvement of primary care quality. The survey first collected information on sexual orientation in 2009 and gender identity in 2021, with the inclusion of “Non binary” as an option along with “Male” and “Female” in the survey question asking about gender, and a second additional question asking “Is your gender identity the same as the sex you were registered at birth?” with response options “Yes”, “No” and “Prefer not to say”. Questions are additionally asked about long-term physical and mental health conditions, and in 2021 a question was asked about shielding during Covid-19.

Approach

The over-arching aim of this research is to provide evidence which will underpin efforts to improve the health and healthcare outcomes of LGBTQ+ populations, with a particular focus on transgender adults, which is the area where large-scale quantitative evidence is most limited. The analysis will answer the following research questions:1. What are the socio-demographic and health characteristics (age, gender, ethnicity, deprivation, sexual orientation, region of residence and long-term mental and physical health condition profile) of transgender and non-binary adults in England? How do these compare with the characteristics of the population of England overall?2. What are the primary care experiences of transgender and non-binary adults in England?3. Were transgender and non-binary adults in England more or less likely to have been shielding during Covid-19, and are any differences explained by age, gender, socio-economic deprivation or long-term health conditions? GP Patient Survey data for this analysis have been shared with the University of Cambridge under a Data Sharing Agreement with NHS England. We develop a full protocol in collaboration with PPI contributors, before carrying out the final analyses for this work.

Findings

We will present the results of these analyses at the 2022 SAPC ASM

Consequences

We will discuss the implications of our findings for policy and practice