Ethnic inequalities in primary care for people with multiple long-term conditions: evidence from the General Practice Patient Survey

Problem

People from minoritised ethnic groups with multiple long-term conditions (MLTCs) face more disadvantage in the number, impact, and quality of care for their long-term conditions. Studies of single conditions suggest that patients from minoritised ethnic groups report poorer experiences in primary care. However, we know little about whether experiences of primary care vary across ethnic groups for people with MLTCs. Given the current emphasis on tackling healthcare inequalities and improving patient experience in the UK, an investigation is required to ascertain whether ethnic inequalities in patient experience for people with MLTCs exist.

Approach

This retrospective study uses data from the GP Patient Survey, the General Practice Workforce and the Office for National Statistics. We focus on experience of accessing primary care and interacting with healthcare professionals which are deemed important for people with MLTCs. Using multilevel regression models, we analyse the relationship between ethnicity and these experiences of primary care and assess the relative importance of demographic, area-level and practice-level factors as influences on primary care experiences across ethnic groups for people with MLTCs.

Findings

After accounting for demographic, practice and area-level factors, the extent to which patients were satisfied with healthcare provider interaction (i.e. how health care providers listened, gave patients enough time, treated patients with care and concern, involved patients in healthcare decisions, met patients’ needs and were trusted by patients) was higher amongst people of Irish ethnicity than white British people. All other ethnic groups had lower levels of satisfaction compared to their white British counterparts with the exception of Black African, mixed white and Black Caribbean and other mixed people whose levels of satisfaction were not significantly different to those of white British people.Irish, Black African and Black Caribbean people had higher levels of satisfaction with accessing primary care (i.e. satisfaction with appointment times, types and overall experience) than white British people. However, people of Arab, Bangladeshi, Chinese, Indian, Pakistani, other Asian, mixed white and Asian, other white and other ethnicity had lower levels of satisfaction with accessing primary care than white British people. The influence of demographic, practice and area-level factors varied across ethnic groups.

Consequences

The ethnic inequalities in the experiences of primary care identified in this study are concerning given that patient experience is a key aspect of healthcare quality and is said to be associated with favourable health outcomes. The poorer experiences of primary care might be one mechanism by which people with MLTCs from minoritised ethnic groups have poorer health outcomes. Qualitative studies are vital for the identification, understanding, and formulation of solutions which will effectively address the sources of ethnic inequalities in primary care experiences for people with MLTCs from minoritised ethnic groups.