LTP Priority: (Equality Groups) LGBT+ and Improving General Practice
Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service
Type of Interventions: Equality Groups
Major driver of health inequalities in your area of work
As the Government’s LGBT Action Plan highlights; your sexual orientation or gender identity can have a significant impact on your physical, mental and sexual health and wellbeing. Existing evidence shows that health outcomes are generally worse for LGBT people than the rest of the population, and that many LGBT people feel that their specific needs are not taken into account in their care (NIESR (2016), ‘Inequality among lesbian, gay bisexual and transgender groups in the UK July 2016’).
The national LGBT survey asked questions about people’s experiences of public healthcare in the 12 months preceding the survey. It asked questions about people’s access to physical, mental and sexual health services, and gender identity services. It also asked whether they had disclosed their sexual orientation or gender identity to healthcare staff, and how they felt this affected their care.
While many respondents to the survey said they had a positive experience accessing healthcare, there is clearly more to do. The survey showed that large numbers of respondents had difficulty accessing healthcare services and especially gender identity clinics. It also showed many respondents had experienced inappropriate questioning and curiosity from healthcare staff, and that some respondents feel their specific needs were ignored or not taken into account when accessing healthcare. Some of the most important findings include:
- at least 16% of survey respondents who accessed or tried to access public health services had a negative experience because of their sexual orientation, and at least 38% had a negative experience because of their gender identity.
- 51% of survey respondents who accessed or tried to access mental health services said they had to wait too long, 27% were worried, anxious or embarrassed about going and 16% said their GP was not supportive.
- 80% of trans respondents who accessed or tried to access gender identity clinics said it was not easy, with long waiting times the most common barrier.
Protected Characteristic: LGBT
Pride in Practice (LGBT Foundation)
Pride in Practice is a quality assurance and social prescribing programme that strengthens and develops primary care services’ relationships with their lesbian, gay, bisexual and trans (LGBT) patients. Pride in Practice enables primary care services to link with community assets and to utilise strength-based approaches to community healthcare delivery.
Pride in Practice is coproduced with commissioners, policymakers, clinicians and LGBT communities.
Assets to the scheme include:
- An accreditation award, including a wall plaque and Pride in Practice logos for letterheads and websites. This enables primary care services to promote their equality credentials, and demonstrates their commitment to ensuring a fully inclusive, patient-centred service. Awards are graded Bronze, Silver or Gold depending on assessment results. Assessments are carried out with the support of a dedicated Account Manager.
- Ongoing support from a dedicated Account Manager providing consultancy and support on a range of topics based on the needs of the service, identified through the supported assessment.
- Community Leaders volunteers who provide insight and lived experience to ensure patient voice, influence and greater public involvement.
- Support to deliver effective active signposting and social prescribing for LGBT communities, linking services with a range of LGBT-affirmative local community assets to facilitate holistic approaches to care.
- Access to training around LGBT inclusion, which provides information on how to provide appropriate services to LGBT people, support around Sexual Orientation and Trans Status Monitoring, myth busting, and confidence building with staff around terminology and appropriate language.
- Access to our Pride in Practice compendium, which includes a wealth of information on conditions of high prevalence in LGBT communities, such as sexual health, mental health, cancer screening for LGBT people, referral pathways into specialist LGBT services (such as Gender Identity Services), and legal rights of LGBT people.
- Access to posters, rainbow lanyards and a suite of LGBT information resources for display in primary care services, which serve as a visual representation of inclusivity whilst also providing relevant support and information to LGBT patients.
- LGBT patient insight so that services can be proactive about meeting LGBT patients’ needs (i.e. access to research, focus group data and case studies sharing best practice), via involvement of Community Leader volunteers who we will support to ensure increased patient and public involvement in the programme.
- Support reviewing Equality & Diversity policies and inclusivity statements.
- Practical support, guidance and confidence building for staff members on how to implement the Sexual Orientation Monitoring Information Standard.
- Celebration of awarded primary care services within LGBT communities, to reduce potential fears or perceptions of homophobia, biphobia and transphobia within those services.
- Support in using Pride in Practice as evidence in CQC assessments.
Since 2016 we’ve worked with 398 primary care services, reaching over 1,600,000 patients across Greater Manchester. 100% of the 4,496 health professionals we’ve trained can evidence improvements within their service as a result of Pride in Practice.
87% of primary care services trained have implemented the NHSE Sexual Orientation Monitoring Information Standard and 60% have implemented trans status monitoring. Our 2018 Patient Survey evidenced that:
- Trans patients at GP practices monitoring trans status were 62.1% more likely to say their GP practice met their needs
- LGB patients at GP practices monitoring sexual orientation were 21.4% more likely to say their GP practice met their needs
- 100% of trans patients at Pride in Practice awarded GP practices say that their GP was supportive of their gender identity and their medical transition
Pride in Practice began as an LGBT charter mark and has become a vehicle for systems change across the health and social care sector, influencing change at all levels. For example, responding to feedback from trans people, the Pride in Practice model brought commissioners, GPs and trans communities together to develop a holistic, primary care led Trans Health Service for Greater Manchester.
Pride in Practice is endorsed and informed by the Royal College of General Practitioners, Care Quality Commission, Royal College of Nursing, and Government Equalities Office as well as regulatory bodies in dentistry, pharmacy, and optometry. In just a few simple steps, it enables practices to evidence their commitment and compliance with the General Medical Council Good Practice Guidelines and the Equality Act 2010.