What trans and non-binary people told Healthwatch England about GP care
Key trends in Healthwatch England survey
The survey highlighted a range of administrative hurdles or poor staff attitudes that trans and non-binary people faced when they wanted to formally change their gender on their GP record or have their gender identity recognised in everyday interactions.
Of the 1393 respondents, 40% (565) said they had formally changed their gender marker on their GP record:
- 28% said they had lost access to a previous NHS record;
- 18% said they were misgendered in NHS written communications;
- 16% had experienced disrupted prescriptions;
- 13% had disruption to ongoing care.
In a separate question, over one in five (21%) of those who changed gender on their GP record said the NHS stopped offering them sex-based care, such as cervical screening, which is a critical check provided to people with a cervix to see if they are at risk of developing cervical cancer."
Overall, people had a mixed experience of GP care, with only 53% rating their GP practice as good for general care, 21% neutral and 22% poor. This figure is lower than for the general public in the annual GP Patient Survey, where 74% of people rated their GP practice as 'good'.
Read Healthwatch England full report
What did people share about their experiences?
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Trans and non-binary people can have negative experiences at the GP front door.
They may risk being outed or made to feel uncomfortable when they book, check in for, or are called in for appointments. Nearly a quarter of those who responded to our survey disagreed that GP receptionists treated them with respect.
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They face administrative hurdles if they want to change their name, pronouns or gender markers on their GP record.
Nearly 30% of those who had changed their gender marker said they had lost access to their previous NHS record. There were disruptions to prescriptions, which 16% had experienced, and 18% were misgendered in NHS written communications.
Changing gender markers also meant people risked making it harder to access to sex-specific care, such as cervical screening. Over one in five respondents (21%) who’d changed their gender marker said the NHS stopped offering them this sort of care.
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They may have lower satisfaction with GP care than the general population.
Just over half (53%) of people answering our survey rated their GP as good or very good for the general care services they had sought. This is lower than the proportion of trans and non-binary respondents (68%) and overall respondents (74%) responding positively to a similar question in the most recent national GP Patient Survey.
Less than a third of respondents (32%) rated their gender-affirming care from their GP as good or very good.
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They experience problems accessing gender-affirming care via their GP due to different interpretations of various guidelines.
Less than a third of respondents who had tried to access hormone replacement therapy (HRT) via their GP told us they hadn’t experienced any delays, stops, or interruptions.
Healthwatch England calls for a new LGBT+ healthcare strategy
The report comes almost seven years after the launch of the 2018 LGBT Action Plan, a cross-government initiative which pledged to tackle health inequalities.
Healthwatch England has called for the government and NHS England to develop a new comprehensive LGBT+ healthcare strategy to ensure that trans and non-binary people get clarity on entitlements to gender-affirming referrals, medication and specialist care and are protected from loss of sex-specific healthcare if they change their gender.
Louise Ansari, Healthwatch England Chief Executive, said:
"In 2018, the government's LGBT action plan said that they wanted "LGBT people to easily access healthcare when they need it most". Seven years on, our findings indicate that many trans and non-binary people feel they face unnecessary hurdles at every stage of care, often in addition to the everyday difficulties the general population faces, such as trying to reach a GP practice by phone.
"From administrative hurdles when changing gender marker to losing access to medical records or having care stopped, the issues have a profound impact on people.
"Deteriorating mental and physical health and being pushed into paying for gender-affirming care are just some of the examples of impacts and health inequalities trans and non-binary people face in the NHS.
“It's now time for the government to develop a holistic and national LGBT+ healthcare strategy that clarifies the extent to which primary care should deliver gender-affirming medical care, especially during long waits for people to see specialists. The strategy should also confirm the future role of adult gender dysphoria clinics, which have been subjected to a national review that has yet to report.”
