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GP survey reveals health and healthcare inequalities of trans, non-binary adults

Trans and non-binary adults were less likely to be involved in decisions about care and treatment (85.0% compared with 93.7%). Those trans and non-binary adults with mental health needs were less likely to have their needs recognized and understood (77.6% compared with 87.3%). Fewer trans and non-binary adults said that overall their needs were met (88.1% compared with 95.2%).

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Trans and non-binary adults are more likely than the general population to experience long term health conditions, including mental health problems, dementia and learning disabilities, and to be autistic, according to new research.

The study – Demographic characteristics, long-term health conditions, and healthcare experiences of 6,333 trans and non-binary adults in England: nationally representative evidence from the 2021 GP Patient Survey – appeared in BMJ Open, and it also found that while trans and non-binary adults report no differences in access to primary care, they prefer to be able to see the same GP for each appointment. They also report more negative experiences of interpersonal communication, such as involvement in decision-making over treatment, and poorer confidence or trust.

Primary care supports people across the courses of their lives as their health and healthcare needs change over time. Understanding the primary care experiences of minority groups including those with protected characteristics – those characteristics for which it is against the law in the UK to discriminate against someone, and which include gender reassignment – is important for addressing potential inequalities and allowing the NHS to plan long-term.

Since 2021, the annual GP Patient Survey conducted by NHS England has included questions about both gender and trans status in its surveys. A team led by researchers at the Department of Public Health and Primary Care, University of Cambridge, analyzed 850,000 survey responses received to the 2021 survey, which included over 6,300 responses where individuals identified as either trans or non-binary. The results are published today in BMJ Open.

Trans and non-binary respondents were more likely to be from Asian, Black, Mixed or Other ethnic groups, less likely to be heterosexual, and were more likely to live in more deprived parts of the country. They were also more likely to be younger – just under one in four (23.6%) trans and non-binary respondents was aged 16-34 years, almost double the proportion among other respondents (13.4%).

After adjustment for age, ethnicity and deprivation, trans and non-binary adults reported higher prevalence for 10 out of the 15 long-term conditions. They were around three times as likely to be living with dementia or to have a learning disability, and twice as likely to be experiencing mental health difficulties. They were almost six times as likely to be autistic.

Dr Katie Saunders from the University of Cambridge, the study’s first author, said: “These findings are consistent with other studies looking at long-term conditions among trans and non-binary adults. The reasons for these differences compared to the general population are likely to be complex, including a mixture of stress, experiences of discrimination, socioeconomic status and the biological effects of hormone treatments.

“It shouldn’t be too surprising that these communities experience higher rates of mental health problems, given media reporting around issues such as the Gender Recognition Act and the Equalities Act and the increasing levels of transphobia that many individuals face on a day-to-day basis.”

When the researchers looked at the experiences of trans and non-binary adults in primary care, they found no difference when it came to accessing primary care. However, almost two-thirds (64.2%) of trans and non-binary adults said they had a preferred GP compared to a half (50.2%) of other respondents.

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Trans and non-binary adults were less likely to be involved in decisions about care and treatment (85.0% compared with 93.7%). Those trans and non-binary adults with mental health needs were less likely to have their needs recognized and understood (77.6% compared with 87.3%). Fewer trans and non-binary adults said that overall their needs were met (88.1% compared with 95.2%).

Dr Saunders added: “If you are trans or non-binary, then every time you see a new GP you are forced to decide whether or not to come out to them, so it isn’t surprising that they prefer continuity in primary care. Once you find a GP who understands your needs, you will want to see them each time you have an appointment.”

The team hope that the findings will help lead to improvements in treatment and care for trans and non-binary individuals.

“There are currently very few guidelines for GPs on how to care for trans or non-binary patients,” said Dr Saunders. “We hope the evidence that we’re presenting will help change this. Knowing that a trans or non-binary patient is more likely to be autistic or to be experiencing mental health difficulties, for example, where guidelines do exist, could help GPs prepare for seeing their patients.”

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