We need to end health inequalities for trans and non-binary people – let’s start with GP services

Many of us have had problems getting a GP appointment. Healthwatch hears from people struggling to see a GP and navigating ‘the 8am scramble’ week in and week out.  

However, stories that trans and non-binary people share with us and local Healthwatch make clear that they face additional obstacles to the everyday difficulties the general population faces.    

We wanted to examine some of these issues in more detail, so last year we invited trans and non-binary communities to share their experiences of GP care. This revealed some notable findings.  

First, satisfaction levels for GP care seem to be lower for trans and non-binary people than for the wider population.

Read more:

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Of the 1,393 people who took our survey, only 53% rated their GP practice as good for general care. This satisfaction figure is low. When a similar question was asked to the general public through the annual GP Patient Survey, 74% of people rated their GP practice as ‘good’.  

This matters. We know that if people begin to lose confidence in health services, it can lead to people failing to come forward when they need care. This, in turn, can store up problems for both the individual and health services further down the line and exacerbate inequalities within the population.  

A big issue influencing confidence level is access to hormone replacement therapy (HRT). Of 1,179 respondents who tried to access HRT via their GP, only 30% experienced no disruptions to their prescription at any point.   

Responses suggest inconsistent access to HRT can have significant impacts on trans and non-binary people’s physical health as well as mental health and wellbeing. For instance, stopping or gaps in HRT medication can result in trans women experiencing menopause symptoms. 

Second, when we dug deeper, our survey pointed to a wide range of administrative hurdles that trans and non-binary patients have to overcome (and which may help to explain low overall levels of satisfaction).  

One example is ending up with more than one NHS number, which can lead to confusion and complications with care. People like Nick, a trans man, have ended up with two different NHS numbers after changing his name and gender marker. He told us that:  

“It’s fine for routine care like GP appointments. But if I use other services like A&E or NHS111, my old records appear. They still list things like old medications that I’m not taking anymore, so doctors, nurses and ambulance staff are looking at the wrong information.”   

This is not only a frustration for people like Nick. It may also lead to clinical risk, such as misdiagnosis and being prescribed the wrong medication.  

And third, trans and non-binary patients can similarly miss out on crucial sex-based care after changing gender markers.  

We found that, concerningly, more than 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. This is a critical check offered to people with cervixes to see if they are at risk of developing cervical cancer.  

GPs are the first port of call for new physical and mental health problems and the entry point for referral routes to specialist clinics or prescriptions. If we don’t get things right at this point in healthcare, we won’t fix access barriers to other services and the ever-growing health inequalities.  

What, then, can be done? We are calling on the government to develop a holistic and national LGBTQ+ 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.  

This strategy would shed much-needed light on the health needs of trans and non-binary people and lift the burden of responsibility that has weighed too heavily on their shoulders to get the care they need. 

Louise Ansari is chief executive of Healthwatch England, the national statutory body representing patients in England.

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