Inequalities in family practitioner use by sexual orientation: evidence from the English General Practice Patient Survey

Abstract Background Persistent health inequalities in relation to both health care experiences and health outcomes continue to exist among patients identifying with a marginalized sexual orientation (MSO). Objective To compare the patterns of sexual orientation disclosure within primary care in England over a 5-year period. Methods Descriptive analysis of cross-sectional, repeat measure, fully anonymized survey data of adults responding to the General Practice Patient Survey (GPPS) January 2012 to 2017. Participants from each year varied between 808 332 (2017) and 1 037 946 (2011/2012). Results The analysis samples comprised between 396 963 and 770 091 individuals with valid sexual orientation data depending on the year. For males, heterosexual disclosure decreased consistently from 92.3% to 91.2% from 2012 to 2017. Male patients reporting gay, bisexual and/or ‘other’ sexual orientations increased from 3.1% to 3.9%. For females, a larger reduction in heterosexual disclosure was recorded from 94% to 92.5%. Those reporting as lesbian, bisexual and/or ‘other’ increased from 1.82% to 2.68%, with the largest increase seen in the reporting of bisexuality, which nearly doubled from 2012 until 2017 (0.56–0.99%). Conclusion We found a year-on-year decline in patients reporting a heterosexual identity and an increase in the proportions of people reporting being either gay, bisexual, ‘other sexual orientation’ or preferring not to say. Heteronormative environments extend to health care settings, which may put increased stress on MSO individuals attending a GP practice. The introduction of environmental signs/symbols to show that a practice is inclusive of MSOs could reduce the potential stress experienced by patients.

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Associations Between Sexual Orientation and Overall and Site-Specific Diagnosis of Cancer: Evidence From Two National Patient Surveys in England

Journal of Clinical Oncology ◽

10.1200/jco.2017.72.5465 ◽

2017 ◽

Vol 35 (32) ◽

pp. 3654-3661 ◽

Cited By ~ 10

Author(s):

Catherine L. Saunders ◽

Catherine Meads ◽

Gary A. Abel ◽

Georgios Lyratzopoulos

Keyword(s):

General Practice ◽

Sexual Orientation ◽

Cancer Patient ◽

Patient Experience ◽

Sexual Minorities ◽

Patient Survey ◽

Heterosexual Women ◽

Diagnosis Of Cancer ◽

Experience Survey ◽

Practice Patient

Purpose To address gaps in evidence on the risk of cancer in people from sexual minorities. Patients and Methods We used data from 796,594 population-based English General Practice Patient Survey responders to explore the prevalence of self-reported diagnoses of cancer in the last 5 years among sexual minorities compared with heterosexual women and men. We analyzed data from 249,010 hospital-based English Cancer Patient Experience Survey responders with sexual orientation as a binary outcome, and International Classification of Diseases, Tenth, Revision, diagnosis as covariate—38 different common and rarer cancers, with breast and prostate cancer as baseline categories for women and men, respectively—to examine whether people from sexual minorities are over- or under-represented among different cancer sites. For both analyses, we used logistic regression, stratified by sex and adjusted for age. Results A diagnosis of cancer in the past 5 years was more commonly reported by male General Practice Patient Survey responders who endorsed gay or bisexual orientation compared with heterosexual men (odds ratio [OR], 1.31; 95% CI, 1.15 to 1.49; P < .001) without evidence of a difference between lesbian or bisexual compared with heterosexual women (OR, 1.14; 95% CI, 0.94 to 1.37; P = .19). For most common and rarer cancer sites (30 of 33 in women, 28 of 32 in men), the odds of specific cancer site diagnosis among Cancer Patient Experience Survey respondents seemed to be independent of sexual orientation; however, there were notable differences in infection-related (HIV and human papillomavirus [HPV]) cancers. Gay or bisexual men were over-represented among men with Kaposi’s sarcoma (OR, 48.2; 95% CI, 22.0 to 105.6), anal (OR, 15.5; 95% CI, 11.0 to 21.9), and penile cancer (OR, 1.8; 95% CI, 0.9 to 3.7). Lesbian or bisexual women were over-represented among women with oropharyngeal cancer (OR, 3.2; 95% CI, 1.7 to 6.0). Conclusion Large-scale evidence indicates that the distribution of cancer sites does not vary substantially by sexual orientation, with the exception of some HPV- and HIV-associated cancers. These findings highlight the importance of HPV vaccination in heterosexual and sexual minority populations.

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Are the needs of people with multiple long-term conditions being met? Evidence from the 2018 General Practice Patient Survey

BMJ Open ◽

10.1136/bmjopen-2020-041569 ◽

2020 ◽

Vol 10 (11) ◽

pp. e041569

Author(s):

Lucina Rolewicz ◽

Eilís Keeble ◽

Charlotte Paddison ◽

Sarah Scobie

Keyword(s):

General Practice ◽

Unmet Need ◽

Patient Survey ◽

Secondary Outcome ◽

Community Based ◽

Long Term Conditions ◽

Local Services ◽

Community Based Services ◽

Practice Patient

ObjectivesTo investigate individual, practice and area level variation in patient-reported unmet need among those with long-term conditions, in the context of general practice (GP) appointments and support from community-based services in England.DesignCross-sectional study using data from 199 150 survey responses.SettingPrimary care and community-based services.ParticipantsRespondents to the 2018 English General Practice Patient Survey with at least one long-term condition.Primary and secondary outcome measuresThe primary outcomes were the levels of unmet need in GP and local services among patients with multiple long-term conditions. Secondary outcomes were the proportion of variation explained by practice and area-level factors.ResultsThere was no relationship between needs being fully met in patients’ last practice appointment and number of long-term conditions once sociodemographic characteristics and health status were taken into account (5+conditions−OR=1.04, 95% CI 0.99 to 1.09), but there was a relationship for having enough support from local services to manage conditions (5+conditions−OR=0.84, 95% CI 0.80 to 0.88). Patients with multimorbidity that were younger, non-white or frail were less likely to have their needs fully met, both in GP and from local services. Differences between practices and local authorities explained minimal variation in unmet need.ConclusionsLevels of unmet need are high, particularly for support from community services to manage multiple conditions. Patients who could be targeted for support include people who feel socially isolated, and those who have difficulties with their day-to-day living. Younger patients and certain ethnic groups with multimorbidity are also more likely to have unmet needs. Increased personalisation and coordination of care among these groups may help in addressing their needs.

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What happens to patient experience when you want to see a doctor and you get to speak to a nurse? Observational study using data from the English General Practice Patient Survey

BMJ Open ◽

10.1136/bmjopen-2017-018690 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018690 ◽

Cited By ~ 7

Author(s):

Charlotte A M Paddison ◽

Gary A Abel ◽

Jenni Burt ◽

John L Campbell ◽

Marc N Elliott ◽

...

Keyword(s):

General Practice ◽

Patient Experience ◽

Secondary Analysis ◽

Patient Survey ◽

Models Of Care ◽

Unintended Consequences ◽

Multidisciplinary Teams ◽

Face To Face ◽

Patient Reported ◽

Practice Patient

ObjectivesTo examine patient consultation preferences for seeing or speaking to a general practitioner (GP) or nurse; to estimate associations between patient-reported experiences and the type of consultation patients actually received (phone or face-to-face, GP or nurse).DesignSecondary analysis of data from the 2013 to 2014 General Practice Patient Survey.Setting and participants870 085 patients from 8005 English general practices.OutcomesPatient ratings of communication and ‘trust and confidence’ with the clinician they saw.Results77.7% of patients reported wanting to see or speak to a GP, while 14.5% reported asking to see or speak to a nurse the last time they tried to make an appointment (weighted percentages). Being unable to see or speak to the practitioner type of the patients’ choice was associated with lower ratings of trust and confidence and patient-rated communication. Smaller differences were found if patients wanted a face-to-face consultation and received a phone consultation instead. The greatest difference was for patients who asked to see a GP and instead spoke to a nurse for whom the adjusted mean difference in confidence and trust compared with those who wanted to see a nurse and did see a nurse was −15.8 points (95% CI −17.6 to −14.0) for confidence and trust in the practitioner and −10.5 points (95% CI −11.7 to −9.3) for net communication score, both on a 0–100 scale.ConclusionsPatients’ evaluation of their care is worse if they do not receive the type of consultation they expect, especially if they prefer a doctor but are unable to see one. New models of care should consider the potential unintended consequences for patient experience of the widespread introduction of multidisciplinary teams in general practice.

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Understanding ethnic and other socio-demographic differences in patient experience of primary care: evidence from the English General Practice Patient Survey

BMJ Quality & Safety ◽

10.1136/bmjqs-2011-000088 ◽

2011 ◽

Vol 21 (1) ◽

pp. 21-29 ◽

Cited By ~ 78

Author(s):

G Lyratzopoulos ◽

M Elliott ◽

J M Barbiere ◽

A Henderson ◽

L Staetsky ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Patient Experience ◽

Patient Survey ◽

Demographic Differences ◽

Practice Patient

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Why do patients with multimorbidity in England report worse experiences in primary care? Evidence from the General Practice Patient Survey

BMJ Open ◽

10.1136/bmjopen-2014-006172 ◽

2015 ◽

Vol 5 (3) ◽

pp. e006172-e006172 ◽

Cited By ~ 20

Author(s):

C. A. M. Paddison ◽

C. L. Saunders ◽

G. A. Abel ◽

R. A. Payne ◽

J. L. Campbell ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Patient Survey ◽

Practice Patient

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Importance of accessibility and opening hours to overall patient experience of general practice: analysis of repeated cross-sectional data from a national patient survey

British Journal of General Practice ◽

10.3399/bjgp18x697673 ◽

2018 ◽

Vol 68 (672) ◽

pp. e469-e477 ◽

Cited By ~ 3

Author(s):

Thomas E Cowling ◽

Azeem Majeed ◽

Matthew J Harris

Keyword(s):

General Practice ◽

Patient Experience ◽

Patient Survey ◽

Cross Sectional ◽

National Patient ◽

General Practices ◽

The Uk ◽

Multilevel Linear Regression ◽

Practice Patient

BackgroundThe UK government aims to improve the accessibility of general practices in England, particularly by extending opening hours in the evenings and at weekends. It is unclear how important these factors are to patients’ overall experiences of general practice.AimTo examine associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours.Design and settingAnalysis of repeated cross-sectional data from the General Practice Patient Surveys conducted from 2011–2012 until 2013–2014. These covered 8289 general practice surgeries in England.MethodData from a national survey conducted three times over consecutive years were analysed. The outcome measure was overall experience, rated on a five-level interval scale. Associations were estimated as standardised regression coefficients, adjusted for responder characteristics and clustering within practices using multilevel linear regression.ResultsIn total, there were 2 912 535 responders from all practices in England (n = 8289). Experience of making appointments (β 0.24, 95% confidence interval [CI] = 0.24 to 0.25) and satisfaction with opening hours (β 0.15, 95% CI = 0.15 to 0.16) were modestly associated with overall experience. Overall experience was most strongly associated with GP interpersonal quality of care (β 0.34, 95% CI = 0.34 to 0.35) and receptionist helpfulness was positively associated with overall experience (β 0.16, 95% CI = 0.16 to 0.17). Other patient experience measures had minimal associations (β≤0.06). Models explained ≥90% of variation in overall experience between practices.ConclusionPatient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience. Policymakers in England should not assume that recent policies to improve access will result in large improvements in patients’ overall experience of general practice.

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