What trans and non-binary people told us about GP care

Evidence suggests that transgender and non-binary people often experience poorer health outcomes than the general population. But what barriers do they face to high-quality care? And what would remove those barriers?

In our latest research, we focused on trans and non-binary people’s experiences with GPs – often the gateway to the healthcare system – to learn some of the answers to those questions.

People told us about administrative hurdles and harmful assumptions about their experiences. The impact of poor care could be serious, with over half of respondents to our self-selecting survey, almost 1,400 people, only slightly confident or not at all confident about using their GP.

But people also shared stories of good care, in which staff treated them with respect and compassion, and took the time to understand the care they needed.

By following our recommendations, GP practices and healthcare decision-makers can take important steps towards ensuring good quality care is a reality for all.

• 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.

• 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.

• 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.

• 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.

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What would improve GP care?

• Trans and non-binary people must be treated by their GP surgeries with respect, dignity and privacy, and without discrimination, in accordance with their rights.

  GP surgeries should ensure staff understand and know how to act in accordance with relevant legislation, and that all patients feel welcomed and respected.

• Trans and non-binary people should be protected from a loss of sex-specific healthcare (such as invitations for screening) if they change their gender.

  The practice of giving people a new GP record and NHS number when people change their gender marker should end. Instead, a single NHS record should include details of both biological sex and any change to gender identity. This should be done in a way that ensures privacy, dignity and respect, and allows clinicians to provide the right clinical care.

  The Department of Health and Social Care should also improve IT and screening systems to ensure trans and non-binary people don’t miss out on sex-based healthcare.

• The government should develop a new LGBT+ strategy.

  This should include steps to address the holistic needs of trans and non-binary adults. It should provide clarity on shared care arrangements and bridging prescriptions, and take action to cut long wait lists for gender dysphoria clinics and support people while they wait.