Understanding trans and non-binary people's experience of GP services in Portsmouth

This Early Insight Report presents initial findings from Healthwatch Portsmouth on trans and non-binary people’s experiences of accessing GP services in Portsmouth, bringing together perspectives from community focus groups and a staff survey of 59 primary care staff. The report provides an overview of current challenges and opportunities associated with inclusion in primary care, based on both lived experience and staff perspectives. 

The findings suggest that barriers are not limited to individual interactions but are embedded across administrative systems, workforce capability, referral pathways, and wider organisational processes. Focus group participants described repeated difficulties in relation to names, titles, gender markers, privacy, and first contact with services. These experiences were often described as frustrating, emotionally burdensome, and at times discouraging enough to reduce trust, openness, or willingness to re-engage with care. 

Staff responses suggest that trans and non-binary patients are a routine part of primary care practice, but confidence and knowledge are variable. While many respondents reported feeling somewhat confident, significant gaps were identified in administrative processes, referral pathways, prescribing, and shared care. A majority of respondents reported receiving no formal training, and concerns about making mistakes were common. 

The report also identifies a disconnect between patient experience and organisational awareness. While participants described barriers to raising concerns and low confidence that feedback would lead to change, most staff reported no awareness of complaints. This suggests that existing feedback systems may not be consistently capturing lived experience or supporting organisational learning. 

Overall, the findings indicate that inclusion is not yet consistently embedded within primary care and remains affected by variation in practice, interpretation of guidance, and limited system-level coordination. 

The report recommends a more structured and practical approach to implementation, including clearer local guidance, stronger administrative consistency, role-specific training, improved referral clarity, strengthened first-contact processes, better use of feedback, and greater system-level coordination across practices, PCNs, and the ICB. 

This report provides early insight rather than final conclusions. Further work in the wider programme will explore these issues in more depth, including additional policy and organisational analysis.