̽��ֱ�� of Cambridge - Katie Saunders

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

cjb250 — Tue, 07 Feb 2023 09:12:25 +0000

̽��ֱ��study, funded by the National Institute for Health and Care Research, 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, ̽��ֱ�� of Cambridge, analysed 850,000 survey responses received to the 2021 survey, which included over 6,300 responses where individuals identified as either trans or non-binary. ̽��ֱ��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 ̽��ֱ�� 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. ̽��ֱ��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.

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 recognised 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.”

̽��ֱ��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.”

Reference
Saunders, CL, et al. 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. BMJ Open; 2 Feb 2023; DOI: 10.1136/bmjopen-2022-068099

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.

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

Katie Saunders

Karollyne Hubert

Trans Rights Protest London, April 2022

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Graduate, get a job … make a difference #7

ta385 — Tue, 19 Sep 2017 10:00:00 +0000

Gwilym Thomas (Trinity Hall), MB, Medicine (2015)

I graduated from Cambridge’s Medicine course in 2015 and I’m now working as a second year GP trainee, having already completed two years of post-qualification foundation training.

I’m currently based in A&E at the West Suffolk Hospital where my focus is on providing timely care and deciding whether someone can then return home or needs to be admitted for on-going treatment.

Junior doctors like me rotate jobs every four to six months so there is constant variety. Prior to A&E, I was working on a Care of the Elderly ward. I hope to be a GP within two to three years and during that time continue my involvement with Primary Care research.

My Motivation

I’m inspired by the positive impact I can make on the lives of patients and their families as part of a multidisciplinary team. I get particular satisfaction from taking a holistic approach, one of the tenets of GP training.

When I started at Cambridge, General Practice was near the bottom of my list of career options. I felt it might be repetitive and lacking in intellectual rigour, but actual experience completely changed my mind. In primary care I had such enthusiastic GP tutors and saw how embracing not just the biological but also psychological and social aspects of a patient’s problem could lead to better outcomes.

On the flipside, the biggest challenges I face are the long hours, difficult decisions and emotional challenges inherent in the job, alongside the wider issues in the NHS and social care.

What Cambridge did for me

̽��ֱ��Cambridge medical course is founded on core science which is later developed during clinical training, which seemed to match my learning style. In unfamiliar situations I can often problem-solve from first principles due to this sound scientific basis. It has also made me familiar with critically appraising evidence and that helps my clinical decision-making.

I discovered the world of primary care research, almost by accident, through Student Selected Components (SSC). Professor Jonathan Mant was my supervisor on my first Primary Care related SSC, which took me to the interface between stroke rehab in the hospital and community. Later, he encouraged me to submit an abstract to the Society for Academic Primary Care (SAPC) regional conference, and presenting there made me very enthusiastic about academic Primary Care. Professor Martin Roland, Dr Charlotte Paddison and Dr Katie Saunders supervised me on my second SSC in the Primary Care Unit. They gave me a lot of support to present again at SAPC, locally and nationally, and to publish the paper with which I won a Royal College of General Practitioners research prize in 2016.

My time at Cambridge proved so many of my preconceptions about primary care wrong. I soon learnt that GPs must use their clinical and diagnostic skills to make diagnoses, or deal with uncertainty, with fewer resources than available in hospital. I found there are also opportunities to develop specialist interests. My clinical placements were in various specialties and locations which helped me learn to integrate rapidly into a team and give me an insight into my eventual career plans. I also received really effective teaching in communication skills, which I continue to develop as a GP trainee.

During my 4th and 5th years, I spent several weeks with the practice team at Nene Valley Medical Practice in Peterborough, and that longitudinal placement really inspired and helped me to become a GP. During my elective in Scotland I received a lot of support and great advice from the anaesthetic department at Lorn and Islands Hospital in Oban. ̽��ֱ��short time I spent at the small, two-GP, Easdale Medical Practice, on the Isle of Seil also inspired me a great deal. Since graduating, the GPs at both Guildhall and Barrow Surgery in Bury St Edmunds, and the Grove Surgery in Thetford have been really supportive, friendly and knowledgeable. West Suffolk Hospital has been a good place to train as a junior doctor.

Applying to Cambridge

I grew up in Shepshed, a village in Leicestershire, and went to school in Loughborough. I was fortunate in having university-educated parents and in attending a school where Oxbridge applications were encouraged. But during my teenage years I had a lot of time out of school due to illness – I was diagnosed with Crohn's disease. I had to restart my GCSE year and, prior to returning, my head teacher advised me that either medicine or Oxbridge might be a realistic goal but, concerned for my health and welfare, they told me it might be best not to aim for both. I doubt they know how much that drove me to prove them wrong!

Crohn’s made the rest of school and the start of university a battle but I was open on my application about my illness and the potential for things to go wrong. I spoke to the ̽��ֱ��’s Disability Resource Centre team at an open day and my College also made me aware of all the support available if I needed it, which fortunately I rarely did. I did, however, receive targeted financial support via a Disabled Student's Allowance which made a huge difference to my confidence when I started at Cambridge. I have been in remission for some time now but being in some situations as both a patient and relative does, I think, help me approach things more holistically as a doctor.

It is really important with a medical degree to consider the course structure. While the traditional model at Cambridge suited me, it may not match everyone’s learning style. As for choosing a college, I didn't know where to start so decided to visit a shortlist on open day. I settled on Trinity Hall, where I felt most at home, a decision I’ve never regretted.

Cambridge graduates enter a wide range of careers but making a difference tops their career wish lists. In this series, inspiring graduates from the last three years describe Cambridge, their current work and their determination to give back.

My time at Cambridge proved so many of my preconceptions about primary care wrong.

Gwilym Thomas, MB, Medicine (2015)

Find out more

For more information about studying Medicine at Cambridge.

Find out more about General Practice as a career.

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