LGBT Forum December 2011
NHS Cumbria (Primary Care Trust) – Understanding Perceptions and Attitudes to Healthcare and GP Commissioning in Cumbria
The consultation began with a brief outline and background.
- Cumbria PCT currently commission healthcare
- GP’s in Cumbria have been more involved in commissioning services since 2006, taking over more of Cumbria PCT’s commissioning role, totalling 97% of the healthcare budget
- The proposal (Coalition Government 2010 ) – that GP’s will take the lead in health services through the commissioning of these services at a local level, this should take into account Local Healthcare needs (DOH have a number of health priorities and Cumbria has a reviewed (2012) Joint Health Needs Assessment, which indicates its health priorities.
NHS Cumbria is committed to reducing inequality in the health of our population. We are also committed to ensuring that all members of our population have equal access to our services (From PCT Strategic Plan)
What do you think of your GP, What do you think of GP commissioning?
There was a mix of feedback, some people expressed positive experiences, whilst others had negative experiences, the overall concern from those participating in the consultation was: The differing levels of knowledge about LGB and T people from one GP practice to another, and from GP to GP, that money for good quality Equality training may not be a priority for GP commissioning
Level of trust in GP’s
"Some Gp’s have objections to working with lesbian, gay or bisexual patients” – example from a gay male, his GP refused to see him and his same sex partner as a couple.
Poor advice for lesbians, gay men, bisexuals and transgender people. Equally poor and inappropriate advice given by a Barrow GP to a young man with gender identity issues, "A young man with gender identity issues went to his own GP, he requested support, at which he was told to go home masterbate and get married!”
Examples referring to medical practices/medical groups, where individual GP’s have refused to continue to see a patient, one they were made aware of the patients sexual orientation.
- "GP’s attitude”
- "How do GP’s decide who they treat?”
- "GP’s don’t want us as patients”
- "You’re lucky if you get to see your own GP, sometimes you are seen by a Locum or a Nurse Practitioner, who you may not be out to”
- "Long waiting times in surgeries”
- "The length of an appointment depends on GP availability, range from 5 – 15 minutes and have a limit on the number of health issues you can disclose”
- "Some GP’s should not be doing this work”
- "Where to go if you do have a complaint against a GP?”
Transgender patients will have some similar experiences, whilst others, differ from those of LGB patients.
- "Attitude of the GP”
- "Stereotypical perceptions about transgender”
- "Cultural and personal views”
- "Can’t or won’t deal with your needs/issues”
*This feedback is not suggesting that any particular GP practice in Cumbria has or follows a policy of refusing anyone with a ‘protected characteristic’ or from a minority group, but the experiences and perceptions of some individuals, leads to the conclusion that some GP’s or GP practices, exclude some people from patient lists.
Do you trust GP’s to commission
Here to there were concerns about the consideration of and the provision of health care to LGB and T people. Participants in the consultation felt that the GP Consortia will be guided by DOH health targets as much as if not more than by local population health needs. Therefore services commissioned would reflect these ‘priorities’ and might exclude any ‘specialist’ or inclusive (targeted) healthcare services.
In order to commission health services which are relevant to the local population, you need to understand the population’s demographics. This means establishing the number and makeup of the population, assessing the broader healthcare needs and identifying any healthcare needs which might be specific to certain groups within the wider population.
Population Data
National LGB organisations and groups have been concerned that the 2001 Census failed to address the issue of ‘how many people in the UK population are lesbian, gay or bisexual. In 2001 the only question you could answer if you were LG was, if you were in a same sex relationship and were cohabiting (sharing the same address).
After a concerted campaign to have questions included in the 2011 Census, which would obtain data to establish a more ‘real’ number of LGB people in the population, once again the only questions asked was; are you in a Civil Partnership?
So the data from the 2011 Census (available in 2012), will only give a statistic for LG people in a Civil Partnership, the data excludes all ‘single’ lesbians, gay men and bisexuals!
The British Medical Association (BMA) and Stonewall in 2005 put the figure of LGB in the population at around 6%. Previously the estimated number of LGB was as high as 10% of the population (Kinsey). In 2009 a survey of LGBT people in the North West by Ecotec, suggested a figure based on available data as between 6% and 7%, with 7% in the more urban areas. The figures are based on surveys and research, but such research and surveys only capture a proportion of the real numbers. Many lesbians, gay men and bisexuals do not wish to, or choose not to answer questions about sexual orientation, for some this is about a lack of confidence, like where the information goes and who has access to it, and so they choose not to identify on equality monitoring forms or to take part in LGBT research.
Therefore the true number of LGB people in the population will almost certainly be higher than 7%, probably closer to 10% of the total population.
Transgender numbers in Cumbria are based on medical records this will not include those who prefer to access medical services out of county, such as gender reassignment, gender disphoria counselling and other services. The Ecotec research in 2009 put the number of transgender people in Cumbria at around 300. We know that through the response to and membership of Transgender support groups in Cumbria, that figure is likely to be higher.
Potential for Partnership work with LGB and T organisations
It is worth mentioning here that the commissioning of health and healthcare services present an ideal opportunity to work with the third sector to provide specialist prevention and advice services to particular groups in the wider population.
When OutREACH Cumbria was part of public health (Carlisle and District PCT), it provided sexual health training to other service providers, and carried out outreach work in commercial venues, such as the gay sauna. ORC provided free condoms and lube and other resources through its outreach work to gay venues and venues hosting gay nights (predominantly in night clubs in Carlisle).
The objective of this work was to promote safer sex and to offer clients an opportunity to talk about other health related issues, in turn we were able to influence the development of strategic health initiatives in Cumbria (North Cumbria Sexual Health Strategy Group). A key part of the outreach work was the access to men who have sex with men, who did not identify as gay, but who’s sexual activities put them at risk of infection as they would not normally access information which targeted the sex they had.
ORC played it’s part in the Stiff workshops for GP’s, helping to widen the knowledge of gay men’s health needs along with the health needs of lesbians and bisexuals. This multi-agency approach allowed for creative ways to maximise funding, targeting both gay men and men who had sex with men, lesbians and bisexuals.
As a minority group, all be it a large minority of between 19.000 – 30.000 people, concerns were voiced about health inequalities and the provision of targeted healthcare, such as gender reassignment and health prevention initiatives such as sexual health.
The work of Public Health in Cumbria and its role in ‘health prevention’ was questioned, how would this work be continued and would health prevention work be a priority in the health budget?
- "Well Man’s Clininc – prostate check, had to ask for two years to have the check up!”
- "Men’s health, not catered for as well as for women”
Doubt was raised about confidence in GP’s leading commissioning taking into consideration specialist areas of health needs, in particular transgender;
- "general practitioner – not a specialist”
- "necessary cosmetic surgery”
- "Gender Disphoria services, as in the North East”
- "Higher and lower surgery costs – vary between £5.000 and £50.000”
All LGB and T people will come into contact with healthcare services at some point in their lives, at a GP surgery, or hospital, or A&E.
In these all of these areas, surveys of LGB and T people have indicated that a lack of awareness in some staff, lead to negative patient experiences and in some cases put of some people from accessing healthcare services
LGBT people have the same rights as everyone else in the population and therefore every right to access health services and to be treated equally and with respect. This should form the basis of any public service and these equal rights must be considered in all aspects of commissioning and the delivery of health and healthcare services in Cumbria.
Richard Kavanagh
OutREACH Cumbria
2012