Decent, Fair & Accessible Healthcare
for Trans People
“Sorry I don’t do emails” & other barriers to trans research
In the last few days, Twitter and other social media have turned the spotlight on transphobia. Clearly, it’s one of the last remaining prejudices which some people feel is acceptable to express and then to react badly when challenged.
While this may not come as a surprise to many of us working in the equalities field, as trans people still commonly encounter high levels of discrimination and prejudice, what is shocking is that it can be so blatant in the health service, which is meant to serve us all. After all, trans people, like everyone else have a right to decent, fair and accessible health care.
Research I recently commissioned to establish how many trans people are accessing GP practices in the North West has provided more examples to add to the reports emerging on Twitter and elsewhere of indifference, humiliation, cruelty and abuse. (Read the Guardian article on the topic here)
I’ll be publishing the full report of this research in February during LGBT History Month, but I thought it was very timely to alert people to our initial findings right now. Of course we know from previous research that trans patients encounter hostility at all levels of the health service, but the amount of resistance from GP surgeries which our researchers encountered, even working with stamp of authority of the NHS, surprised even us.
The initial part of the research involved contacting a random sample of 200 GP practices across the North West, to provide a brief explanation about the purpose of the project* and ask them to fill in a short survey either on paper (which would be posted to them) or online, whichever was most convenient.
Of course, GP practices are extremely busy and work under great pressure, so we did our best to provide lots of notice that we would be contacting them, including briefing all the Local Medical Committees (LMCs) in the region well ahead of time. We even sent them examples of the trans awareness poster we had produced for display in waiting rooms, to ensure there were no surprises. All the LMCs were extremely supportive and receptive, which raised our hopes that individual practices would be equally co-operative.
However, just getting past the first hurdle of the receptionist to speak to the practice manager proved impossible in many cases. Of course, it’s hard to be sure whether this was deliberate intransigence, lack of awareness, casual transphobia, or just the automatic stonewalling for anything perceived as outside core business.
Stage 1: trying to speak to the practice manager
These are just a few of the reasons – or excuses – given for not being able to help the researcher
- The practice manager is not in, call back later
- Calling back later only to be told the practice manager is ‘on leave’ or does not work in the afternoons.
- The practice manager is out, at lunch, on leave, away from the desk or in meetings,
- No one in the practice could say when the practice manager would be able to take a call.
- The reception staff taking details of the call, putting the researcher on hold and then returning saying that the practice manager is either not here or too busy to talk.
- The researcher is asked to give a contact number, but never received a call back.
The researchers were persistent and to their enormous credit managed to speak to 103 practice managers, but very few were positive about the project or willing to engage, in some cases using language which could easily be misinterpreted as transphobic.
Stage 2: talking to the practice manager
- One explained that because in their opinion the patient numbers were so small, this wasn’t relevant enough for them to do an audit.
- “There aren’t many around here in Cumbria because they’d stick out like a sore thumb,” the researcher was told, which itself speaks volumes for the assumptions about how transgender people may look or be perceived. Another practice manager refused to reveal the list sizes, even though list sizes of previous years are in the public domain.
- Many other practice managers or receptionists did not understand what the term ‘transgender’ meant, in some cases even after the researcher had explained it to them.
- Others used a number of problematic terms to describe transgender people such as ‘sex change’. One practice manager said that she was concerned about putting up the posters because it might offend her other patients, particularly those from minority ethnic groups.
- Another refused to use the poster on the grounds that ‘women and children come in here’.
- Some refused to accept the credentials of an official letter from NHS North West supporting the research, or simply stated that they were not interested. Another practice manager said they that didn’t know about any trans patients so could not help, and that there was no point emailing them as “I don’t use emails”.
These are just a few examples – the report in February will have a full report-back on the range of responses received.
It was not all bad news though – there was an occasional example of good practice to cheer us, including a practice which had adapted their forms to monitor transgender patients as well as other minority groups; some which had a good understanding of the term ‘transgender’ and the broader issues trans people may face which could bring them to a GP, such as stress from social exclusion; and also an awareness of how to improve inclusion, such as changes to the way they call patients into appointments.
However, despite these rays of light, this research indicates an unacceptable variation in the level and quality of responses from GP practices, often the first point of contact with the NHS.
It is deeply ironic that the research – which was intended to find out how accessible NHS services are to trans people – should itself be hindered in this way, which is of course an indication of how much this research is needed.
However, when we publish the full report in February, this will include some thoughts on how we can support increased awareness and understanding of the health needs of the trans population, and how we can help our GP practices provide better care for their trans patients.
*Note
- The research was commissioned to establish up-to-date information on the number of trans people accessing GP practices in the North West region (calculated as a percentage of the total list size).
- We wanted to get reliable estimates of the trans population to help NHS bodies in the region – including the newly established Clinical Commissioning Groups – to plan appropriate services.
- We also wanted to get an idea of instances of co-morbidity in the trans population, based on key findings from GP practices across the North West.
- We know that building an evidence base on other health conditions that trans people face is essential for considering health issues over their lifetime, so that health services can plan for long-term and end-of-life care.
- Finally, we also need to know the average distance that trans people in the North West have to travel in order to attend Gender Identity Clinic appointments – to help us link need to locality.
Updated: 14 January 2013