How do transgender people experience their relationships with their GPs?

Problem

Transgender people, on average, have been found to experience greater health inequalities than lesbian, gay, and bisexual cisgender people. Experiencing discrimination in healthcare settings has been documented to contribute to trans people delaying or avoiding seeking healthcare in the future, amplifying these health inequalities. Primary care is often the first entry into the healthcare system, and as a result the relationships people have with their general practitioner (GP) can impact health outcomes.

The Royal College of General Practitioners’ position statement on transgender care in June 2019 highlighted key issues with current National Health Service (NHS) systems and pathways. However, there is a dearth of research into trans peoples’ experiences of primary care, much less within the NHS setting. This study aimed to explore how transgender people experience their relationship with their GP and what factors contribute to this.�

Approach

In this exploratory study eight semi-structured, in-depth interviews were completed face to face or over Skype. In-depth interviews are beneficial for understanding the contexts in which people live whilst their versatility enables participants to talk about what matters to them. A purposive sampling methodology was used to select participants registered with a GP in England, and a thematic analysis was carried out on verbatim transcripts.

Findings

Three main themes emerged. (1) All participants had one or more long term conditions, but none described the care they received from their GPs for these as a contributing factor to having a meaningful relationship with their GP. Half the participants felt their dissatisfaction with this care impeded their ability to build such a relationship. (2) Communication was central to how participants experienced their relationships with their GPs. It was a facilitator where GPs engaged personally with participants and provided space for participants to negotiate their needs and wants. Where there was a breakdown in communication due to GPs exercising their professional dominance over participants, this became an interpersonal barrier. (3) Participants faced structural barriers within the GP practice and wider NHS system which impacted on how they related to their GPs. A perceived lack of administrative staff training resulted in five participants viewing their GP practice as a whole more negatively, whilst the computer system’s inability to communicate the anatomy of participants’ bodies impeded care delivery.

Consequences

These results provide a new insight into an area where there is limited previous research available. The implications for GP practice are to relate to the significance of communication, and developing an awareness of the structural barriers transgender people have to overcome when seeing their GP. However, as an exploratory study, these implications are subject to further research. With further research, a deeper understanding of the underlying processes which impact the healthcare experiences of transgender people can help to promote better health outcomes.