GP partner in Brighton and Management in Practice event speaker, Dr Sam Hall, who has several areas of interest including women’s health and trans affirming care, shares how he believes general practice can become more LGBTQ+ inclusive.
What led you to focus on the specialisms of women’s health, trans affirming care and neurodivergence?
I’m a 52-year-old GP, but I’ve only been a GP for the past six or seven years now, prior to that I was a hospital consultant in anaesthetics and intensive care. I moved into general practice primarily because I’m a trans person myself and I had a very negative experience as a service user of the NHS. As a result of my own experience, I realised that trans healthcare was in disarray.
That was my motive for becoming a GP, essentially because it seemed like a platform from which I could start to make a difference.
One of the things I think is crucial to understand is that in terms of healthcare inequalities, a good way to address them is to have people who are, or hold, some kind of protected characteristic actually working within the health service. There’s that trope, you can’t be what you can’t see. Role models are very important, and people are flocking to our GP surgery to have trans affirming healthcare precisely because of the trans clinician working there.
But I want to develop that by teaching my colleagues how to deliver trans affirming care themselves.
What are some of the barriers that LGBTQ+ communities face when coming into primary care?
When you look at the number of trans people we think are in the population, it’s probably around 1%. But the fact that most GP surgeries won’t have – or won’t know – that anything like 1% of their patients are trans, non-binary or intersex is because of poor monitoring. Also, of course, because people don’t engage in healthcare.
The system is very binary in its nature, so for example when we use an e-consult, it asks a person to declare your gender at the start. That can be problematic.
Also, if somebody is misgendered at the first contact, they won’t come back. They won’t feel respected or heard or listened to. And healthcare won’t feel safe if a someone’s personhood isn’t acknowledged. If you feel invisible, you’re certainly not going to trust any care that’s coming from that organisation.
There are also particular issues related to the fact that if trans people have a different gender marker on their records than that which they were assigned, they might fall out of screening systems and so are more likely to experience negative health outcomes.
For example, somebody who is a trans masculine person with a male gender marker and has a cervix should automatically be invited to a cervical screening programme.
How do practice managers start to make changes within their practice to increase inclusivity?
The first step is finding out who your trans patients are so that you can look after them better and make your service inclusive.
In our practice, about 80% of our staff – whether they’re clinical or not – state their pronouns in their email signature. It’s a really simple way to demonstrate they are aware of the issues that trans people face.
Another one is using people’s chosen names and pronouns – even if record keeping doesn’t allow you to make changes. We also hang trans flags during Pride.
As a practice manager, it’s all about the visible signs, so using pronoun badges and making sure your policies and procedures are not gendered in a way that’s exclusive. It’s about raising awareness internally and putting on training for themselves and their staff about what it means to be LGBT inclusive.
We’re not a particularly sizable practice at 17,500 patients, but we’ve grown from having 40 trans, non-binary and intersex patients to nearly 500 in three years. It just shows what can happen if you open the doors in terms of access.
What’s your hope for the next couple of years in terms of creating a more LGBTQ+ inclusive general practice?
My personal hope is that we can do what’s needed, which is to be able to provide basic trans healthcare. By this I mean giving trans affirming healthcare hormones, if people need them, in primary care rather than people having to go to specialist services.
A big hole in medicine in general is attributed to gender bias and inadequate consideration of women’s bodies. So, if GPs generally don’t feel equipped to manage cis people’s [those whose gender identity and sex assigned at birth are the same] hormones, they’re certainly not going to manage trans people’s hormones. That’s why the bulk of my work is on women’s health, because it’s become obvious to me that that’s where the deficit lies.