Alex Matheson, deputy director of education at the LGBT Foundation, speaks to senior reporter Beth Gault about how its outreach programme Pride in Practice is having an impact on patient care and what the next government needs to prioritise.
Beth Gault (BG): How is Pride in Practice, your outreach programme that aims to improve the experiences of LGBTQ+ patients accessing primary care services, going?
Alex Matheson (AM): It’s going exceptionally well. It’s the longest project that we’ve been delivering in the education field, as it launched in 2010. We class it as being education, because that’s one of its core components. But it’s also a quality assurance scheme.
It’s now expanding more nationally and outside of primary care, which we’re going to focus on over the next two years. We’ve seen a huge increase in secondary care requests and social care requests. It’s a natural step for us, we have a lot of work with social care anyway, so it makes sense to expand Pride in Practice into those areas.
In terms of accreditation, we have just trained our 1,000th GP practice in South Tyneside, which is really exciting. We also support other primary care outlets as well, so pharmacies, dentists and optometrists.
We’ve predominantly worked with GP practices in the Manchester area as that’s where we’re based, have been the longest and seen the greatest impact. We’re funded by the Combined Authority in Manchester, so we cover all 10 boroughs.
Because we’ve been there and working with practices for so long, we provide a lot of support over and above the assessment and training process. A lot of case holding. We get patients that will contact us because they’ve seen the award in their practice, and they’ve had a problem. We’ll also provide a mediation with the GPs, or if they’ve done the training a while ago but then not had a situation where they needed to use it until now, they might then contact us for support when the circumstances arise.
Places that we’ve been for a couple of years, we’re also starting to see that happening more. So, it’s something that we’re starting to think about – how do we embed that as we go into new areas, because it’s a really useful part of Pride in Practice, having that expert advice for clinicians and patients.
BG: You said you’re expanding nationally, where abouts?
AM: We’ve got a good geographical spread. We’re not over the whole country yet and up until last year our growth has been very organic. We haven’t had people pitching to practices, so our growth has happened through GPs, PCNs and practices talking to others.
But we’re now starting to target growth and to look at how we expand. We’re really thinking about it from a health inequalities perspective. We know from our patient survey that in areas where Pride in Practice is implemented, patients have a significantly higher view of their GP practice and are more likely to feel supported and safe, so we’ve started to think about more strategic expansion across England from the perspective of all those patients that are currently not having that level of service.
BG: What role can primary care networks play in this?
AM: Quite often it’s the PCNs who commission us to go into practices within their network, and we’ll train PCN staff as well. They can encourage practices, not just by providing the funds, but also by saying this is something within our PCN where we want to see change.
BG: How much funding do they need to set aside for this?
AM: It varies as to whether we’re delivering in person or online, but it’s approximately £1,250 per practice in person. That’s 12 months of support, training of a minimum of 80% of their staff and the assessment. Then after 12 months it’s a renewal.
We encourage PCNs to think about how they roll it out. So, they might want to think we’ll do half of our practices this year, then next it will be the other 50%. But the PCN will still be able to access the support for the whole time because they’re funding it.
BG: Looking towards the second half of the year, what are your hopes and fears for the next election?
AM: We are increasingly seeing that LGBTQ+ people are being used as a bit of a political football. And it negates the fact that we’re all people and it’s really dehumanising.
The barriers for accessing healthcare for LGBTQ+ people are high, and my concern about how they’re being treated politically is that it has a worsening impact. We’re seeing people feeling less secure accessing health care. We already access healthcare later than others, we already have a far higher chance of missing the opportunity for first line treatments. Then because of that, we’re more likely to need second line treatments and we’re less likely to have positive health outcomes as a result. My concern is that we see that worsening because of an increasingly difficult political climate.
BG: What needs to happen at a government level or ICB level to improve care?
AM: There isn’t one thing that can happen, there are so many things that need implementing. But if I had to pick, I would say put money into supporting and overcoming barriers for LGBTQ+ people accessing healthcare.
Aside from Pride in Practice, as an organisation, we do training and education throughout healthcare and one of the big things we’ve started doing is going into universities where they’re doing medical training and telling them about the needs of our communities because it’s not part of the curriculum.
So some kind of recognition of that and the need on a national basis, as well as being implemented, would be wonderful.
BG: What is care like for LGBTQ+ patients at the moment?
AM: It’s so varied. We have pockets of excellent care. There is some brilliant work being done in primary care around ensuring trans, non-binary people can access screening effectively, for example.
But on the other hand, we see huge numbers of our communities experiencing inequitable care. Every time I do a focus group with other lesbian, gay, bisexual women, I hear of instances from every person about how they’ve been treated as a result of the fact that they have sex with women.
There are repeated questions around are they using contraception? When the answer is no, then ‘do you need to be?’. A no should be sufficient, but we always talk about how often we have to come out.
Personally, I’ve gone for smears and come out with packs of condoms even though I’m a married lesbian and I’ve specifically said I don’t need them. That creates a real issue of lack of faith.
I had a great conversation with a breast screening unit yesterday who had a trans masculine patient, and they were really conscious that this guy sat in an area that is entirely female gendered. I’m not saying let’s remove female gender, but we could tame that down or at least have some visible inclusion so that someone identifying a different way doesn’t feel so uncomfortable.
There are some great examples of care happening, but there’s a lot of poor care happening. And more often than not, it’s through ignorance or through pathways and protocols that are inappropriate. The amount of protocols for example that require a pregnancy test in someone who is of childbearing age, no matter what.
In healthcare, we talk about personalised care, but then we work within structures that don’t allow for that. A lot of the work we do is to try and get the system to think about how appropriate these pathways and protocols are and other ways around it.
BG: What is care like post-Cass review?
AM: Care for trans and non-binary young people has been consistently poor for many years, but it’s gotten worse. That wasn’t the intent of the Cass review, I’m sure. But unfortunately, it has been impacted by the Cass review in removing access.
There is the possibility of positive change, but it always takes time. And so far, we’ve seen with the closing of the Tavistock and the new hubs coming online, the level of care offered has dropped because less people are being seen.
They may be able to offer care in the future, and I would hope the level of care they get in the newer services will be far greater than they’ve had previously. But at the moment, they don’t have capacity. So, more people are going on the waiting list and their lives are on hold effectively.
Alongside this, the options to access private care have been reduced and there’s not that much to replace them. I was asked by a pharmacist what the referral pathways are that we can offer to people when they’re approaching us with prescriptions we can no longer fulfil, and there aren’t any.
There are two hubs currently, and as far as we’re aware they’re not taking patients off the waitlist, they’re only able to support the patients that were actively on the caseload for the old service.
So, more people are going to have to sit on that list. And a huge portion of young people on the list will hit the age threshold for no longer being within that service, and move into adult services, and then sit on another list without ever having seen someone who is proficient in their care or getting any care or support.
BG: Are there any good examples of care that you can share?
AM: There are practices who have set up separate micro-screening clinics for trans and non-binary patients because of being involved in Pride in Practice. There are places where they’ve started monitoring properly, because there isn’t an information standard around trans people. So, once they’ve started monitoring, they’ve seen they’ve got lots of patients in this group that they didn’t realise they’ve had.
There are also PCNs who are directly targeting queer women because about 33% of them have been told they don’t need a cervical smear at some point by a healthcare professional. So, some places have sent information directly to these patients to say yes you do need one.
BG: What can PCNs can do to help their practices be more welcoming to LGBTQ+ patients?
AM: Imagine the patient journey and perspective. As someone registering at a practice, what do I see? Do I see myself? Am I represented? When I’m filling in the form, do I have the opportunity to identify myself? Are you asking monitoring questions, and if so, will I see my identity there as an option? Because it makes a difference. So as a PCN, think about that journey, and walk your practices through those touch points.
A version of this story was first published on our sister title Pulse PCN.
