Award criteria

Any practice that engages with Pride in Practice should be highly celebrated!

It domonstrates that they are commited to providing an inclusive service to all the communities that they serve and recognise the specific needs of lesbian, gay and bisexual patients.

Practice's pay an annual subscription to Pride in Practice to have access to the wide selection of services offered by Pride in Practice to support and celebrate each practice. 

All Pride in Practice awarded surgeries will now complete the self assessment and submit supporting documentation before being awarded. Below is the self assessmnt questions, and teh reasons behind each question asked. Each 'yes' equals one point and the grades are:

  • Bronze: 16-19 points

  • Silver: 20-23 points

  • Gold: 23- 25 points

We welcome feedback so please do contact pip@lgf.org.uk to share you feedback with us and so we can contiue to develope the service we provide.  

Pride in Practice Self-Assessment

Staff = All staff with direct patient contact (unless otherwise specified)

Policies

1. Does your practice have a ‘zero tolerance’ policy regarding abusive behaviour or offensive language, which includes homophobia and biphobia (aimed at or conducted by either patients or staff)?

This is a very clear way of communicating that your practice is a welcoming and safe environment for lesbian, gay and bisexual (LGB) people.

Reception environment

2. Do all staff feel confident in enforcing the zero tolerance policy and challenging any homophobic or biphobic language or actions observed in the practice?

(NB if the practice answers ‘no’ to Q1, they cannot answer ‘yes’ to Q2)

Having a policy is one thing but the policy needs enforcing consistently by all staff. Often it is assumed that all staff know what counts as ‘homophobia’ or ‘biphobia’ but that is often not the case.

For example: in the event of teenagers using the term ‘gay’ as a negative term / instead of the word ‘bad’, do all staff count that as homophobic? Then you must consider the training staff receive on best practice when challenging homophobia or biphobia.

Furthermore you should consider how you measure people’s confidence in enforcing your zero tolerance policy. Is it via peer assessment, self-assessment etc? Is that method a valid reflection of an individual’s confidence?

3. Do your registration forms have a confidentiality statement included?

It is important that a patient feels confident that the information they share with practice staff is kept confidential.  Reducing this concern and reassuring patients will build their trust and in turn make them more open with your practice staff.

Having a statement on registration forms (which is often the first occasion when you ask patients to divulge private and personal information) can be reassuring and therefore increase your chances of collecting more accurate information.

4. Are all patients that wish to be accompanied by another person (friend/partner/family member) during a consultation empowered to do so and have their companion made to feel welcome?

It is important that all patients are made to feel safe and confident during consultation. For some patients this means they may like to be accompanied by someone else.

To ensure fair and equal treatment of patients if someone’s same sex partner accompanies them, that individual should be included and acknowledged in the same way as heterosexual partners would be.

It is important to not assume that if an LGB patient is accompanied by someone of the same sex it does not necessarily mean that are in a relationship. 

5. Does your practice publicly display:

a. An equality and diversity policy with a positive statement of equal care, with specific reference to sexual orientation?

This is a very clear way of communicating that your practice is a welcoming and safe environment for LGB people. This is a key message for both LGB patients and all other patients. 

b. A statement of how often all staff receive equality and diversity training?

This demonstrates your practice’s on-going commitment to ensuring that all staff are equipped with the skills, knowledge and understanding to meet the current needs of patients and staff. 

c. A statement of how often your equality and diversity policies are reviewed and updated?

This demonstrates your practice’s on-going commitment to ensuring that policies reflect the current needs of patients and staff. 

d. A confidentiality statement in the waiting area?

It is important that a patient feels confident that the information they share with practice staff is kept confidential.  Reducing this concern and reassuring patients will build their trust and in turn make them more open with your practice staff.

e. Leaflets / posters / magazines which are specifically targeted at the lesbian, bisexual and gay communities?

LGB people have told us that they often scan service venues for clues to identify if the service will be inclusive for them.

Displaying leaflets, posters and magazines targeted at the LGB community is a very simple way of helping create ma welcoming environment for LGB patients.

The resource pack Pride in Practice  sends out to your practice will include information you can display. To receive more resources please contact you dedicated account manager or email pip@lgf.org.uk.  

Medical consultations

6. Do all staff receive training on the prevalence and impact of conditions and issues thatparticularly affect lesbian, gay and bisexual communities, such as suicide ideation and self-harming (in addition to HIV and sexual health)?

Frequently the prevalence and impact of various conditions differs in the LGB community compared to the rest of the general population. Often people are aware of the difference in HIV rates or STI but there are great differences across many aspects of health and wellbeing. Many of the difference are covered on the compendium for example:

13% of GB men have had a problem with their weight or eating in the last year compared to 4% of men in general.[1]

7. Do all staff have knowledge of evidence relating to the health of minority groups within the lesbian, gay and bisexual community?

It is important to recognise that people often fall into more than one protected characteristic. There is a lack of research and evidence into the minority groups within the LGB community, however some research is detailed in the compendium provide by Pride in Practice. For example:

7% of women over 25 years old have never had a cervical screen.[2]

15% of LB women over 25 years old have never had a cervical screen. [3]

19% of BME LB women of over 25 years old have never had a cervical screen. [4]

8. Do your medical staff know the latest prevalence rate of HIV in your area; rate per thousand as published by Health Prevention Agency?

The Health Protection Agency advises that local authorities and NHS bodies with a diagnosed HIV prevalence greater than 2 per 1,000 population of 15-59 years should implement routine HIV testing for all general medical admissions. If you do not know the prevalence rate your practice could be falling short of the Health Prevention England guidelines.

To find out the HIV prevalence in your geographical area please use the link below:

http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1221722386448

9. During consultation, are sexually active men who have sex with men encouraged to have a HIV test at least once year?

British Society for Sexual Health and HIV (BASHH) suggests that men who have sex with men should be tested annually or more frequently if clinical symptoms are suggestive of seroconversion or ongoing high risk exposure.

You can encourage testing during consultations. If a patient consents to have their contact details shared with Pride in Practicewe can email them a reminder in 12 months’ time, with details of general STI testing centres, that include HIV tests. If you do not have the referral form for patients to access this service please contact your dedicated account manager or email pip@lgf.org.uk.

10. When in consultation with women of child bearing age, do any medical staff in your practice ask questions that presume that her sexual partners are male?

One of the most frequent frustrations from LGB patients Pride in Practice receives is that very often health professional presume heterosexuality until told otherwise. This leaves the LGB patient unsure of whether to correct the mistake (and be unsure of the response they will receive) or receive information or advice that may not be relevant to them.

The most frequent reports of presumed heterosexuality are from LB women, who are exclusively sexual active with women, being asked about contraception (not safer sex practices).

Too frequently we hear reports of from LB who are immediately asked about the methods of contraception after answering that they are sexually active, but not before being asked about the gender of their sexual partner or partners. 

11. When providing safer sex advice or STI testing to patients, is the gender of their sexual partner or partners asked for?

Using gender neutral language is important to ensure patients do not feel as though they are in a heterosexist environment. For example, the use of ‘partner’ instead of ‘boyfriend/ girlfriend’ or ‘husband/wife’.

However there will be frequent times, especially when discussing sexual health, when the gender of sexual partners is required. Medical staff must ensure that the patient is offered the opportunity to disclose their partner’s gender rather than having to correct an assumption.

For example:

Medical staff member: ‘Are you sexually active?’
Patient: ‘Yes’
Medical staff member: ‘Are your partner or partners male, female or both?’

If challenged the staff member can simply answer:

‘I did not want to presume your sexual orientation. I want to ensure I give you the most relevant medical information and advice’.

Information gathered via this type of questioning could indicate:

  • That a male patient should be offered an STI screen that includes rectal and pharyngeal sites.
  • That female patients who are having sex women should be made aware of safer sex practices.

Remember! When promoting the use of dental dams for women who have oral sex with women, dental dam use should also be encouraged with heterosexual patients too. This is to ensure that no patient is receiving less favorable service and the message of safer oral sex is consistent.

Legislation / legal rights

12. Do all medical staff understand current legislation that gives same-sex couples with registered civil partnership status equivalent rights to married couples, including entitlement to decision-making regarding health and social care?

The government is hoping the first same sex marriage should go ahead in early summer 2014, therefore it is still important that medical staff are aware of the current legislation that states that a civil partner is always acceptable as next of kin.

13. When same-sex couples want information on parenting options, do all medical staff in your practice feel confident in discussing the legal frameworks and choices available to the couple?

For many people the first port of call for family planning advice is their GP practice, and therefore all medical staff need to be aware of the options that are available for same sex couples wanting family planning advice, and are able to sign post for further information.

New Family Social is a good contact for couples looking into adoption and fostering. They are a growing national charity that provides support and information for prospective and existing LGBT adopters and foster carers.

‘A guide for gay dads’: http://www.stonewall.org.uk/at_home/parenting/4696.asp

‘Pregnant Pause: A guide for lesbians on how to get pregnant’: http://www.stonewall.org.uk/at_home/parenting/3463.asp

14. Are all medical staff aware of the legal rights that same-sex couples have when deciding on their or their partner’s child’s health care?

It is important when dealing with the children of same sex couples that medical staff are aware of the extent decision making that that couples can have for their child.

Citizens Advice Bureau uses the following definitions:

Same-sex partners living together
A same-sex partner has no automatic parental responsibilities and rights for their partner's children that they live with. However if a child is conceived by donor insemination or fertility treatment on or after 6 April 2009 a same-sex partner can be the second legal parent.

Civil partners
A civil partner does not have automatic parental rights over their partner’s children but has a general duty to safeguard the health and welfare of children under 16 who live in the household. If a child is conceived by donor insemination or fertility treatment on or after 6 April 2009 a civil partner can be the second legal parent and have automatic parental responsibilities and rights towards the child. 

Information provided under Questions 12, 13 and 14 are taken from the Citizens Advice Bureau.

Signposting and referrals

15. Do all staff have the knowledge, ability and confidence to signpost to potential sources of support and advice specific to the patients' sexual orientation, if appropriate or requested?

There is a continuing change of LGB specific services, especially in this climate when the difficulty in securing funding means local voluntary/community groups are ceasing. If you signpost to The Lesbian & Gay Foundation we can signpost patients to the services in their area.

If a patient is happy to have their contact details shared with The Lesbian & Gay Foundation, we encourages you do so. Then we can call the patient to discuss the services they are looking for, rather than relying on the patient to make the first step.  

16. Do medical staff have an awareness of whether or not there are referral pathways to local or relevant agencies that can provide specialist services and support to lesbian, gay and bisexual patients, and do they have the ability and confidence to refer?

The Lesbian & Gay Foundation can signpost patients to services however some organisations have specific referral pathways that if used can mean patients’ needs can be met quicker, rather than going via The Lesbian & Gay Foundation.

If your Practice is based in Greater Manchester that are a number of services delivered by The Lesbian & Gay Foundation that require specific referral forms. If you are not aware of these please contact you dedicated account manager. 

17. Do medical staff offer a choice between a mainstream service and an LGB-specific service (if available) when referring a patient for a service such as counselling?

Patient choice is crucial as part of meeting a patient’s needs. Not every LGB patient will want to access LGB specific services but offering such services alongside main stream providers gives patient’s options.

Patient voice

18. Does your practice consult with lesbian, gay and bisexual patients/staff in the development of health promotion activities?

Engaging with the LGB community on any health promotion topics means that one is able to guage if the message is reaching the community, and consultation is recommended for all major health promotion (not only those promotions focusing on sexual health).

It is important to remember that not everyone who identifies as LGB would want to be considered an ‘expert’ or consulted on LGB health promotion activities.

Sexual orientation monitoring

19. Does your practice monitor sexual orientation of all staff?

It is reported to The Lesbian & Gay Foundation and recommended in our sexual orientation monitoring guide (you should receive a hard copy in your resource pack from Pride in Practice it is also downloadable at http://www.lgf.org.uk/SOM) that if staff are used to being asked their sexual orientation they are often more comfortable with gathering sexual orientation data, and deepens their understanding of the reasons why such data is collected.

20. Does your practice monitor sexual orientation of new patient registrations?

Monitoring for all protected characteristics including sexual orientation is essential as it will help build an evidence base, and enable you to better understand staff and service users and provide for their different needs.

Furthermore by conducting monitoring LGB patients and staff can be consulted in health promotion activities.

21. When current patients are updating their contact details are they encouraged to update all demographic information including sexual orientation?

Identification sexual orientation can be fluid as are many all of the other protected characteristics (disability, religion, maternity etc.), therefore is it recommended that when updating a patient’s contact details that one should ask a patient to check their demographic information too and update it if necessary.   

[1] Guasp A. (2012) ‘Gay and Bisexual Men’s Health Survey’ Stonewall

[2] Hunt R & Fish J, Prescription for Change, Stonewall, 2008

[3] Hunt R & Fish J, Prescription for Change, Stonewall, 2008

[4] Guasp A. and Taylor J. (2012) Ethnicity – Stonewall Health Survey