The benefits of a clinical rationale

As part of the dataset and full evidence case being compiled for LGB people and patients it was agreed that a clinical rationale to support the need for a more targeted focus on this group was essential and would support the evidence and detailed research already collected by the LGF, thereby improving outcomes and the patient’s experience of healthcare.

The BHP budget was not able to fund the clinical rationale so SMCCG provided financial support and capacity to take it forward for the partnership (http://www.bodey.co.uk/info.aspx?p=11) – considering the benefits all round. That support was very welcome and has enabled a truly cooperative approach to these health priorities.  

This method had a number of benefits as outlined in the recommendations:

  • Improved awareness of health inequalities affecting LGB patients including smoking, alcohol use, drug use, mental health conditions, sexual health and social isolation in older adults.
     
  • Clinicians to be aware of General Medical Council guidance and promote equality and diversity in the workplace.
     
  • Consider the role of the equality and diversity lead in South Manchester CCG and attempt to gain national opinion of sexual orientation monitoring in healthcare settings through liaison with professional and regulatory groups.
     
  • Clinicians to have an awareness of the law surrounding sexual orientation monitoring especially the Equality Act 2010 and the equality duty applicable to public sector organizations.
     
  • To begin monitoring of sexual orientation of staff and patients in order to comply with the Equality Act 2010.
     
  • To encourage practice participation in “Pride in Practice” to increase confidence and skills allowing effective communication with LGB patients surrounding sex and sexual orientation.
     
  • To begin addressing patients in a - gender neutral - manner along with training in effective ways to discuss sexual orientation with patients.
     
  • Respond positively to a patient’s disclosure of their sexual orientation; challenge any inappropriate homophobic opinions of staff and patients.
     
  • Display LGB inclusivity posters in waiting and consultation rooms in order to demonstrate a welcoming disclosure environment for LGB patients.
     
  • For practices to have access to up to date information of available services for LGB patients
     
  • To gain the advice of patient participation groups on whether monitoring is beneficial.
     
  • The majority of clinicians would want sexual orientation to be monitored at new registration. However, they would want a standardised form, strict guidance on why the information is being collected, how it will be used and how patients’ privacy will be protected.

How the evidence can be used

In the case of the LGF the legacy of BHP is to use all the outputs of the project to influence agencies to make lasting change: reducing health inequalities and improving access for LGB&T people, some are listed below:

  • CCGs
  • Commissioning
  • NHS England
  • Health & Wellbeing Boards
  • Public Health
  • Health Education England NW
  • Local Medical Council
  • Research institutions
  • Voluntary Sector Assembly 

Discussion point

Has your client group benefitted from clinical support in this way in the last 5 years? If so, how has this information been shared and what results have been brought about?

If not, what are the possibilities for this? What relationships do you have with clinicians to support this approach?

Activity

Read the clinical rationale written by Simon Rogers – GP at The Bodey Practice in Fallowfield, South Manchester - Sexual Orientation Monitoring and Health Inequalities in the Lesbian, Gay and Bisexual Communities

Consider how these findings could support LGB people in your own client group, and how this type of approach might benefit other groups.

Examples

HIV Local Research Project

The Bodey invited around 140 people for testing. At the suggestion from the BHP group, the letter was rather vague in order to preserve confidentiality and prevent any panic. However it was made clear that it was important for the patient to contact the surgery regarding the letter so it was not ignored. Getting the balance of increasing test uptake and not causing alarm was very important to the practice that put a lot of time and thought into the wording of the letter. Participants were offered a telephone consultation, where their risk factor(s) were explained, and the patient consented to the test.

Approximately 60 patients took up the offer (Nov 2013) and the remainder of non-responders were being telephoned to discuss testing.

The majority of the decliners did so because they had recently had a HIV test elsewhere (i.e hospital admission, pregnancy, GUM clinic attendance).

Following the testing process, patients were given a questionnaire to complete so that qualitative data could be assessed from the process. Out of all the respondents, approximately 2 disliked the way the letter was worded and would have preferred a phone call from the Surgery instead of a letter (they did still opt to have the test). Nearly all of the respondents were relaxed with the discussion they had with the GP prior to test.

The Bodey’s aim is to normalise testing for HIV. The stigma of a positive diagnosis is slowly starting to change for the better. Being able to give a result to patients within 20 minutes seems to have lessened the trauma of the test itself. All of the patients in the project agreed on that.

The response from one patient who was telephoned to invite for a test that did not respond to the initial letter as they had moved out of area and therefore could not have the test:

"Wow, thank you for phoning, I have always been scared of getting a test done and didn't like the thought of waiting a week [for the result]. 20 minutes?, that's incredible! I'm going to ask my new GP for a test, see if they can beat that, I've got no excuse now..."

Patient

Practical consideration

If it is agreed that a clinical rationale to support the need for a more targeted focus on your own client group is essential and would support the evidence and research you already collect, think about HOW it would improve the outcomes and the patient’s experience of healthcare.

What links do you have with clinicians to start a conversation about this type of approach?

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