Inequalities in family practitioner use by sexual orientation: evidence from the English General Practice Patient Survey

OBJECTIVE: To test for differences in primary care family practitioner usage by sexual orientation. DESIGN: Multivariate logistic analysis of pooled cross-sectional postal questionnaire responses to family practitioner usage. SETTING: Patient-reported use and experience of primary care in England, UK. Data from several waves of a postal questionnaire (General Practice Patient Survey) 2012–2014. POPULATION: 2 807 320 survey responses of adults aged 18 years and over, registered with a family practitioner. MAIN OUTCOME MEASURES: Probability of a visit to a family practitioner within the past 3 months. RESULTS: Lesbian women were 0.803 times (95% CI 0.755 to 0.854) less likely to have seen a family practitioner in the past 3 months relative to heterosexual women (bisexual women OR=0.887, 95% CI 0.817 to 0.963). Gay men were 1.218 times (95% CI 1.163 to 1.276) more likely to have seen a family practitioner relative to heterosexual men (bisexual men OR=1.084, 95% CI 0.989 to 1.188). Our results are robust to the timing of the family practitioner visit (0–3, 0–6, 0–12 months). Gay men were more likely to have seen a family practitioner than heterosexual men where the proportion of women practitioners in the practice was higher (OR=1.238, 95% CI 1.041 to 1.472). CONCLUSIONS: Inequalities in the use of primary care across sexual orientation in England exist having conditioned on several measures of health status, demographic and family practitioner characteristics. The findings suggest these differences may be reduced by policies targeting a reduction of differences in patient acceptability of primary care. In particular, further research is needed to understand whether lower use among heterosexual men represents unmet need or overutilisation among gay men, and the barriers to practitioner use seemingly occurring due to the gender distribution of practices.