Ethnic inequalities in primary care persist for patients with multiple long-term conditions

A recent study funded by The Health Foundation has highlighted the challenges faced by people from minoritised ethnic groups with multiple long-term conditions (MLTCs) in accessing and interacting with primary healthcare services, such as GP practices, in England.

Conducted by researchers from City St George’s, University of London and King’s College London, the study has revealed ethnic inequalities, with differential experiences among minoritised ethnic groups, in two domains of primary care:

1. Access to primary care services – including appointment scheduling and availability.
2. Interactions with healthcare professionals – encompassing trust, communication, and patient involvement in decision-making.

The authors call for a move away from blanket approaches to improving healthcare experiences that fail to recognise the nuances between different minoritised ethnic groups. The study has been published in Public Health.

To understand more about how and why there are ethnic differences in primary care experiences, the researchers used a large dataset, encompassing over 310,000 survey responses from the 2018–19 General Practice Patient Survey. They used statistical models to examine how factors such as practice size, the proportion of ethnic minority residents in a neighbourhood, and socio-economic deprivation influenced patient experience.  Their decision to examine practice and area level factors was based on evidence that suggests (a) patients registered in larger practices and practices located in deprived areas with high levels of patient need often report poorer experiences of primary care, and (b) minoritised ethnic people are more likely to be registered in practices with these characteristics.

The study found that patients from Arab, Bangladeshi, Chinese, Indian, Pakistani, and other Asian ethnic groups, as well as mixed White and Asian groups, reported lower levels of satisfaction in both domains of primary care experiences compared to white British patients even after accounting for demographic, practice and area-level factors.

For Bangladeshi, Indian and Pakistani people, adjusting for practice and area-level factors strengthened inequalities in the experience of accessing primary care suggesting that levels of satisfaction were lower than expected.

The study also explored the impact of healthcare workforce composition, revealing that higher numbers of nurses were linked to lower patient satisfaction, potentially reflecting preferences for GP-led care among patients with complex needs.

It was also seen that age and gender had an effect, as women and younger patients reported lower satisfaction levels compared to men and older individuals when it came to accessing appointments and interacting with healthcare staff.

Speaking about the study, Dr Brenda Hayanga, first author of the study and Presidential Research Fellow at City St George’s, University of London, said:

“Our study has shed light on the significant disparities in primary care experiences for patients with multiple long-term conditions across minoritised ethnic groups in England. Patient satisfaction is not just a measure of service quality; it is also closely tied to health outcomes. Higher satisfaction is associated with improved medication adherence, lower readmission rates, and better overall health. The findings raise concerns about the broader impact of these disparities on the health of minoritised ethnic communities.

“Poorer experiences in primary care might also contribute to the adverse health outcomes often observed among minoritised ethnic groups. We need further research to explore the experiences of minoritised ethnic people with multiple conditions to identify the drivers of lower levels of satisfaction in order to develop acceptable initiatives that effectively address ethnic inequalities in primary care experiences. At the same time, we need to interrogate the quality and availability of translation/interpreter services and assure digital inclusion among minoritised ethnic people to reduce inequalities arising from language barriers and digital exclusion.”