Care for Disempowered Patients

Question 1

What is meant by the ‘inverse care law’?

Answer 1

There is a perverse relationship between the need for healthcare and its actual utilisation

those who most need medical care are least likely to receive it, whilst those with the least need for health care tend to use health services more

Question 2

Where do inequalities in health arise from?

Which group is most affected by this?

Answer 2

1. Variations in access to health services
2. Variations in the quality of health care from area to area
3. Variations in factors outside the control of the NHS - wealth, lifestyle, genetics, environment

populations living in high socio-economic deprivation suffer on all three counts - they use poor quality services which they have difficulty securing access to

Question 3

What trends are seen between deprivation and quality of GP services?

Answer 3

Patients in more deprived areas tend to have a greater number of psychological problems, more long-term illness and more multimorbidity

• access to appointments takes longer
• satisfaction is lower
• patients have more problems to discuss, yet consultations were shorter
• GP stress is higher and patient enablement is lower

Question 4

What is meant by patient enablement?

Answer 4

The ability to deal with psychosocial problems

Question 5

How can historic social or health system discrimination affect a patient?

Which group of patients is particularly affected?

Answer 5

It can affect a patient feeling at ease during a consultation

patients who identify as lesbian, gay or bisexual are 1.5 times more likely to report unfavourable experiences, especially relevant to primary care intervention

Question 6

How can discrimination impact transgender men?

Answer 6

Transgender men are less likely to attend a smear test than cisgenedered women

screening is important in the prevention of cervical cancer, which is one of the most frequently encountered gynaecological malignancies

Question 7

In what ways could the quality of healthcare for transgender men be improved?

Answer 7

• Trans men need sensitive and respectful screening experiences
• education for trans men about the importance of cervical screening
• education for healthcare professionals about the important of screening for trans men and how to provide sensitive environments for screening

Question 8

What barriers exist for recent entrants to the UK?

Answer 8

New migrants, refugees and asylum seekers may struggle, especially if they feel uncertain about their entitlements, perceive a lack of need for health care or hold any fears about an overlap between health and immigration services

Question 9

What is the biggest barrier to general practice registration?

Answer 9

The inability to provide paperwork

e.g. Lack of ID, proof of address or immigration status

Question 10

What has happened in hospitals since the introduction of the Hostile Environment?

Answer 10

Hospitals have had to charge undocumented migrants living in the UK for non-emergency medical care

this includes pregnant women

£7,000 for the basic maternity package (uncomplicated pregnancy and delivery) with bills often being higher

Question 11

What can an experience of discrimination from public services and society often lead to?

Answer 11

It can cause some people to avoid actively seeking help, especially if it is coupled with a lack of personal support network

Question 12

How does homelessness affect GP use?

Answer 12

Homeless people are 40 times more likely to not be registered with a GP practice than other sections of the general population

Question 13

What is meant by ‘health literacy’?

Answer 13

A person’s ability to identify health problems and to know where and when to seek support

they need the skills and confidence to discuss their illness and treatment with doctors or nurses, ask about options, or question why a treatment might be right for them

Question 14

What are the key factors involved in obtaining a GP appointment?

Answer 14

• Whether the patient is registered with a GP
• availabilty of appointments
• capacity within practice
• availability of clear information
• access to a professional interpreter
• ease of the booking system

people are less likely to obtain an appointment if they do not understand the system, if appointments are not available at convenient times or if the practice is not responsive to their needs

Question 15

Which groups tend to face barriers to accessing primary care?

Answer 15

1. Transgender patients
2. Homeless or unstably housed
3. Refugees, asylum seekers and vulnerable migrants
4. People with drug and alcohol problems
5. Sex workers
6. People with learning disabilities
7. People with mental health problems
8. Gypsies and traveller communities ‘’

Question 16

How can health beliefs act as a barrier to accessing health care?

Answer 16

Cultural, religious or other health beliefs can lead to an inability to recognise an issue

e.g. For mental health, some people may explain the issue as a spiritual issue rather than a health issue

Question 17

How can the barriers to healthcare be addressed?

Answer 17

1. Funding to boost the NHS in deprived areas
2. Care that is compassionate, kind, non-judgemental and friendly
3. Awareness of entitlement to care
4. Good communication and appropriate translation services
5. Take into account the patient’s social situation
6. Patient participation groups - feed back into the design of services