Ethnic inequalities in primary care for people with multiple long-term conditions: evidence from the General Practice Patient Survey

ObjectiveTo examine the relationship between ethnicity and experiences of primary care for people with multiple long-term conditions (MLTCs) and assess the relative importance of demographic, practice, and area-level factors as influences on primary care experiences across ethnic groups. DesignA retrospective study using 2018-19 GP Patient Survey data linked to the General Practice Workforce data, and the Office for National Statistics data. SettingUK Participants: 294,987 respondents with two or more long-term conditions with complete data on selected demographic variables (age, gender, ethnicity, economic activity), practice and area-level variables (number of full-time equivalent GPs and nurses, practice size, area-deprivation, area life expectancy and ethnic density). Main outcome measuresMultilevel regression analysis used to assess the relationship between ethnicity and experience of accessing primary care (i.e. satisfaction with appointment times, types and booking experience) and interacting with healthcare professionals (i.e. satisfaction with confidence and trust in healthcare professionals and the extent to which patients feel healthcare professionals listen to them, give them enough time, treat them with care and concern, involve them in healthcare decisions, and meet their needs). Separate regression models built for each outcome and included i) each covariate separately, ii) demographic factors (iii) demographic, practice, and areal-level factors. ResultsUpon full adjustment Arab, Bangladeshi, Chinese, Indian, Pakistani, other Asian, mixed white and Asian, other white and other ethnic group people with MLTCs have both lower levels of satisfaction with primary care access and interacting with healthcare professionals compared with white British people. The influence of demographic, practice and area-level factors is not uniform across ethnic groups. For example, demographic factors account for the inequalities in levels of satisfaction with access to primary care between white British people and Black other, mixed other, mixed white & Black Caribbean and Gypsy & Irish Travellers. However, practice and area-level factors strengthen inequalities in the experience of accessing primary care for Bangladeshi, Indian and Pakistani people. ConclusionsGiven that patient experience is a key aspect of healthcare quality and is said to be associated with favourable health outcomes, the inequalities identified in this study are concerning. The poorer experiences of primary care might be one mechanism by which people with MLTCs from minoritised ethnic groups have poorer health outcomes. In addition to the assessment of other practice and area-level factors, qualitative studies are required to understand and effectively address the sources of ethnic inequalities in primary care experiences for people with MLTCs.