People from sexual minority groups in England who report a long‑term mental health condition are significantly less likely to feel involved in decisions about their care and are more prone to rate clinicians' interpersonal skills negatively, according to a large analysis of patient experience data published in eClinicalMedicine.
Large survey highlights uneven experiences
The study examined responses from around 1.27 million participants in the 2022–23 General Practice Patient Survey and explored how sexual orientation and the presence of a long‑term mental health condition relate to evaluations of GP services. Depending on the outcome assessed, the proportion of respondents reporting a positive experience ranged from 62.5% to 94.3%, indicating overall moderate to high satisfaction across different aspects of primary care.
Despite generally favourable overall scores, the authors found specific inequalities affecting sexual minority patients with a long‑term mental health condition. These patients were notably less likely than other groups to say they felt involved in decisions about their treatment and more likely to give poorer ratings for health professionals' interpersonal skills.
Mixed pattern across other measures
Conversely, for some other elements of primary care assessment the same group reported somewhat better experiences than might have been predicted from the combined effects of sexual orientation and mental health status. These areas included whether patients felt their mental health needs were recognised, their confidence and trust in clinicians, and whether they felt their overall needs had been met. The study notes these patterns as unexpected and potentially indicative of complex interactions between personal, social and service factors.
| Item | Range/Aggregate reported |
|---|---|
| Survey sample size | 1.27 million |
| Positive experience across measures | 62.5%–94.3% |
| Journal | eClinicalMedicine (DOI: 10.1016/j.eclinm.2026.104016) |
Implications for practice and policy
The findings point to particular deficits in shared decision‑making and in perceived interpersonal skills among clinicians for this patient group. That matters because involvement in decisions and the quality of clinician–patient interactions have been linked in previous literature to treatment adherence, satisfaction and health outcomes. However, the authors are careful to stress that the study is observational and cannot establish causation.
Possible explanations for the observed patterns are not tested directly in the analysis but could include:
- Differences in how clinicians communicate with patients who identify as sexual minorities or have long‑term mental health conditions;
- Variation in patient expectations and prior experiences influencing survey responses;
- Structural barriers or micro‑discrimination that affect trust and engagement in some consultations.
The research team suggests that the mixed findings — with some outcomes showing small advantages for sexual minority patients with mental health conditions — point to complex, potentially buffering processes that warrant further investigation. Understanding these mechanisms could help shape targeted interventions to reduce inequalities.
Strengths and limits of the evidence
Strengths of the study include the very large, nationally representative sample drawn from the annual GP Patient Survey and the use of multiple measures of primary care experience. The authors note several limitations: the data are self‑reported, cross‑sectional and cannot unpack causal pathways; the survey relies on how individuals choose to identify and report their conditions; and residual confounding by unmeasured factors is possible.
Given these limits, the paper calls for further research using designs able to examine causal links and the contextual factors shaping patient experience. It also recommends that primary care services consider boosting training and support focused on shared decision‑making and interpersonal communication skills, particularly for clinicians serving diverse communities.
The study is published in eClinicalMedicine (DOI: 10.1016/j.eclinm.2026.104016).
