OPEN LETTER TO THE GMC & MSC

As LIMA we have written an open letter to the General Medical Council & the Medical Schools Council, calling for LGBTQ+ healthcare to be included in the UK medical undergraduate curriculum (through inclusion in Outcomes for Graduates and the content assessed in the Medical Licensing Assessment. 

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You can read our open letter below (or click here to view the PDF), and also sign in support of the letter here (click link for form). We are looking for signatures from many different groups - medical students, doctors, allied healthcare professionals and students, medical educators, activists, and the public. You can see the names of those who have signed (consent given) at the end of the letter

(last updates 09/10/22). 

22/06/2022 

An open letter to the General Medical Council and the Medical Schools Council 

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Dear 

Dr Colin Melville (GMC Director of Education and Standards) 

and 

Professor Malcolm Reed (MSC Lead Co-Chair and Chair of Education Sub-Committee) 

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LGBTQ+ health in the medical curriculum: a call for change 

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Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) patients face substantial healthcare inequalities and barriers to accessing healthcare. In their 2018 report LGBT In Britain, Stonewall reported that over half of LGBT people have experienced depression; one in four LGBT people witnessed discriminatory remarks about LGBT people by healthcare staff; and one in seven LGBTQ+ people have avoided treatment due to fear of discrimination (1). These statistics demonstrate the stark healthcare inequalities that LGBTQ+ people face, and are wholly unacceptable. 

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LGBTQ+ patients face unique challenges across a broad spectrum of healthcare. From accessing gendered screening programmes, to receiving fertility treatment and pregnancy care, to accessing hormone therapy, to differing health risks. A key example of this was demonstrated by the LGBT Foundation’s ITEMS Project which found that 30% of trans and non-binary birthing parents did not access any NHS or private pregnancy care services, and 80% of these people did not feel confident to access care at all (2). LGBTQ+ patient groups have also been shown to have higher rates of both physical and mental ill health (3, 4). LGBTQ+ healthcare is more than treating all patients equally - it is about equity in ensuring the specific needs of LGBTQ+ patients are addressed. All patients deserve to be treated to a high standard with dignity and respect, free from discrimination and prejudice. 

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All healthcare professionals will encounter patients who are LGBTQ+ and, whilst their gender identity and sexuality is not always relevant to their medical treatment, it impacts individuals’ experiences of their health and their care. It is therefore key that medical students are sufficiently equipped with the knowledge they need to treat and work with LGBTQ+ patients. 

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Despite this, there is a significant lack of teaching on LGBTQ+ healthcare in UK medical schools. Studies at UK medical schools have shown students report a lack of LGBTQ+ healthcare teaching, and that this can have impacts on their confidence in treating LGBTQ+ patients (5, 6). Medical students are also directly asking for more training on LGBTQ+ healthcare - a study at one medical school found 85% of respondents wanted more training on LGBTQ+ healthcare (6).  

LGBTQ+ healthcare is not explicitly mentioned in the General Medical Council’s ‘Outcomes for Graduates’, and consequently neither in the content of the Medical Licensing Assessment, due to its basing on ‘Outcomes for Graduates’. Whilst it may be assumed that having generic equality, diversity and inclusion standards is sufficient, the unique healthcare needs of LGBTQ+ patients, and the specific barriers they face, call for the explicit requirement of knowledge of LGBTQ+ healthcare as a standard that should be met by all medical graduates. The previously mentioned statistics also clearly show the current standards are not sufficient. 

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The authors and signatories of this letter are therefore calling for a mandate to include assessed teaching on LGBTQ+ healthcare in all UK medical schools. We believe the best way to ensure this is by the following: 

• The General Medical Council to include LGBTQ+ healthcare knowledge in the standards of ‘Outcomes for Graduates’. 

• The Medical Schools Council to include LGBTQ+ healthcare knowledge as specific content assessed in the Medical Licensing Assessment. 

Any changes made should be formulated in collaboration with key stakeholders in the LGBTQ+ community, and using the knowledge of experts on LGBTQ+ healthcare. It should also be ensured that the curriculum looks through a lens of intersectionality between different identities, and acknowledges the impacts on health associated with intersectionality. We believe this change is the best way to create a culture shift in the way that UK medical schools approach LGBTQ+ healthcare, and will ensure that all UK medical students receive sufficient training on LGBTQ+ healthcare to care for their future LGBTQ+ patients. 

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We are keen to meet to discuss the content of this letter, as well as how meaningful change can be made. We look forward to a response and continuing dialogue. 

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Yours Sincerely, 

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The LGBTQ+ Inclusive Medical Education Alliance (LIMA) 

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The LGBTQ+ Inclusive Medical Education Alliance (LIMA) is a network of medical students, doctors and service users campaigning for better LGBTQ+ teaching for medical students and doctors to improve healthcare professionals' Medical Curriculum and queer patients' experiences. Our vision is for teaching on LGBTQ+ health to be a requirement across UK Medical Schools, in order to sufficiently equip medical students to treat LGBTQ+ patients in their future practice. More information regarding the organisation can be found at: https://lgbtqima.wixsite.com/website  

Endorsing Organisations 

The following organisations support the aims as stated in the letter:

GLADD 

LGBT Foundation 

The British Medical Association Student Committee

Gendered Intelligence

Leeds University LGBT+ Medics Society 

Feminist Gender Equality Network (FGEN) 

University College London LGBTQ+ Medics Network 

Trans Actual 

Glasgow University Medical Students LGBTQIA+ Society 

The Trans Gap Project (TGP) 

University of Birmingham LGBTQ+ Medics Society

Steph’s Place

Cardiff MedSoc

Gender Identity Research & Education Society

Healthcare Equality and Advocacy for LGBTQ+ (HEAL) Society at Cardiff University

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Key Signatories

The following people support the aims as stated in the letter:

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Professor Mark Kearney 

Dean, Leeds School of Medicine 

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Professor Laura Stroud 

Deputy Dean, Leeds School of Medicine 

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Dr Christopher Morrison 

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Dr Bridgette Bewick 

EDI Lead, Leeds School of Medicine

Professor Louise Bryant 

Dean of Equality, Diversity & Inclusion, University of Leeds 

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Dr Kate Nambiar

Gender Clinician & Endocrinology Specialist

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Dr Joseph Hartland

University of Bristol Deputy Education Director for Student EDI, MSC EDI Alliance Executive Board

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Dr Alex George

UK Government Youth Ambassador for Mental Health

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Dr Hannah-Barham Brown

GP Registrar, Equalities Campaigner and Consultant

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Stephen Gowland-Mahon

Head of MSQC (Clinical Years) Medical School Lead for EDI University of Central Lancashire

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Professor Alison Carr

Head of Medical School University of Central Lancashire  

Alex Matheson

NHS Rainbow Badge Programme Manager

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The LIMA Team

Dr Poppy Welsh

Dr Alexander Flach

Dr William Ballard

Dr Emily Pattinson

Jack Bonnington

Alice Barber

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Signatories

We have collected over 250 signatures from a combination of Service Users, Doctors, Allied Healthcare Professionals, & Medical Students. 

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References

1. Bachmann CL, Gooch B. LGBT In Britain: Health Report. London, UK: Stonewall; 2018. 

2. LGBT Foundation. Trans and Non-Binary Experiences of Maternity Services. 2022. Accessed from: https://dxfy8lrzbpywr.cloudfront.net/Files/97ecdaea-833d-4ea5-a891-c59f0ea429fb/ITEMS%2520report%2520final.pdf 

3. Streed, CG, Davis, JA. Improving Clinical Education and Training on Sexual and Gender Minority Health. Current Sexual Health Reports. 2018;10:273–280. doi: https://doi.org/10.1007/s11930-018-0185-y 

4. LGBT Foundation. Hidden Figures: LGBT Health Inequalities in the UK. 2020. Accessed from: https://lgbt.foundation/hiddenfigures. 

5. Parameshwaran, V, Cockbain, BC, Hillyard, M, Price, JR. Is the Lack of Specific Lesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students. Journal of Homosexuality. 2017;64(3):367–381. doi: 10.1080/00918369.2016.1190218 

6. Arthur, S, Jamieson, A, Cross H, Nambiar, K, Llewellyn CD. Medical students' awareness of health issues, attitudes, and confidence about caring for lesbian, gay, bisexual and transgender patients: a cross-sectional survey. BMC medical education. 2021;21(1):56. doi: https://doi.org/10.1186/s12909-020-02409-6 

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