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Background: The large-scale quantitative evidence base to understand and improve health and healthcare outcomes for people who are trans and/or non-binary is still developing, although what research there is suggests that risk of poor health is high, and experiences of healthcare services are often poor. In 2021 the GP Patient Survey, which is carried out annually to measure patient experience in primary care in England, added inclusive questions about gender identity and trans status for the first time. Methods: This protocol paper pre-registers the methods that we will use for this work for a secondary analysis of these data, including both the statistical analysis protocol and early patient and public involvement work, to answer the following three research questions: (1) What are the (a) demographic characteristics, (b) health conditions, and (c) healthcare experiences of trans and/or non-binary adults in England? (2) Was there any difference in whether people who are trans and/or non-binary had been asked to shield during the COVID-19 pandemic or not compared with all other survey responders? (3) Does the relationship between being trans and/or non-binary, and self-reported long-term mental health problems, autism and autistic spectrum disorder and learning disability vary by age, gender, ethnicity, deprivation, sexual orientation or region?

WISH2 is a mixed-methods longitudinal project designed to explore the mental health and wellbeing (MHW) impacts of HS2 Phase 2 across 6 work-packages: the development of a framework (WP1), a longitudinal survey of mental wellbeing, social inclusion and health-related behaviours (WP2), interviews and focus groups exploring change and adaptation (WP3), analysis of existing data sources to explore community-level trends over time (WP4), health economic evaluation of the MHW effects of HS2 (WP5), and the integration of results and incorporation of stakeholder feedback (WP6). This will involve three rounds of data collection during the 10-year study period. The full project is pre-registered at ISRCTN (doi.org/10.1186/ISRCTN58916738). This protocol describes the initial analyses being undertaken as part of WP2 (survey) at the first stage of data collection (Wave 1).

OBJECTIVE: Younger people, minority ethnic groups, sexual minorities and people of lower socioeconomic status report poorer experiences of primary care. In light of NHS ambitions to reduce unwarranted variations in care, we aimed to investigate whether inequalities in patient experience of primary care changed between 2011 and 2017, using data from the General Practice Patient Survey in England. METHODS: We considered inequalities in relation to age, sex, deprivation, ethnicity, sexual orientation and geographical region across five dimensions of patient experience: overall experience, doctor communication, nurse communication, access and continuity of care. We used linear regression to explore whether the magnitude of inequalities changed between 2011 and 2017, using mixed models to assess changes within practices and models without accounting for practice to assess national trends. RESULTS: We included 5,241,408 responses over 11 survey waves from 2011-2017. There was evidence that inequalities changed over time (p < 0.05 for 27/30 models), but the direction and magnitude of changes varied. Changes in gaps in experience ranged from a 1.6 percentage point increase for experience of access among sexual minorities, to a 5.6 percentage point decrease for continuity, where experience worsened for older ages. Inequalities in access in relation to socio-economic status remained reasonably stable for individuals attending the same GP practice; nationally inequalities in access increased 2.1 percentage points (p < 0.0001) between respondents living in more/less deprived areas, suggesting access is declining fastest in practices in more deprived areas. CONCLUSIONS: There have been few substantial changes in inequalities in patient experience of primary care between 2011 and 2017.

Protocol for an analysis of responses to the 2021 GP Patient survey

Supplemental material, sj-pdf-1-hsr-10.1177_1355819620986814 for Sociodemographic inequalities in patients’ experiences of primary care: an analysis of the General Practice Patient Survey in England between 2011 and 2017 by Catherine L Saunders, Sarah Flynn, Efthalia Massou, Georgios Lyratzopoulos, Gary Abel and Jenni Burt in Journal of Health Services Research & Policy

Additional file 1. Pre workshop ranking form.

Supplemental material, sj-pdf-2-hsr-10.1177_1355819620986814 for Sociodemographic inequalities in patients’ experiences of primary care: an analysis of the General Practice Patient Survey in England between 2011 and 2017 by Catherine L Saunders, Sarah Flynn, Efthalia Massou, Georgios Lyratzopoulos, Gary Abel and Jenni Burt in Journal of Health Services Research & Policy

Supplemental material, sj-pdf-1-msc-10.1177_0969141320987271 for Cervical screening attendance and cervical cancer risk among women who have sex with women by Catherine L Saunders, Efthalia Massou, Jo Waller, Catherine Meads, Laura AV Marlow and Juliet A Usher-Smith in Journal of Medical Screening

Supplemental material, sj-pdf-2-msc-10.1177_0969141320987271 for Cervical screening attendance and cervical cancer risk among women who have sex with women by Catherine L Saunders, Efthalia Massou, Jo Waller, Catherine Meads, Laura AV Marlow and Juliet A Usher-Smith in Journal of Medical Screening

Wellbeing Impact Study of HS2 https://wish2.org/ https://doi.org/10.1186/ISRCTN58916738

Additional file 2. ‘Your Wellbeing’ sheet.

Key Points Question Does a smartphone application that prompts monthly skin self-monitoring result in individuals with increased risk of melanoma having more timely or more frequent family practice consultations for skin changes? Findings In this phase 2 randomized clinical trial of 238 participants, there were no significant differences in skin consultation rates, measures of skin self-monitoring, or psychological harm. Meaning Because there was no evidence that a smartphone application increased skin self-examination or health care consulting rates among a family practice population at increased risk of melanoma, its implementation is not yet recommended., This phase 2 randomized clinical trial studies the effect of a commercially available skin self-monitoring smartphone application among individuals with increased risk of melanoma on their decision to seek help for changing skin lesions., Importance Melanoma is among the most lethal skin cancers; it has become the fifth most common cancer in the United Kingdom, and incidence rates are rising. Population approaches to reducing incidence have focused on mass media campaigns to promote earlier presentation and potentially improve melanoma outcomes; however, interventions using smartphone applications targeting those with the greatest risk could promote earlier presentation to health care professionals for individuals with new or changing skin lesions. Objective To study the effect of a commercially available skin self-monitoring (SSM) smartphone application among individuals with increased risk of melanoma on their decision to seek help for changing skin lesions. Design, Setting, and Participants This phase 2 randomized clinical trial was conducted in 12 family practices in Eastern England between 2016 and 2017. A total of 238 participants, aged 18 to 75 years and with an increased risk of melanoma, were identified using a real-time melanoma risk assessment tool in family practice waiting rooms. Analysis was intention to treat. Participants were observed for 12 months, and data analysis was conducted from January to August 2018. Intervention The intervention and control groups received a consultation with standard written advice on sun protection and skin cancer detection. The intervention group had an SSM application loaded on their smartphone and received instructions for use and monthly self-monitoring reminders. Main Outcomes and Measures The coprimary outcomes were skin consultation rates with family practice physicians and patient intervals, measured as the time between noticing a skin change and consulting with a family practice clinician. Follow-up questionnaires were sent at 6 and 12 months, and consultation rates were extracted from family practice records. Secondary outcomes included skin self-examination benefits and barriers, self-efficacy for consulting without delay, perceived melanoma risk, sun protection habits, and potential harms. Results A total of 238 patients were randomized (median [interquartile range] age, 55 [43-65] years, 131 [55.0%] women, 227 [95.4%] white British; 119 [50.0%] randomized to the intervention group). Overall, 51 participants (21.4%) had consultations regarding skin changes during the 12 months of follow-up, and 157 participants (66.0%) responded to at least 1 follow-up questionnaire. There were no significant differences in skin consultation rates (adjusted risk ratio, 0.96; 95% CI, 0.56 to 1.66; P = .89), measures of SSM (adjusted mean difference, 0.08; 95% CI, −0.83 to 1.00; P = .86), or psychological harm (eg, Melanoma Worry Scale: adjusted mean difference, −0.12; 95% CI, −0.56 to 0.31; P = .58). Conclusions and Relevance In this study, recruitment, retention, and initial delivery of the intervention were feasible, and this research provided no evidence of harm from the SSM smartphone application. However, no evidence of benefit on skin self-examination or health care consulting was found, and there is no reason at this stage to recommend its implementation in this population at increased risk of melanoma. Trial Registration isrctn.org Identifier: ISRCTN16061621

Supplemental material, HSR911392 Supplemental Material for Healthcare utilization among migrants to the UK: cross-sectional analysis of two national surveys by Catherine L Saunders, Adam Steventon, Barbara Janta, Mai Stafford, Carol Sinnott, Lucinda Allen and Sarah R Deeny in Journal of Health Services Research & Policy