Ethnic inequalities in primary care experiences for people with multiple long-term conditions: Evidence from the general practice patient survey

To 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. A retrospective study using 2018–19 GP Patient Survey data linked to General Practice Workforce data and small area data published by the Office for National Statistics. We conducted multilevel regression analysis to assess the relationship between ethnicity and experience of accessing primary care and interacting with healthcare professionals. We built separate regression models for each outcome and included (i) each covariate separately, (ii) demographic factors and (iii) demographic, practice, and area-level factors. Upon full adjustment Arab, Bangladeshi, Chinese, Indian, Pakistani, other Asian, mixed white and Asian, and other white people with MLTCs have 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; 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. Given the link between patient satisfaction and patient-related health outcomes, the lower levels of satisfaction with accessing primary care and interacting with healthcare professionals among the aforementioned minoritised ethnic groups are concerning and require further scrutiny. Qualitative studies are required to understand and address the sources of poor experiences in primary care for minoritised people with MLTCs to improve patient-centred healthcare and outcomes.