1. Pride in Practice Excellence in LGBT Oral Healthcare Andrew Gilliver

2. LGBT Foundation exists to support the diverse group of people who identify as lesbian, gay, bisexual and trans.
Established in 1975.
A nationally significant charity, the largest of it's kind in the UK, based in Greater Manchester, providing support to over 40,000 people a year.

5. Pride in Practice is a quality assurance support service that strengthens and develops Primary Care Services relationship with LGBT patients within the local community . Pride in Practice is suitable for all Primary Care Services, supported by The British Dental Association. Pride in Practice enables you to effectively and confidently meet the needs of your LGBT patients. In just a few simple steps, Pride in Practice evidences your commitment and compliance with the Equality Act 2010.

6. Without Pride in Practice…
Lack of information to improve services
Not being open with
health professionals
Lack of patient voice and participation
Delayed engagement with
health services due to fear of homophobia/
biphobia/transphobia
Reduced access to health care
Reduced health outcomes

7. With Pride in Practice…
Increase of information to improve services
Open with
health professionals
Increase of patient voice and participation
Increased and earlier engagement with
health services
Increased access to health care
Increased health outcomes

8. Barriers to accessing services Unless LGBT patients see positive acknowledgement that a service is LGBT inclusive they may assume that it isn't! In wider society many LGBT people still face/have faced discrimination in all areas of life including in provision of healthcare. LGBT patients may fear judgement, discrimination or a lack of understanding or knowledge about their health.

9. How to be LGBT inclusive  By making small changes in practice such as displaying inclusive posters, monitoring of sexual orientation, gender identity and trans status, dental practices can ensure they are reaching out to their LGBT patients.  A dental professional who knows a patient is LGBT is: - better informed about the person accessing their service. - less likely to ask inappropriate questions or make assumptions - able to pay due regard to protected characteristics in line with Equality Act (2010)

10. Some oral risk factors for LGBT people
Among LGBT people there is a much higher rate of smoking than in the general population (ash.org.uk and others) .
Many LGBT people use recreational drugs compared to general population (londonfriend.org.uk)
An increase in STI's amongst MSM could be due to HIV reduction strategies ( Nat.Centre for Biotechnology Info,US)
Higher rates of HIV and hepatitis among LGBT communities. (Public Health England)
Stigma around HIV & STIs can keep patients from seeking dental care

11. Some oral risk factors for LGBT people
 LGBT people  can experience unique stress factors that can contribute to the development of an eating disorder.(nationaleatingdisorders.org)
LGBT people with poor mental health may have significantly higher prevalence of not using dental services (Nat.Centre for Biotechnology Info, US)
1 in 4 homeless youth are likely to be LGBT (akt.org.uk)
Many trans people have experienced domestic abuse (scottishtrans.org)
Some trans people may self-medicate with hormones bought online (bmj.com).

12. Oral risk factors for LGBT people in Manchester
37% of LGB people used drugs in the past month compared to 5% of the general population
86% of LGB people reported binge drinking at least once in the past month
62% of trans respondents to AUDIT-C questions gave answers which suggested alcohol dependency
80% of trans people have experienced domestic abuse
3 in 10 bisexual women have had an eating disorder compared to 1 in 20 of general population

13. Oral risk factors for LGBT people in Manchester
30% of LGBT people smoke compared to 21% of general population
17% of trans people are self-medicating with hormones bought online
1 in 3 homeless youth are LGBT
1 in 10 gay, bisexual and MSM are living with HIV
Risk of HIV infection is nearly 50 times higher for trans women compared to general population worldwide
UK wide surge in syphilis, 85% of diagnoses were MSM, 31% of the MSM said oral sex was the most likely route

14. How many LGBT people are there?
5-7% of the UK population is LGB (2004)
1% of the UK population don't identify with gender assigned at birth (2012)
Based on a mid-point of this estimate and Greater Manchester population statistics, an estimated 215,000 LGBT people currently live in Greater Manchester.  This is equivalent to the population size of Rochdale!

15. Useful to know…
Sexual Orientation Monitoring Information Standard - consistent mechanism for recording sexual orientation of all patients +16 yrs across all health services in England.
National LGBT Survey  Gov Equalities Office Over 108,000 responses. Action Plan on back of findings .
2021 Census - the next census is set to include questions on sexual orientation and gender identity for the first time.

17. Sexual Orientation Monitoring
Over the last two decades, LGBT communities have seen legislative change which has led to greater acceptance. However, there is still a huge lack of evidence about LGBT people, our needs and experiences.
Monitoring sexual orientation, gender identity and trans status is a proven way to address that lack of evidence.
Since October 2017, organisations are now able to use this standard to implement sexual orientation monitoring.
LGBT Foundation worked with NHS England and a number of stakeholders to make sure that healthcare services collect information on patient sexual orientation and use this to improve services by creating a sexual orientation monitoring Information Standard.

18. Trans Awareness Transgender
Someone whose gender identity is different from the gender that they were given at birth.

19. Trans Awareness Trans woman
Somebody whose gender identity is woman and who was assigned male at birth.
A woman who is trans.
Pro tip: trans is an adjective (describing word) like tall, short, cheerful or thoughtful

20. Trans Awareness Trans man
Somebody whose gender identity is man and who was assigned female at birth.
A man who is trans.

21. Trans Awareness Non-binary
Somebody who does not identify as a man or a woman, or who identifies as both, or as something else.
May refer to themselves as: genderqueer, genderfluid, agender, or in a number of other ways.

22. Remember! You can’t guess somebody’s gender by looking at them.
Use gender neutral language if someone hasn’t told you how they identify – this way you can never be wrong!
You can always ask “what pronoun do you use?” or “how would you like to be referred to?”

23. Visibility
There can often be a perception that unless LGBT patients see some positive acknowledgement that a service is LGBT inclusive, then they will assume it isn’t.

24. Patient Experience
‘I have an issue with dentists due to previous issues with poor diet and sugary foods. To make things worse  I  have had issues with recreational drug use and certain substances like speed (amphetamine ) that made me grind my teeth a lot . I’m aware of the damage that has been caused in the past to my teeth and gums and this makes it harder for me to face any dentist now when I feel ashamed about the state of my teeth. I really want to find a dentist that can help me but I need to feel sure that they will not judge me either for my past history, my HIV status or how I’ve handled my health care in the past.’ 
Gay Man, Salford.

25. Trans Positive Experiences Transgender patients have unique but diverse health needs. Dental professionals should be aware of the barriers to care unique to transgender patients (US) Many trans people have reported that practice staff were happy to change their name and title on the system and did so very easily (LGBT Patient Survey 2017) 'I told them I had changed my name and title, they gave a friendly and cheerful reaction and congratulated me on my deed poll ' Gay trans man, Manchester 

26. How Embarrassing!
The reason it can seem embarrassing to ask someone about their sexual orientation, gender identity or trans status is because of the stigma and discrimination towards LGBT people, not because being LGBT is embarrassing.

27. Should not be made a special case
How to ask the question
Which of the following options best describes you? 
-Heterosexual/Straight 
-Lesbian/Gay
-Bisexual
‘Prefer not to say’
Should not be made a special case 

28. How to ask the question
Which of the following best describes how you think of yourself?
- Female (including trans women)
Male (including trans men)
Non-binary
- In another way
Is your gender identity the same as the gender you were given at birth?
- Yes
- No

29. What do dentists say?
“Your role is to bring up anything that you can see that affects their oral health”.
“You have to give people the option to be honest. They have to choose whether or not to be honest with you, but at least you asked.”
– GM Dentist

30. Pride in Practice
Training sessions for all dental practices on the needs of LGBT service users
A supported assessment and accreditation award
A Bronze, Silver or Gold plaque to celebrate the practice’s achievement
Ongoing support from LGBT Foundation

33. andrew.gilliver@lgbt.foundation Tel: 0345 3 30 30 30
@LGBTfdn #PrideinPractice