Primary care experiences at the intersection of sexual minority status and long-term mental health conditions in England: a cross-sectional analysis using the English General Practice Patient Survey

Background Sexual minorities and individuals with mental health conditions (MHC) often report poorer healthcare experiences, but evidence on inequalities at their intersection remains limited. Methods We analysed data from 1,277,383 respondents to the 2022–23 English General Practice Patient Survey using survey-weighted logistic regressions. Sexual orientation and self-reported long-term MHC were fully interacted to estimate adjusted predicted probabilities for six indicators of primary care experience: recognition of mental health needs, confidence and trust in healthcare professionals (HCP), HCP interpersonal skills, involvement in care decisions, overall needs met, and help-seeking before appointments. Findings Sexual minorities with MHC accounted for 1.2% of our analytical sample and reported the lowest satisfaction with involvement in care decisions (89.8% [89.3–90.2]), and HCP interpersonal skills (8.9% [8.4–9.3]) compared to all other groups. Interaction effects indicated partially protective patterns among sexual minorities with MHC for recognition of mental health needs (81.7% [80.6–82.7]), confidence/trust in HCP (93.3% [92.8–93.9]), and overall needs met (91.3% [90.7–91.9]), with the interaction effects corresponding to positive departures from additivity of 0.8 to 2.1 percentage-points. For these outcomes, sexual minorities with MHC exhibited moderate levels of positive primary-care experience, falling between the highest- and lowest-positive endorsement groups. Interpretation Sexual minority orientation and long-term MHC independently related to lower primary care satisfaction. However, their intersection was associated with both disadvantage and relative protection across different domains. Recognising these patterns is essential for reducing inequalities and better tailoring primary care services. Funding This article was not commissioned or funded by any external agency.