The findings of the NHS Race and Health Observatory’s report on trust in NHS primary care expose a troubling reality: systemic discrimination and exclusion remain deeply embedded within the UK’s healthcare system. The report, ‘Patient Experience and Trust in Primary Care’ was published on March 7.
While the NHS prides itself on delivering universal care, the lived experiences of Black, Asian, and ethnic minority communities tell a different story—one where trust in primary care providers is alarmingly low, and racial biases shape treatment outcomes. With just over half of respondents expressing confidence in their healthcare providers, the report makes it clear that the structural inequalities affecting access, treatment, and engagement are not incidental but intrinsic to the system itself. Addressing these issues requires more than surface-level commitments to diversity and inclusion; it demands a fundamental rethinking of how the NHS engages with, and provides for, the diverse communities it serves.
The recent report by the NHS Race and Health Observatory on trust in NHS primary care exposes deeply embedded structural inequalities that disproportionately affect Black, Asian, and ethnic minority communities. While the NHS claims to provide universal healthcare, the findings of this report suggest otherwise. The survey of 2,682 respondents highlights how systemic exclusion and institutionalised discrimination continue to shape the patient experience within the UK’s healthcare system. That only 55% of respondents trust NHS primary care providers to meet their health needs most or all of the time is not just a statistic—it indicts a system that routinely fails marginalised communities. A third of South Asian respondents reported rarely or never trusting primary care to address their health concerns, indicating a profound breakdown in the patient-provider relationship.
This erosion of trust is not accidental; it is the direct result of historically entrenched disparities in access, treatment, and engagement within healthcare institutions. When institutions fail to account for cultural, linguistic, and socio-economic differences, they reinforce the very inequalities they purport to challenge.
The report demonstrates that discrimination is not an anomaly but an embedded feature of NHS primary care, which fails to accommodate the lived realities of diverse communities.
Institutionalised discrimination within the NHS manifests in both overt and covert ways, shaping patient experiences and outcomes. Over half (51%) of survey respondents reported experiencing discrimination from NHS primary care providers, with 38% of Asian respondents and 49% of Black respondents stating that their ethnicity affected how they were treated. This suggests that racial biases are not only prevalent but also structurally embedded in healthcare delivery.
The report highlights that women, particularly from ethnic minority backgrounds, face additional layers of exclusion. Many reported that their pain was routinely dismissed, reinforcing long-standing critiques about gendered and racialised biases in medical treatment. The assumption that certain patients exaggerate their pain or symptoms is a form of epistemic injustice, wherein healthcare professionals systematically discredit the knowledge and experiences of marginalised groups.
The issue extends beyond individual prejudice; it is a symptom of an institutional culture that normalises differential treatment.
Furthermore, the report points to a lack of cultural competency in the NHS, particularly in addressing health conditions disproportionately affecting ethnic minorities, such as sickle cell disorder, lupus, and diabetes. The absence of targeted training and resources for such conditions is indicative of a system that prioritises majority populations, rendering minority health concerns invisible.
For Muslim patients, institutionalised Islamophobia compounds these challenges, creating additional barriers to equitable healthcare. The report highlights that visibly Muslim patients—such as those wearing hijabs—often feel that they are treated with suspicion or indifference. Some respondents shared experiences where assumptions about their religiosity influenced the care they received, with healthcare professionals exhibiting a lack of understanding about Muslim health practices.
This form of cultural incompetence extends beyond microaggressions; it actively alienates patients and deters them from seeking care. The lack of engagement with religious and cultural sensitivities signals a broader unwillingness to adapt healthcare provision to the needs of diverse communities.
Additionally, language barriers further exacerbate these issues, as many non-English-speaking patients struggle to communicate their symptoms effectively. However, the report shows that healthcare institutions do little to accommodate linguistic diversity, leading to misdiagnoses, ineffective treatments, and a growing distrust in medical professionals.
When Muslim patients hesitate to seek care due to fear of discrimination or mistreatment, the NHS is failing in its duty to provide equitable healthcare for all. Addressing these issues requires more than tokenistic diversity initiatives; it necessitates a fundamental restructuring of how the NHS engages with minority communities.
The barriers to access in NHS primary care are not incidental but systemic, shaped by policies and practices that privilege certain populations while marginalising others. The report highlights that ethnic minority patients experience significant challenges in booking appointments, navigating digital platforms, and receiving adequate follow-ups.
Remote consultations, which became widespread during the Covid-19 pandemic, have disproportionately disadvantaged minority communities. The report finds that confidence in telephone and video consultations was significantly lower among ethnic minority groups, particularly those for whom English is not a first language. The shift to digital healthcare has created a two-tier system in which those with digital literacy and access to technology receive better care, while those without are left behind.
This digital exclusion is symptomatic of broader structural inequalities in healthcare provision, where convenience for the system takes precedence over accessibility for vulnerable populations.
Moreover, the report underscores how NHS policies on appointment scheduling and triaging reinforce disparities. Limited availability of interpreters, rushed consultations, and dismissive attitudes towards non-English-speaking patients contribute to poorer health outcomes. These barriers are not merely bureaucratic inefficiencies but reflect a deeper institutional failure to prioritise inclusivity in healthcare delivery.
The NHS Race and Health Observatory’s recommendations offer a roadmap for addressing these entrenched inequalities, but without systemic reform, they risk being reduced to symbolic gestures. The report calls for increased cultural competency training, better interpreter services, and longer consultations for non-English-speaking patients.
However, addressing institutionalised discrimination requires more than training modules; it demands accountability at every level of the NHS. Healthcare institutions must be held responsible for their role in perpetuating disparities, and the solution begins with measurable outcomes. Implementing trust metrics, patient feedback loops, and transparency in performance evaluations are necessary steps toward meaningful change.
Additionally, the NHS must go beyond surface-level engagement with ethnic minority communities and commit to co-producing healthcare strategies that reflect their needs. This includes improving ethnicity coding in patient records, ensuring equitable distribution of healthcare resources, and integrating community voices into policy decisions. Without these structural interventions, the NHS will continue to operate as a system that privileges the health and well-being of some while marginalising others. If trust in primary care is to be restored, the NHS must confront its legacy of exclusion and commit to genuine, long-term reform.
Restoring trust in NHS primary care requires urgent, systemic reform rather than tokenistic initiatives. The report’s recommendations, from improving cultural competency training to ensuring equitable access to healthcare resources, offer a necessary starting point—but true change demands accountability at every level of the NHS. Without concrete action, institutional discrimination will continue to erode patient confidence and exacerbate health inequalities.
If the NHS is to fulfil its promise of universal healthcare, it must confront its legacy of exclusion and commit to policies that place equity at the heart of healthcare delivery. Anything less risks perpetuating a system where the most marginalised remain unheard, underserved, and systematically disadvantaged.
Tahir Abbas,
FRSA FAcSS, Professor, Institute of Security and Global Affairs, Leiden University, The Hague, Netherlands
