How GP practices can comply with the PSED

The Public Sector Equality Duty (PSED) is a legal requirement to have due regard to three aims in everyday decision and policy-making. The PSED applies to all general practitioner (GP) practices that deliver NHS services.

This note explains when it applies and other important information to help you advance and promote equality in your practice.

The PSED applies when organisations, such as GP practices, carry out a public function.

There are several factors which mean that a GP practice is carrying out a public function. These include: 

• providing NHS services
• being closely monitored by government inspectorates and regulators

Organisations carrying out public functions can include private businesses. They may also include voluntary organisations that are contracted to perform public functions on behalf of public authorities.

The PSED also places additional duties on some public authorities. These are called specific duties. The PSED specific duties do not apply to GP practices.

The PSED applies to the delivery of NHS services. If your practice is a private business, the PSED only applies to your delivery of NHS services. It does not apply when you deliver private medical services and does not cover your role as an employer.

Due regard means the amount of consideration you must give to meeting the aims of the PSED in a particular activity or decision.

How much regard is due depends on how relevant your activity or decision is to equality. If the activity or decision has implications for equality, you must make sure you fully consider the impact on people with relevant protected characteristics.

For example, when setting up online systems to book appointments, due regard must be given to ensuring everyone can access appointments. In this example, due regard would mean that practices would likely need to consider providing alternative ways to access appointments to meet the needs of people with different protected characteristics, for example, by allowing people to book appointments over the phone or in person.

There are nine protected characteristics. The Equality Act 2010 protects people with any of these characteristics from being discriminated against.

The aims of the PSED apply to patients with protected characteristics.

The first aim of the duty applies to all nine protected characteristics. The second and third aims apply to all except marriage and civil partnership.

GP practices carrying out public functions must have due regard to meeting the aims of the PSED. The three aims are as follows.

1. Put an end to unlawful behaviour under the Equality Act 2010, including discrimination, harassment and victimisation

This means taking action to prevent unlawful behaviour under the Equality Act 2010 from happening in the GP practice.

For example, your practice could create a policy which sets out the practice's commitment to equality, and the responsibilities of staff to reflect those commitments when dealing with the public. This could include a commitment to providing accessible, non-digital alternatives to services that have been digitalised and ensuring staff are trained to offer the alternatives to patients.

2. Advance equal opportunities between people who share a relevant protected characteristic and those who do not share it

This aim means:

• removing or minimising disadvantages connected to a protected characteristic 
• taking steps to meet the different needs of people with different protected characteristics
• encouraging people who share a protected characteristic to participate fully where their participation is disproportionately low

There are many ways that GP practices can take steps to meet the different needs of people with different protected characteristics. For example, this may include a surgery setting up a disabled patients’ user group to find out their views about a proposed online consultation system. This may help the surgery meet its positive duty to make reasonable adjustments for disabled people.

3. Foster good relations between people who have a relevant protected characteristic and those who do not have it

This means having due regard to the need to tackle prejudice and promote understanding. For example, you could display informative material in your practice and on your website that presents neurodiverse patients in a positive way.

Decision makers in GP practices need to have enough information to comply with the duty. If they do not have enough information, they must acquire it.

The type of information that needs to be gathered depends on the decision or policy being made. It could involve gathering evidence about the experience of patients who share a protected characteristic to understand their needs when using NHS services.

You can acquire evidence using:

• anonymised patient records
• relevant data from commissioning bodies
• patient engagement mechanisms

By using the PSED, your practice can target action on health inequalities. It provides a methodology to tackle equality challenges in a proportionate and impactful way.

There are also resources that can help you fill in any gaps in your data. This could include our Equality and Human Rights Monitor, as well as data and reports from the NHS, health inspectorates, ombuds and regulators.

It is good practice to keep a record of how equality in policy and decision making has been considered.

Doing so may help your decision makers take informed and transparent policy decisions and manage the requirements of the duty. It is highly likely that such record keeping could also be useful if your organisation’s decision is challenged. To do this, we recommend that you consult our guidance, How to consider equality in policy making: A 10-step guide for public bodies in England. This guidance is also relevant to GP practices in Wales, which has guidance aimed at public authorities but not GP practices.

The principles of the PSED are reflected in healthcare inspection standards. Adopting approaches that meet the three aims of the PSED may therefore help you comply with these inspection standards, while promoting and advancing equality in your practice.

For example, in England, the PSED aligns with key quality statements in the Care Quality Commission’s (CQC) single assessment framework. CQC uses the quality statements in their inspections of GP practices. Two particularly relevant statements are:

• equity in access
• equity in experiences and outcomes

In Wales, the aims of the PSED are also reflected in the Health and Care Quality Standards 2023, in particular in the ‘equitable’, ‘person-centred’, 'timely' and 'culture' standards.

For more information about the PSED, read our technical guidance for England and technical guidance for Wales.