Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study

Murphy, Mairead; Scott, Lauren J; Salisbury, Chris; Turner, Andrew; Scott, Anne; Denholm, Rachel; Lewis, Rhys; Iyer, Geeta; Macleod, John; Horwood, Jeremy

doi:10.3399/bjgp.2020.0948

Cited by 333 publications

(451 citation statements)

References 24 publications

(33 reference statements)

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“…2 Studies highlighted that remote consultations in primary care rapidly increased during the pandemic, changing management of patients. 4 We have some understanding of challenges facing PCPs during other pandemics. Previous work during influenza, Ebola and SARS pandemics showed that primary care professionals (PCPs) want to help in a pandemic.…”

Section: Introductionmentioning

confidence: 99%

Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries

et al. 2021

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Background: Primary care has a crucial role in responding to the COVID-19 pandemic as the first point of patient care and gatekeeper to secondary care. Qualitative studies exploring the experiences of healthcare professionals during the COVID-19 pandemic have mainly focused on secondary care. Aim: To understand the experiences of European PCPs working during the first peak of the COVID-19 pandemic. Design and Setting: An exploratory qualitative study, using semi-structured interviews in primary care in England, Belgium, the Netherlands, Ireland, Germany, Poland, Greece and Sweden, between April and July 2020. Method: Interviews were audio recorded, transcribed and analysed using a combination of inductive and deductive thematic analysis techniques. Results: Eighty interviews were conducted with PCPs. PCPs had to make their own decisions on how to rapidly transform services in relation to COVID-19 and non-COVID-19 care. Despite being overwhelmed with guidance, they often lacked access to practical training. Consequently, PCPs turned to their colleagues for moral support and information to try to quickly adjust to new ways of working, including remote care, and deal with uncertainty. Conclusion: PCPs rapidly transformed primary care delivery despite a number of challenges. Representation of primary care at policy level and engagement with local primary care champions will facilitate easy and coordinated access to practical information on how to adapt services, ongoing training and access to appropriate mental health support services for PCPs. Preservation of autonomy and responsiveness of primary care are critical to preserve the ability for rapid transformation in any future crisis of care delivery.

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Section: Introductionmentioning

confidence: 99%

Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries

et al. 2021

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“…The implementation of lockdowns in the UK resulted in the majority of medical consultations in primary care shifting to audio or video encounters with patients [ 30 , 31 ]. Lockdown-specific barriers to disclosure of abuse [ 32 ] and barriers to general practice consultations linked to the system switch to remote consulting [ 33 ] have occurred at the same time as the incidence of abuse has increased [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic (PRECODE): protocol of a rapid mixed-methods study in the UK

et al. 2021

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Background The implementation of lockdowns in the UK during the COVID-19 pandemic resulted in a system switch to remote primary care consulting at the same time as the incidence of domestic violence and abuse (DVA) increased. Lockdown-specific barriers to disclosure of DVA reduced the opportunity for DVA detection and referral. The PRECODE (PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic) study will comprise quantitative analysis of the impact of the pandemic on referrals from IRIS (Identification and Referral to Improve Safety) trained general practices to DVA agencies in the UK and qualitative analysis of the experiences of clinicians responding to patients affected by DVA and adaptations they have made transitioning to remote DVA training and patient support. Methods/Design Using a rapid mixed method design, PRECODE will explore and explain the dynamics of DVA referrals and support before and during the pandemic on a national scale using qualitative data and over four years of referrals time series data. We will undertake interrupted-time series and non-linear regression analysis, including sensitivity analyses, on time series of referrals to DVA services from routinely collected data to evaluate the impact of the pandemic and associated lockdowns on referrals to the IRIS Programme, and analyse key determinants associated with changes in referrals. We will also conduct an interview- and observation-based qualitative study to understand the variation, relevance and feasibility of primary care responses to DVA before and during the pandemic and its aftermath. The triangulation of quantitative and qualitative findings using rapid analysis and synthesis will enable the articulation of multiscale trends in primary care responses to DVA and complex mechanisms by which these responses have changed during the pandemic. Discussion Our findings will inform the implementation of remote primary care and DVA service responses as services re-configure. Understanding the adaptation of clinical and service responses to DVA during the pandemic is crucial for the development of evidence-based, effective remote support and referral beyond the pandemic. Trial registration PRECODE is an observational epidemiologic study, not an intervention evaluation or trial. We will not be reporting results of an intervention on human participants.

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“…These were collected as part of the mixed-methods RAPCI (Rapid COVID-19 intelligence to improve primary care response) Study, the results of which are reported elsewhere. 16…”

Section: Methodsmentioning

confidence: 99%

“…These were collected as part of the mixed-methods RAPCI (Rapid COVID-19 intelligence to improve primary care response) Study, the results of which are reported elsewhere. 16 Recruitment Practices in BNSSG were provided with study information by the CCG. Expressions of interest were received from practices and a selection were recruited, ensuring a mix of practice sizes and deprivation scores.…”

Section: Methodsmentioning

confidence: 99%

“…Existing literature on the GP response to delivering services during the COVID-19 pandemic has largely focused on the impact of shifting to mostly remote consultations, 5,7,16,19,20 for example, data from practices using the AskmyGP platform showed a large drop in patient requests for face-to-face contact. 21 Guidance was rapidly issued on when certain types of consultation may be most appropriate 6 and subsequently there has been re ection on the innovations that should be retained post-pandemic, 19 including evidence of emerging narratives in the media that are more critical of the trade-offs entailed by a permanent shift to remote consultations as the default.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Maintaining face-to-face contact during the COVID-19 pandemic: a longitudinal qualitative investigation in UK primary care

Turner

Scott

Horwood

et al. 2021

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BackgroundIn March 2020 the COVID-19 pandemic required a rapid reconfiguration of UK general practice to minimise face-to-face contact with patients to reduce infection risk. However, some face-to-face contact remained necessary and practices needed to ensure such contact could continue safely.AimTo examine how practices determined when face-to-face contact was necessary and how face-to-face consultations were reconfigured to reduce COVID-19 infection risk. Design and SettingQualitative interview study in general practices in Bristol, North Somerset and South Gloucestershire.MethodLongitudinal semi-structured interviews with clinical and managerial practice staff at four timepoints between May and July 2020.ResultsPractices worked flexibly within general national guidance to determine when face-to-face contact with patients was necessary, influenced by knowledge of the patient, experience, and practice resilience. For example, practices prioritised patients according to clinical need using face-to-face contact to resolve clinician uncertainty or provide adequate reassurance to patients. To make face-to-face contact as safe as possible and keep patients separated, practices introduced a heterogeneous range of measures that exploited features of their indoor and outdoor spaces and altered their appointment processes. As national restrictions eased in June and July, the number and proportion of patients seen face-to-face generally increased. However, the reconfiguration of buildings and processes reduced the available capacity and put increased pressure on practices.ConclusionPractices responded rapidly and creatively to the initial lockdown restrictions. The variety of ways practices organised face-to-face contact to minimise infection highlights the need for flexibility in guidance.

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Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study

Cited by 333 publications

References 24 publications

Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries

Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries

PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic (PRECODE): protocol of a rapid mixed-methods study in the UK

Maintaining face-to-face contact during the COVID-19 pandemic: a longitudinal qualitative investigation in UK primary care

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