Revolution in UK General Practice Due to COVID-19 Pandemic: A Cross-Sectional Survey

Abstract

To assess how UK General Practitioners (GPs) and Practice Managers (PMs) have coped with the challenges posed by the coronavirus disease-19 (COVID-19) pandemic and whether they felt adequately supported by the wider National Health Service (NHS). Methods This is a cross-sectional survey. All GPs and PMs (total 1,354) in Leicester, Leicestershire, and Rutland (LLR) were invited to participate in an online questionnaire. Results A total of 95 invitees completed the survey. Over a quarter had required time off work due to COVID symptoms or contact. All respondents described either introducing or increasing the use of remote patient consultations. Most striking was the rise in video consultations from just 3% to 95% during the pandemic. Almost half of the feedback on the usefulness of remote consultations were positive, 16% were negative and 17% were mixed. The most commonly cited benefit was time efficiency. Drawbacks of remote consultations included technical difficulties and poor patient communication. Practice premises, systems and processes also required significant modifications during the pandemic to ensure the provision of safe clinical care, including reception screens, one-way patient flow, greater infection prevention measures. However, despite their ability to introduce such widescale change virtually overnight, over 10% of respondents reported that the strain had placed their practice at risk of closure. Over half of respondents felt they were not provided with adequate personal protective equipment (PPE) for the safety of their staff. Perception of the support provided by NHS England and the Clinical Commissioning Groups (CCGs) was rather mixed, although additional guidelines were broadly welcomed. The most requested enduring changes related to remote patient consultations (59%) and remote triage (19%). However, in order to support such largescale permanent change, study respondents felt that a different funding and financial structure is required together with improved IT infrastructure, greater patient education and a more supportive regulatory environment. Conclusions COVID-19 has substantially accelerated the pace of change within NHS primary care. The long-1 2 3 4 5 6

Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries

“… 2 Similar findings resulted from a survey among GPs in the UK, specifically mentioning technical difficulties, financial issues and inadequate provision of PPE. 9 12 A commentary on the primary care response in six well-resourced countries highlighted areas where COVID-19 has directly spurred progress (telemedicine and collaboration with public health), as well as exposed latent weaknesses (non-COVID and chronic conditions management), 13 which was reinforced by interview studies with Flemish GPs. 14 Such opinions might be supported and/or compared with data from the PPAS2.…”

Client satisfaction and experience of telemedicine and home use of mifepristone and misoprostol for abortion up to 10 weeks’ gestation at British Pregnancy Advisory Service: A cross-sectional evaluation

“…Furthermore, contact with a health care provider, including a visit or referral to hospital, does not necessarily indicate a serious adverse event. It's possible that the pandemic may have resulted in more clients visiting hospitals/ED because many doctor's offices were offering reduced inperson services [32] . Overall serious adverse events are rare during medication abortion up to 10 weeks' gestation at a reported frequency of 0.03% to 0.6% [33] .…”

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

“…22 Our ndings corroborate those of Sharma et al, who conducted an online survey of GPs and practice managers in the East Midlands during May and June 2020 to explore how practices were coping with the pandemic. 12 They found practices implementing a similar range of measures, to both buildings and processes, to make face-to-face contact possible. This is despite much higher infection rates in the East Midlands (Leicester was the rst city in England to be put under new restrictions after a second spike in local COVID-19 infections in June 2020 23 ) demonstrating the likely utility of these measures even in high infection areas.…”

“…GPs argued strongly that this was not the case. 12,13 Royal College of General Partitioners (RCGP) and the British Medical Association (BMA) guidance on workload prioritization published in April 2020 9 adopted a red-amber-green (RAG) rating in which green activities must continue whatever the prevalence of COVID-19, amber activities should continue if practices had the capacity, and red activities could be deferred if there was high prevalence. Green activities included long-term condition (LTC) reviews for patients at high-risk (e.g.…”