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

Abstract

Background: To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video or online consultation platforms.Aim: To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic.Design and Setting: Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire.Methods: Quantitative: Longitudinal observational analysis comparing volume and type of consultations in April-July 2020 with April-July 2019. Negative binomial models were used to identify if changes differed amongst different groups of patients. Qualitative: 87 practice staff longitudinal interviews in four rounds investigated practices experience of the move to remote consulting, challenges faced and solutions. A thematic analysis utilised Normalisation Process Theory.Results: There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April-July 2020 compared to 2019; GPs/nurses maintained a focus on older patients, shielding patients and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased.Conclusions: The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model may need adjustment.

Changes in potential cancer indicator reporting in primary-care during the COVID-19 pandemic

“…For further details on consultation rates, see our previous paper. 4 Patients reporting potential cancer indicators reduced in April-July 2020 compared to 2019 (IRR 0.65, 95% CI 0.62 to 0.68, p<0.001; Table 2). This reduction was stable across ethnicity (interaction p-value=0.956), IMD (p=0.955), and shielding status (p=0.090), but differed by age (p<0.001), sex (p=0.003) and mental health status (p<0.001; Table 2).…”

“…Data were extracted for the RAPCI Study (Rapid COVID-19 intelligence to improve primary-care response), a mixed-methods study on the rapid change to remote consulting in the initial months of the pandemic; primary results are reported elsewhere. 4…”

“…6 This was partly supported by our ndings; among adults, we noted the largest drop in 50 to 84-year olds, but patients aged 85+ had less of a reduction than this group, perhaps indicating the success of increased focus on this groups by GPs during the pandemic. 4 In 2015-2017, over 50% of cancers were in people aged 70+ but only 0.2% in children aged 0-4, 18 so GPs concerns being focused on the older age groups is not surprising.…”

“…GP and nurse consulting rates markedly dropped in April-May 2020 during the period of UK lockdown, but had largely returned to normal by July 2020, 4 with the majority of consultations carried out remotely (mostly via telephone). Further, there was a reduction in weekly reported incidence of asthma, intestinal infectious diseases, and upper and acute respiratory tract infections from the start of lockdown.…”

The impact of COVID-19 on primary health care and antibiotic prescribing in rural China: qualitative study

“…Primary health care (PHC) systems in countries like the UK and Australia have rapidly responded to COVID-19, including key measures like shifting to remote consultations and providing online training and guidance, whilst facing challenges to manage increased workload and to practice good infection control. [1, 2] In China, PHC practitioners were designated to conduct COVID-19 screening and referral, monitoring, education and publicity by the National Health Commission. [3] The regulations and guidance issued by state government strictly prohibit any consultation or treatment for patients with fever or cough in PHC and require that all identified COVID-19 suspected patients be transferred to specialist fever clinics at designated hospitals.…”