How have GP practices adapted to the COVID-19 pandemic?

Project aims

We wanted to identify the changing demands on GP practices across Bristol, North Somerset and South Gloucestershire during the COVID-19 pandemic. We investigated the common challenges and innovative solutions that practices came up with.

During the spring and summer of 2020 we published regular rapid reports which we shared with GPs and commissioners, followed by more in-depth research papers exploring:

• How remote consultations were implemented
• How the pandemic has affected patients’ reporting of cancer symptoms
• How and why patients were seen face-to-face rather than remotely during the pandemic

What we did

We collected data from 21 GP practices in Bristol, North Somerset and South Gloucestershire.

We collected information on all consultations with GPs, nurses and paramedics between February 2019 and July 2020, for all 350,000 patients registered at these practices. This included how the consultation took place and what it was about. We compared the period following the start of lockdown with the same period the previous year.

We conducted 87 interviews with practice staff at four points over a three month period, investigating their experience of the move to remote consulting, the challenges they faced and the solutions they found.

What we found and what this means

How remote consultations were implemented

The pandemic drove a rapid change so that 90 per cent of GP consultations (compared with 31 per cent in April 2019) and 46 per cent of nurse consultations were done remotely by April 2020.

Practice staff universally agreed that remote consulting was necessary to reduce the risk of COVID-19 infection.

There were fewer consultations in April-July 2020 compared to the same period in 2019. GPs and nurses focussed on older patients, shielding patients and patients with a mental health condition.

The drop in consultations released staff to rapidly implement changes. Text messaging increased more than three-fold. Practice staff reported telephone consulting was sufficient for many patient problems, while video consulting was used more rarely and became less necessary as lockdown eased. GPs were concerned about increased risk to their patients and some had difficulties deciding which patients to see face-to-face as lockdown eased.

How the pandemic has affected reporting of cancer symptoms

During April-July 2019, 56% of over 50s who were registered with the GP practices had a consultation and 17% reported potential cancer symptoms. In April-July 2020, this had reduced to 45% of over 50s having a consultation and 11% reporting symptoms.

In 2019, potential cancer symptoms were reported in 21% of face-to-face GP consultations in over 50s, compared to only 13% of remote consultations. In 2020, this was 17% face-to-face and 14% remotely. Of the most commonly reported potential cancer symptoms, reporting of chest infections, fever, coughs, fatigue and urinary tract infection reduced most dramatically. The eight alarm symptoms (blood in the urine, poo or vomit, coughing up blood, yellowing of the skin or eyes, breast lump, postmenopausal bleeding in women aged 55 and over, and difficulty swallowing) saw a less pronounced decline, but still reduced by 27% overall.

During the first UK lockdown, at risk groups such as older people and those shielding tended to access GP consultations more frequently. However, even these consultations did not result in higher levels of reporting of potential cancer symptoms. This suggests that these consultations were for existing or routine issues rather than new health problems.

Patients with mental health conditions had a smaller reduction in reporting of these symptoms compared to other groups. This may be because GPs were particularly focused on this group at this time.

The findings reinforce an earlier Cancer Research UK survey where GPs felt they were receiving fewer reports of cancer symptoms during the first UK lockdown.

How face-to-face contact was maintained

General practices creatively and rapidly adjusted the way they operate during the COVID-19 pandemic to continue face-to-face contact for patients who needed it most.

Practices worked within national guidance to determine when face-to-face contact with patients was necessary. This included prioritising patients according to clinical need and using face-to-face contact when GPs were uncertain of a diagnosis or to reassure patients.

To make face-to-face contact as safe as possible and keep patients socially-distanced, practices altered their appointment processes and introduced a wide range of measures. These included taking advantage of their indoor and outdoor spaces, such as using carparks as waiting and treatment areas.

As the UK passed the peak of the first wave of the pandemic in June and July 2020, in person GP services were scaled-up again and confidence seeing patients face-to-face grew. However, the need to maintain social-distancing and enhanced infection control measures reduced capacity and were time consuming, increasing pressure on practices.

The variety of ways practices organised face-to-face contact to minimise infection highlights the importance of providing good centralised guidance while allowing local flexibility.

Rapid reports

We published a series of regular reports summarising our findings from this project between April and July 2020.

Final report (PDF)
The final report from a study that monitored changes in general practice during the first few months of the coronavirus pandemic reveals how staff have coped and how consultations with patients have changed. The report analysed data gathered between April and July 2020.

Report 4 – 31 July 2020 (PDF)
This fourth summary report presents qualitative findings from 22 interviews held with GPs and managers from 20 GP practices between 3 and 29 July 2020 and quantitative data extracted from the patient record.

Report 3 – 10 July 2020 (PDF)
This third summary report presents qualitative findings from 20 interviews held with GPs and managers from 20 GP practices between 15 June and 2 July 2020.

Report 2-19 June 2020 (PDF)
This second summary report presents qualitative findings from 23 interviews held with GPs and managers from 20 GP practices between 28 May and 13 June 2020. There is a sub-section on perceived impact on health inequalities in this report.

Report 1-5 June 2020 (PDF)
This first summary report presents qualitative findings from 22 interviews held with GPs and managers from 14 GP practices between 13 and 17 May 2020. There is a sub-section on new consultation models implemented in this report

What next?

We are continuing to share our findings from this study with a range of audiences.