Mairead Murphy1, Lauren J Scott2, Chris Salisbury2, Andrew Turner2, Anne Scott1, Rachel Denholm3, Rhys Lewis4, Geeta Iyer5, John Macleod2, Jeremy Horwood2. 1. Centre for Academic Primary Care (CAPC), University of Bristol, Bristol Medical School, Bristol. 2. National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol; CAPC, University of Bristol, Bristol Medical School, Bristol. 3. NIHR Bristol Biomedical Research Centre, University of Bristol; CAPC, University of Bristol, Bristol. 4. One Care, Whitchurch, Bristol. 5. North Somerset and South Gloucestershire Clinical Commissioning Group, Bristol.
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. METHOD: Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff 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 to July 2020 compared to 2019; GPs and 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. CONCLUSION: 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 will need adjustment.
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. METHOD: Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff 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 to July 2020 compared to 2019; GPs and 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. CONCLUSION: 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 will need adjustment.
Authors: Jessica Watson; Chris Salisbury; Penny F Whiting; William T Hamilton; Jonathan Banks Journal: Br J Gen Pract Date: 2022-06-06 Impact factor: 6.302
Authors: Lauren J Scott; Mairead Murphy; Sarah Price; Rhys Lewis; Rachel Denholm; Jeremy Horwood; Tom Palmer; Chris Salisbury Journal: BMJ Open Date: 2021-05-24 Impact factor: 3.006
Authors: Teele Kuusk; David Cullen; Joana Briosa Neves; Nicholas Campain; Ravi Barod; Ekaterini Boleti; Soha El-Sheihk; Lee Grant; John Kelly; Marta Marchetti; Faiz Mumtaz; Prasad Patki; Navin Ramachandran; Pedro Silva; My-Anh Tran-Dang; Miles Walkden; Maxine G B Tran; Thomas Powles; Axel Bex Journal: BJU Int Date: 2021-05-25 Impact factor: 5.969