Andrew Turner1,2, Anne Scott3, Jeremy Horwood4,3, Chris Salisbury4,3, Rachel Denholm3,5, Lauren J Scott4,2, Geeta Iyer6, John MacLeod4,3, Mairead Murphy3. 1. National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK andrew.turner@bristol.ac.uk. 2. Population Health Sciences, University of Bristol, Bristol, UK. 3. Centre for Academic Primary Care (CAPC), University of Bristol, Bristol Medical School, Canynge Hall, Bristol, UK. 4. National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK. 5. NIHR Bristol Biomedical Research Centre (BRC), Bristol, UK. 6. North Somerset, and South Gloucestershire Clinical Commissioning Group (BNSSG CCG), Bristol, UK.
Abstract
BACKGROUND: In 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. AIM: To 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 & SETTING: Qualitative interview study in general practices in Bristol, North Somerset and South Gloucestershire. METHOD: Longitudinal semi-structured interviews with clinical and managerial practice staff at four timepoints between May and July 2020. RESULTS: Practices 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. CONCLUSION: Practices 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.
BACKGROUND: In 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. AIM: To examine how practices determined when face-to-face contact was necessary and how face-to-face consultations were reconfigured to reduce COVID-19infection risk. DESIGN & SETTING: Qualitative interview study in general practices in Bristol, North Somerset and South Gloucestershire. METHOD: Longitudinal semi-structured interviews with clinical and managerial practice staff at four timepoints between May and July 2020. RESULTS: Practices 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. CONCLUSION: Practices 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.
Authors: Jeremy Horwood; Christalla Pithara; Ava Lorenc; Joanna M Kesten; Mairead Murphy; Andrew Turner; Michelle Farr; Jon Banks; Sabi Redwood; Helen Lambert; Jenny L Donovan Journal: Front Sociol Date: 2022-09-15