OpenSAFELY NHS Service Restoration Observatory 2: changes in primary care activity across six clinical areas during the COVID-19 pandemic
Authors: Curtis Helen J , MacKenna Brian , Wiedemann Milan , Fisher Louis , Croker Richard , Morton Caroline E , Inglesby Peter , Walker Alex J , Morley Jessica , Mehrkar Amir , Bacon Sebastian CJ , Hickman George , Evans David , Ward Tom , Davy Simon , Hulme William J , Macdonald Orla , Conibere Robin , Lewis Tom , Myers Martin , Wanninayake Shamila , Collison Kiren , Drury Charles , Samuel Miriam , Sood Harpreet , Cipriani Andrea , Fazel Seena , Sharma Manuj , Baqir Wasim , Bates Chris , Parry John , Goldacre Ben 
Published: June 2022

Background

The COVID-19 pandemic has disrupted healthcare activity across a broad range of clinical services. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible.

Aims

Using routinely collected data, our aim was to describe changes in the volume and variation of coded clinical activity in general practice in: (i) cardiovascular disease, (ii) diabetes, (iii) mental health, (iv) female and reproductive health, (v) screening, and (vi) processes related to medication.

Design and setting

With the approval of NHS England, we conducted a cohort study of 23.8 million patient records in general practice, in-situ using OpenSAFELY.

Methods

We selected common primary care activity using CTV3 codes and keyword searches from January 2019 - December 2020, presenting median and deciles of code usage across practices per month.

Results

We identified substantial and widespread changes in clinical activity in primary care since the onset of the COVID-19 pandemic, with generally good recovery by December 2020. A few exceptions showed poor recovery and warrant further investigation, such as mental health, e.g. “Depression interim review” (median across practices in December 2020 -41.6% compared to December 2019).

Conclusions

Granular NHS GP data at population-scale can be used to monitor disruptions to healthcare services and guide the development of mitigation strategies. The authors are now developing real-time monitoring dashboards for key measures identified here as well as further studies, using primary care data to monitor and mitigate the indirect health impacts of Covid-19 on the NHS.

How this fits in

During the COVID-19 pandemic, routine healthcare services in England faced significant disruption, and NHS England recommended restoring NHS services to near-normal levels before winter 2020. Our previous report covered the disruption and recovery in pathology tests and respiratory activity: here we describe an additional six areas of common primary care activity. We found most activities exhibited significant reductions during pandemic wave 1 (with most recovering to near-normal levels by December); however many important aspects of care - especially those of a more time-critical nature - were maintained throughout the pandemic. We recommend key measures for ongoing monitoring and further investigation of the impacts on health inequalities, to help measure and mitigate the ongoing indirect health impacts of COVID-19 on the NHS.