Quick link to RAPCI project publications

The COVID-19 pandemic has meant GP practices have rapidly changed the way they deliver consultations. In March 2020, the UK Government instructed GP practices to conduct consultations remotely unless there was urgent need for a face-to-face appointment. As a result, most GP practices stopped using face-to-face appointments as the first point of contact. Instead, most patients were offered telephone or video consultations.

We undertook rapid research so our findings could help improve GP practices’ response to the pandemic as it was happening. We wanted to find out how GP practices responded to the pandemic in terms of:

• Coping with changes in demand
• Implementing alternatives to face-to-face consultation
• The impact these changes are having on patient care
• This project is also known as Rapid COVID-19 intelligence to improve primary care response (RAPCI).

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.

What next?

We are still looking at why and how some patients were seen face-to-face during the pandemic.

Co-Principal Investigators

• Dr Jeremy Horwood, Associate Professor of Social Sciences and Health, Centre for Academic Primary Care (CAPC), University of Bristol and NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol
• Dr Mairead Murphy, Research Fellow, CAPC, University of Bristol

Centre for Academic Primary Care (CAPC) Staff

• Professor Chris Salisbury, Professor in Primary Health Care
• Professor John Macleod, Professor in Clinical Epidemiology and Primary Health Care
• Dr Andrew Turner, Senior Research Associate
• Dr Rachel Denholm, Lecturer, CAPC,
• Dr Anne Scott, Research Associate, CAPC,
• Ms Helen Bolton, CAPC communications officer
• Dr Victoria Wilson, CAPC Patient and Public Involvement and Engagement Co-ordinator,
• Collaborators
• Geeta Iyer, GP Clinical lead for Primary Care Development at NHS Bristol, North Somerset & South Gloucestershire CCG (BNSSG CCG).

Partners on this project

• University of Bristol
• NIHR ARC West
• Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (BNSSG CCG)
• OneCare

Funding

This project is funded by the NIHR School for Primary Care Research. Funding award: £39,801 and support from NIHR ARC West.