Abstract
Background: In order to minimise transmission of SARS-CoV-2, the virus causing COVID-19, delivery of English general practice consultations was modified in March 2020 to enable the separation of patients with diagnosed or suspected COVID-19 from others. Remote triage and consultations became the default, with adapted face-to-face contact used only when clinically necessary. Face-to-face delivery modifications were decided locally and this study aimed to identify the different models used nationwide in spring/summer 2020. Methods: In June 2020, a survey was sent by email to the 135 Clinical Commissioning Groups (CCGs) responsible for planning and commissioning NHS health care services in England to identify the local organisation of face-to-face general practice consultations since March 2020. Results: All CCGs responded. Between March and July 2020, separation of patients with diagnosed or suspected COVID-19 ('COVID-19 patients') from others was achieved using the following models: zoned practices(usedwithin47% of CCGs), where COVID-19 and other patients were separated within their own practice;'hot' or 'cold' hubs (used within 90% of CCGs), separate sites where COVID-19 or other patients registered at one of several collaborating practices were seen;'hot' and 'cold' home visits (used within 70% of CCGs). For around half of CCGs, either all their GP practices used zoning, or all used hubs; in other CCGs, both models were used. Demand-led hub availability offered flexibility in some areas.Home visits were mainly used supplementally for patients unable to access other services, but in two CCGs, they were the main/only form of COVID-19 provision. Conclusions: Varied, flexible ways of delivering face-to-face general practice consultations were identified. Analysis of the modified delivery in terms of management of COVID-19 and other conditions, and other impacts on staff and patients, may both aid future pandemic management and identify beneficial elements for practice beyond this.
Highlights
In March 2020 it was estimated that more than 80% of patients with COVID-19 would not require hospitalisation,[1] and it was likely that many would seek treatment in general practice
Replies were received from all Clinical Commissioning Groups (CCGs), 99% by 31st July 2020, with the final response received on 2nd October 2020
Complete response sets, were used, together with internet searches and further CCG contacts, to interpret and categorise all face-to-face consultation types according to the models in this report
Summary
In March 2020 it was estimated that more than 80% of patients with COVID-19 would not require hospitalisation,[1] and it was likely that many would seek treatment in general practice. In order to minimise transmission of the causative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during general practice (GP) consultations, NHS England’s Standard Operating Procedure was revised in March 2020 to a remote triage and consultation default, with adapted models for face-to-face contact used only when clinically necessary.[2] The use of telephone, video and online consultations in English general practice has been studied elsewhere.[3] In this paper we report on the delivery of face-toface general practice consultations across England during the first wave of the pandemic, in spring/summer 2020. The need to separate patients with diagnosed or suspected COVID-19 [‘COVID-19’ patients] from others to minimise cross-infection during clinically necessary face-to-face consultations was evident. In order to minimise transmission of SARS-CoV-2, the virus causing COVID-19, delivery of English general practice consultations was modified in March 2020 to enable the separation of patients with diagnosed or suspected COVID-19 from others. Between March and July 2020, separation of patients with diagnosed or suspected COVID-19 (‘COVID19 patients’) from others was achieved using the following models: 1. zoned practices (used within 47% of CCGs), where COVID-19 and other patients were separated within their own practice; 2. ‘hot’ or ‘cold’ hubs (used within 90% of CCGs), separate sites where COVID-19 or other patients registered at one of several collaborating practices were seen; 3. ‘hot’ and ‘cold’ home visits (used within 70% of CCGs)
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