Modifications to the delivery of NHS face-to-face general practice consultations during the COVID-19 pandemic in England.

Lorna J Duncan,Kelly F.D Cheng

doi:10.12688/f1000research.52161.1

Abstract

Background: To minimise transmission of SARS-CoV-2, the virus causing COVID-19, delivery of general practice consultations has been modified to enable the separation of diagnosed or suspected COVID-19 patients from others. Remote triage and consultations are currently the default model, with adapted face-to-face contact used when clinically necessary. This study aimed to identify the modified face-to-face delivery models used across England, and evidence for their effectiveness. Methods: In June 2020, a national survey was sent by email to the 135 Clinical Commissioning Groups (CCGs) in England to identify local organisation of face-to-face general practice consultations since March 2020. An email was sent to Public Health England (PHE) requesting information about COVID-19 outbreaks or clusters linked to general practice. Results: All CCGs responded. Separation of COVID-19 patients from others was achieved using combinations of the following models: zoned surgeries (used in 47% of CCGs), where COVID-19 and other patients are separated within their own practice;'hot' or 'cold' hubs (used in 90% of CCGs), separate sites where COVID-19 or other patients registered at one of several collaborating practices are seen;'hot' and 'cold' home visits (used in 70% of CCGs). One of seven model combinations was used across each CCG, with some flexibility according to changing need shown through hub availability. Concomitant PHE data showed less than 2% of COVID-19 outbreaks or clusters in England were linked to general practice. Conclusions: Varied, flexible ways of delivering face-to-face general practice consultations were identified. While COVID-19 outbreaks or clusters linked to general practice constituted a small proportion of totals, their investigation, together with evaluations of the modified delivery models in terms of management of COVID-19 and other conditions and impacts on staff and patients, may aid future management of the pandemic and identify aspects of adapted practice of benefit beyond this.

Highlights

While more than 80% of patients with COVID-19 may not require hospitalisation,[1] many will seek treatment in general practice
This study aimed to identify the ways in which delivery of NHS face-to-face general practice has been re-organised across England to meet infection prevention and control (IPC) standards during the pandemic, together with any evidence regarding the effectiveness of these measures
Replies were received from all Clinical Commissioning Groups (CCGs), 99% in June and July 2020, with the final response received on 2nd October

Summary

Introduction

While more than 80% of patients with COVID-19 may not require hospitalisation,[1] many will seek treatment in general practice. After remote triage, a face-to-face general practice consultation is considered necessary, the requirement to separate those patients with suspected or diagnosed COVID-19 [‘COVID-19’ patients] from others is clear. To minimise transmission of SARS-CoV-2, the virus causing COVID-19, delivery of general practice consultations has been modified to enable the separation of diagnosed or suspected COVID19 patients from others. Remote triage and consultations are currently the default model, with adapted face-to-face contact used when clinically necessary. Methods: In June 2020, a national survey was sent by email to the 135 Clinical Commissioning Groups (CCGs) in England to identify local organisation of face-to-face general practice consultations since March 2020. ‘hot’ or ‘cold’ hubs (used in 90% of CCGs), separate sites where COVID-19 or other patients registered at one of several collaborating practices are seen; 3. Separation of COVID-19 patients from others was achieved using combinations of the following models: 1. zoned surgeries (used in 47% of CCGs), where COVID-19 and other patients are separated within their own practice; 2. ‘hot’ or ‘cold’ hubs (used in 90% of CCGs), separate sites where COVID-19 or other patients registered at one of several collaborating practices are seen; 3. ‘hot’ and ‘cold’ home visits (used in 70% of CCGs)

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Conclusion