Abstract
BackgroundThe COVID-19 pandemic has disrupted healthcare activity. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible.AimTo describe the volume and variation of coded clinical activity in general practice, taking respiratory disease and laboratory procedures as examples.Design and settingWorking on behalf of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY.MethodActivity using Clinical Terms Version 3 codes and keyword searches from January 2019 to September 2020 are described.ResultsActivity recorded in general practice declined during the pandemic, but largely recovered by September. There was a large drop in coded activity for laboratory tests, with broad recovery to pre-pandemic levels by September. One exception was the international normalised ratio test, with a smaller reduction (median tests per 1000 patients in 2020: February 8.0; April 6.2; September 6.9). The pattern of recording for respiratory symptoms was less affected, following an expected seasonal pattern and classified as ‘no change’. Respiratory infections exhibited a sustained drop, not returning to pre-pandemic levels by September. Asthma reviews experienced a small drop but recovered, whereas chronic obstructive pulmonary disease reviews remained below baseline.ConclusionAn open-source software framework was delivered to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September, with some important tests less affected and recording of respiratory disease codes was mixed.
Highlights
The ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected over 200 million people worldwide with at least 4.4 million deaths owing to COVID-19 as of August 2021.1 The need to direct resources towards patients requiring treatment for COVID-19 and to minimise opportunities for spread by reducing face-to-face contact between individuals meant that routine healthcare services faced significant levels of disruption
The COVD-19 pandemic led to a substantial change in healthcare activity
In a rapid assessment conducted in May 2020, World Health Organization (WHO) found that across the world there has been a considerable impact on the treatment of people with non-communicable disease (NCDs, noninfectious diseases not passed from person to person) caused by severe disruption to the delivery of national healthcare services.[5]
Summary
The ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected over 200 million people worldwide with at least 4.4 million deaths owing to COVID-19 as of August 2021.1 The need to direct resources towards patients requiring treatment for COVID-19 and to minimise opportunities for spread by reducing face-to-face contact between individuals meant that routine healthcare services faced significant levels of disruption. Recommendations included rapid assessment of healthcare capacity and the development of key performance metrics, and highlighted the importance of keeping this data up to date.[2,3] The NHS in England responded to the emerging pandemic by stopping nonurgent work in hospitals, and suggesting that, where possible, patients should have non-urgent primary care appointments remotely.[4]. In a rapid assessment conducted in May 2020, WHO found that across the world there has been a considerable impact on the treatment of people with non-communicable disease (NCDs, noninfectious diseases not passed from person to person) caused by severe disruption to the delivery of national healthcare services.[5] Subsequently, NHS England issued guidance on the ‘third phase’ of the NHS response to COVID-19 on 21 July 2020. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible
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