The Impact of COVID on a Rural Community GP Practice: A Qualitative Analysis

Problem

COVID presented specific challenges for rural populations due to the features of the community, infrastructure and environment, which in turn presented rural primary care with unique challenges to negotiate Difficulties with distance to services and poor public transport may have been exacerbated by COVID due to the stay at home orders, and the reliance of many rural patients on others for transport to health care services. Isolation in rural areas already impacts mental health and is expected to have been further exaggerated by COVID. The move to increased use of telephone and video remote consultations during the pandemic may more severely impact rural communities, who often face poor internet coverage and phone signals. These combined issues may mean that rural communities are more at risk of delayed presentation and constrained ability to access primary care.

Approach

This case study population comprised of patients registered at a single rural Yorkshire practice, covering a remote rural area of approximately 200 square miles. Participants were invited to complete a survey about recent symptoms and attitudes to accessing healthcare with regards potential symptoms of colorectal cancer. Fourteen survey respondents were purposively sampled to take part in a semi-structure interview, exploring their thoughts about accessing health care after the pandemic and the impact on their community. Interviews were conducted one to one, remotely, audio-recorded and transcribed. An inductive analytical approach was undertaken as this is a novel topic.

Findings

Five themes were derived from the data.Theme 1; The impact of COVID on healthcare interaction emphasised the importance of trust between the GP Practice and the community. Rural GP practices already face accessibility issues, however, the move to remote consultations impacted not only health care interactions, but also a valued community space and opportunity to interact. Theme 2 covered Perceptions of Health and Wellbeing, particularly the heightened sense of isolation experienced by many. Theme 3 considered the Impact to the Rural Economy, and the tensions created over the communities’ differing economic needs. Theme 4; Community Interaction and Protection highlighted how the pandemic unified the community in their efforts to protect each other, whilst also dealing with the perceived threat of “outsiders”. Theme 5; The Environment, showed how behaviour and feelings were shaped (positively and negatively) by rural location.

Consequences

Whilst COVID has impacted rural patients’ feelings about accessing health care, the impact of the pandemic on rural communities was most acutely noticeable in relation to community interaction and support, and the mental health impacts, as a result of increased loneliness, solation and worries about financial security for those working in rural tourist economies. Community mobilisation resulting from the pandemic highlights the potential power of community engagement in future public health campaigns in rural areas.