The Changing Face of Primary Care in a Pandemic: a comparison of primary care systems before and 'after' the Covid-19 Pandemic

Problem

The COVID-19 pandemic led to the rapid reconfiguration of primary care services. In line with government guidance, routine activities were suspended; face-to-face consultations were limited, and remote consultations quickly became standard practice. While this wholescale shift in response to COVID-19 demonstrates the ability of primary care to deliver remote consultations, little is known about the patient safety consequences of such a shift. There are legitimate concerns about the long- term impact on the diagnosis and treatment of potentially life-threatening illnesses such as cancer and stroke, and disruption to other important preventive and long-term condition care. Alongside the reconfiguration of services for patients, clinical and non-clinical staff experienced significant alterations to roles and responsibilities and faced the challenge of rapidly changing national guidance. The aim of this study is to explore the nature and experience of primary care reconfiguration in response to the Covid-19 pandemic; and to examine the consequences of remote consultations for patient safety.

Approach

A multi-site focused ethnographic study of 12 primary care practices describes the process of primary care reconfiguration, changes to primary care systems and patient and professional views of safety issues in the context of remote consulting. Practices were purposively sampled to represent a range of characteristics, and include small and large practices, practices serving affluent, mixed, and deprived populations, as well as those situated in remote, rural and urban communities. Semi-structured interviews with clinical and non-clinical primary care staff from each practice were conducted. Interviews focused on the practice culture and communication, the approach to significant adverse events, experiences of reconfiguration, and the quality of care / patient safety since service reconfiguration to remote consulting.

Findings

The speed of reconfiguration had a lasting impact on practice systems. Direct and dramatic impacts were described by both clinical and non-clinical staff. Despite not seeing patients face to face, all staff described increased work loads. Non-clinical staff in particular reported an extension of their role. Ad-hoc triage arrangements operated by reception staff were introduced, such arrangements have been maintained beyond the pandemic period. Impacts on patient groups were also identified including the shift to remote consultation, accessibility of services and ‘missing’ patient groups.

Consequences

The reconfiguration of primary care systems as a result of the COVID-19 pandemic has had direct impact on both practice staff, and accessibility of health services for patients, with this impact enduring beyond pandemic restrictions.