Primary care gatekeeping during the Covid-19 pandemic: A survey of 1234 Norwegian regular GPs

Problem

How this fits in GPs play an essential role as gatekeepers in protecting secondary health services in the Nordic healthcare system, but there is sparse research about this role during a public health crisis. This paper shows how GPs triaged and managed suspected Covid-19 patients and handled other patients during the first societal lockdown in Norway in Spring 2020. The vast majority were managed in primary care, and only 3.6% of suspected cases were admitted to hospitals, indicating well-functioning protection of hospitals. In 9% of non-Covid-related consultations, the GPs were concerned about delayed treatment for patients with potential severe diseases. The findings highlight the value of strong primary health care. Background In the Nordic healthcare systems, general practitioners (GPs) regulate access to secondary health services as gatekeepers. Limited knowledge exists about the gatekeeper role of GPs during public health crises seen from the GPs’ perspective. Aim To document GPs’ gatekeeper role and organisational changes during the initial Covid-19 lockdown in Norway.

Approach

Method A cross-sectional online survey was addressed to all regular Norwegian GPs (n = 4858) during pandemic lockdown in spring 2020. Each GP documented how patients with potential Covid-19 disease were triaged and handled during a full regular workday. The survey also covered workload, organisational changes and views on advice given by the authorities.

Findings

Results A total of 1234 (25%) of Norway’s GPs participated. Together, they documented nearly 18,000 consultations, of which 65 % were performed digitally (video, text, and telephone). Suspected Covid-19 symptoms were reported in 11% of the consultations. Nearly all these patients were managed in primary care, either in regular GP offices (56%) or GP-run municipal respiratory clinics (41%), while 3.7% (n = 73) were admitted to hospitals. The GPs proactively contacted an average of 0.8 at-risk patients per day. While 84% were satisfied with the information provided by the medical authorities, only 20% were able to reorganise their practice in accordance with national recommendations.

Consequences

Conclusion and implications During the early stage of the Covid-19 pandemic in Norway, the vast majority of patients with Covid-19-suspected symptoms were handled in primary care, thereby protecting secondary health services from potentially detrimental exposure to contagion and breakdown of capacity limits.