Identification of challenges to implementation of infection control guidance in primary care during COVID-19 incidents: Lessons for pandemic planning

Objectives
Despite service delivery modifications to minimise transmission in primary care during the pandemic, 609 COVID-19 incidents linked to English general practice (GP) were mandatorily reported to the United Kingdom Health Security Agency (UKHSA) between March 2020 and April 2022. This study aimed to identify themes in case management records of GP-linked COVID-19 incidents to inform future infection prevention and control (IPC).

Study design
Thematic analysis was undertaken of all GP-linked COVID-19 incidents reported to UKHSA in South West England.

Methods
Records were included where at least one confirmed COVID-19 case was linked to a GP setting. Analysis of outbreaks/clusters (at least two cases, with/without an epidemiological link respectively) and single case exposures was undertaken. Cases, contacts and potential transmission routes were evaluated in outbreaks; impacts to health/service provision were analysed for all incidents.

Results
42 outbreaks, 10 clusters and 10 single case exposures were included for analysis. Staff comprised 95% of 210 outbreak cases, with six family member cases and one patient case. At least one IPC breach was identified in over 70% of outbreaks, commonly involving inadequate social distancing/personal protective equipment use, or multi-site/symptomatic working. Some breaches indicated guidance impracticability. No deaths, but two hospitalisations, occurred and a single case could necessitate site closure.

Conclusions
COVID-19 cases in GP-linked outbreaks in South West England were predominantly identified in staff, impacting service delivery. Some IPC breaches involved implementation challenges. Mitigations span premises/IT adaptations, contingency planning and tailored guidance. This emphasizes the need for specific primary care representation in pandemic planning.