Abstract
Background
In March 2020 the COVID-19 pandemic required a rapid reconfiguration of UK general practice to minimise face-to-face contact with patients to reduce infection risk. However, some face-to-face contact remained necessary and practices needed to ensure such contact could continue safely.
Aim
To examine how practices determined when face-to-face contact was necessary and how face-to-face consultations were reconfigured to reduce COVID-19 infection risk.
Design and Setting
Qualitative interview study in general practices in Bristol, North Somerset and South Gloucestershire.
Method
Longitudinal semi-structured interviews with clinical and managerial practice staff at four timepoints between May and July 2020.
Results
Practices worked flexibly within general national guidance to determine when face-to-face contact with patients was necessary, influenced by knowledge of the patient, experience, and practice resilience. For example, practices prioritised patients according to clinical need using face-to-face contact to resolve clinician uncertainty or provide adequate reassurance to patients. To make face-to-face contact as safe as possible and keep patients separated, practices introduced a heterogeneous range of measures that exploited features of their indoor and outdoor spaces and altered their appointment processes. As national restrictions eased in June and July, the number and proportion of patients seen face-to-face generally increased. However, the reconfiguration of buildings and processes reduced the available capacity and put increased pressure on practices.
Conclusion
Practices responded rapidly and creatively to the initial lockdown restrictions. The variety of ways practices organised face-to-face contact to minimise infection highlights the need for flexibility in guidance.
In March 2020 the COVID-19 pandemic required a rapid reconfiguration of UK general practice to minimise face-to-face contact with patients to reduce infection risk. However, some face-to-face contact remained necessary and practices needed to ensure such contact could continue safely.
Aim
To examine how practices determined when face-to-face contact was necessary and how face-to-face consultations were reconfigured to reduce COVID-19 infection risk.
Design and Setting
Qualitative interview study in general practices in Bristol, North Somerset and South Gloucestershire.
Method
Longitudinal semi-structured interviews with clinical and managerial practice staff at four timepoints between May and July 2020.
Results
Practices worked flexibly within general national guidance to determine when face-to-face contact with patients was necessary, influenced by knowledge of the patient, experience, and practice resilience. For example, practices prioritised patients according to clinical need using face-to-face contact to resolve clinician uncertainty or provide adequate reassurance to patients. To make face-to-face contact as safe as possible and keep patients separated, practices introduced a heterogeneous range of measures that exploited features of their indoor and outdoor spaces and altered their appointment processes. As national restrictions eased in June and July, the number and proportion of patients seen face-to-face generally increased. However, the reconfiguration of buildings and processes reduced the available capacity and put increased pressure on practices.
Conclusion
Practices responded rapidly and creatively to the initial lockdown restrictions. The variety of ways practices organised face-to-face contact to minimise infection highlights the need for flexibility in guidance.
| Original language | English |
|---|---|
| Pages (from-to) | 1-11 |
| Number of pages | 11 |
| Journal | British Journal of General Practice Open |
| Volume | 5 |
| Issue number | 5 |
| Early online date | 31 Aug 2021 |
| DOIs | |
| Publication status | Published - Oct 2021 |
Bibliographical note
Funding Information:This study was funded by the National Institute for Health Research (NIHR) School for Primary Care Research (Ref: SPCR_493). Additional funding for staff time was provided by NIHR Applied Research Collaboration West (NIHR ARC West) and One Care. Professor Chris Salisbury is an NIHR Senior Investigator. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Funding Information:
The authors would like to thank all the participants in this study, Bristol North Somerset and South Gloucestershire CCG, One Care for providing the data extract, the NIHR Clinical Research Network for adopting the study on the NIHR portfolio and the NIHR SPCR for funding the research.
Publisher Copyright:
© 2021, The Authors
Research Groups and Themes
- Covid19
Keywords
- COVID-19
- face-to-face consulting
- general practitioners
- referral and consultations
- primary healthcare
- general practice