Modifications to the delivery of NHS face-to-face general practice consultations during the COVID-19 pandemic in England [version 3; peer review: 2 approved]

Abstract

Background: In order to minimise transmission of SARS-CoV-2, the virus causing COVID-19, delivery of English general practice consultations was modified in March 2020 to enable the separation of patients with diagnosed or suspected COVID-19 from others. Remote triage and consultations became the default, with adapted face-to-face contact used only when clinically necessary. Face-to-face delivery modifications were decided locally and this study aimed to identify the different models used nationwide in spring/summer 2020. Methods: In June 2020, a survey was sent by email to the 135 Clinical Commissioning Groups (CCGs) responsible for planning and commissioning NHS health care services in England to identify the local organisation of face-to-face general practice consultations since March 2020. Results: All CCGs responded. Between March and July 2020, separation of patients with diagnosed or suspected COVID-19 (‘COVID-19 patients’) from others was achieved using the following models: zoned practices (used within 47% of CCGs), where COVID-19 and other patients were separated within their own practice; ‘hot’ or ‘cold’ hubs (used within 90% of CCGs), separate sites where COVID-19 or other patients registered at one of several collaborating practices were seen; ‘hot’ and ‘cold’ home visits (used within 70% of CCGs). For around half of CCGs, either all their GP practices used zoning, or all used hubs; in other CCGs, both models were used. Demand-led hub availability offered flexibility in some areas. Home visits were mainly used supplementally for patients unable to access other services, but in two CCGs, they were the main/only form of COVID-19 provision. Conclusions: Varied, flexible ways of delivering face-to-face general practice consultations were identified. Analysis of the modified delivery in terms of management of COVID-19 and other conditions, and other impacts on staff and patients, may both aid future pandemic management and identify beneficial elements for practice beyond this.