Descriptive analysis of patterns of primary care demand in England during the COVID-19 pandemic

Date of ISAC Approval: 
08/07/2020
Lay Summary: 
The COVID-19 pandemic has had a profound effect on the health and social care system, which may have led to the suppression of demand for primary care services. For example, people who would usually present in primary care with cancer symptoms may not be attending due to fear of contracting COVID-19. This “accumulated” demand may lead to a spike in demand for primary and community care services in the future, leading to increased demand for secondary care services or affecting future mortality rates or other population health outcomes. This project will provide understanding of the impact of COVID-19 on primary care and consequences for population health by measuring patterns of demand by age, sex and clinical reason prior to the pandemic and how this has changed in 2020. We will look at changes in the outcomes of consultations (e.g. referrals) and at changes in demand for people with pre-existing long-term conditions such as diabetes. The pandemic has brought health inequalities into the spotlight, and consequently we will look at demand by level of deprivation in the area. The results from this study will feed into a wider project being conducted as part of The Health Foundation’s response to the pandemic in collaboration with other thinktanks that is looking at the change in use of health and care services by non-COVID patients. This will ultimately provide evidence and analysis that will help policymakers and system leaders manage the demand and ensure that health and social care services are configured to respond.
Technical Summary: 
The aim of the study is to produce summary statistics on the use of primary care at a high level, by age, sex: 1. Consultation type (e.g. face-to-face, telephone) and role of staff member conducting consultation. 2. We will then look at changes in the reason for consultation through the diagnosis codes: showing the mention of a conditions or COVID-19, 3. The outcomes of consultations (referrals, prescribing, tests, immunisation), 4. Using diagnosis codes form the patient’s historical data, we will look at changes in items 1-3 for patients with pre-existing long-term conditions, and finally: 5. We will look at items 1-4 by practice-level Index of Multiple Deprivation We will compare the summary statistics (means and variance) of primary care activity and mortality for different groups (age, sex, pre-existing condition and local IMD) in 2020 to the same periods from the past 4 years (2016-2019), while taking into account trends in activity levels for those groups using a simple time series trend analysis, taking into account observed seasonality in primary care use and mortality. This analysis will be performed on consultation rates and mortality rates per person in the defined groups. We will then perform similar time trend analysis on the per consultation rates for face to face / phone, referral rates, prescribing rates, testing and where the diagnosis code refers to a pre-existing condition / COVID-19. An early, high level understanding of the effect of COVID-19 on primary care use will inform policy in how best for the NHS to recover, in addition it will inform areas for further research on the impact of COVID-19 on non-COVID patients.
Health Outcomes to be Measured: 
Primary care consultation rates – key variables are: age; sex; reasons for consultation or diagnosis (including COVID-19); consultation type; practice staff role; outcome of consultation (referral, prescribing, test, immunisation); mortality (using the ONS linkage); practice-level Index of Multiple Deprivation; the presence of pre-existing long-term condition: Cancer, Diabetes, Heart Failure, Coronary Heart Disease, Atrial Fibrillation, Asthma, Chronic Obstructive Pulmonary Disorder, Stroke, Chronic Kidney Disease, Chronic Liver Disease, Depression, Anxiety, Dementia
Collaborators: 

Toby Watt - Chief Investigator - The Health Foundation
Miqdad Asaria - Collaborator - The Health Foundation
Roseanna Hamilton - Corresponding Applicant - The Health Foundation
Zoe Firth - Collaborator - The Health Foundation

Linkages: 
ONS;Practice IMD (Standard)