Curtis, Helen J; MacKenna, Brian; Croker, Richard; Inglesby, Peter; Walker, Alex J; Morley, Jessica; Mehrkar, Amir; Morton, Caroline E; Bacon, Seb; Hickman, George; +26 more... Bates, Chris; Evans, David; Ward, Tom; Cockburn, Jonathan; Davy, Simon; Bhaskaran, Krishnan; Schultze, Anna; Rentsch, Christopher T; Williamson, Elizabeth J; Hulme, William J; McDonald, Helen I; Tomlinson, Laurie; Mathur, Rohini; Drysdale, Henry; Eggo, Rosalind M; Wing, Kevin; Wong, Angel Ys; Forbes, Harriet; Parry, John; Hester, Frank; Harper, Sam; Evans, Stephen Jw; Douglas, Ian J; Smeeth, Liam; Goldacre, Ben; (The OpenSAFELY Collaborative); The OpenSAFELY Collaborative; (2021) OpenSAFELY NHS Service Restoration Observatory 1: primary care clinical activity in England during the first wave of COVID-19. The British journal of general practice : the journal of the Royal College of General Practitioners, 72 (714). e63-e74. ISSN 0960-1643 DOI: https://doi.org/10.3399/BJGP.2021.0380
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Abstract
BACKGROUND: The COVID-19 pandemic has disrupted healthcare activity. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible. AIM: To describe the volume and variation of coded clinical activity in general practice, taking respiratory disease and laboratory procedures as examples. DESIGN AND SETTING: Working on behalf of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY. METHOD: Activity using Clinical Terms Version 3 codes and keyword searches from January 2019 to September 2020 are described. RESULTS: Activity recorded in general practice declined during the pandemic, but largely recovered by September. There was a large drop in coded activity for laboratory tests, with broad recovery to pre-pandemic levels by September. One exception was the international normalised ratio test, with a smaller reduction (median tests per 1000 patients in 2020: February 8.0; April 6.2; September 6.9). The pattern of recording for respiratory symptoms was less affected, following an expected seasonal pattern and classified as 'no change'. Respiratory infections exhibited a sustained drop, not returning to pre-pandemic levels by September. Asthma reviews experienced a small drop but recovered, whereas chronic obstructive pulmonary disease reviews remained below baseline. CONCLUSION: An open-source software framework was delivered to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September, with some important tests less affected and recording of respiratory disease codes was mixed.