Modifications to the delivery of NHS face-to-face general practice consultations during the COVID-19 pandemic in England [version 2; peer review: 1 approved, 1 approved with reservations]

Background: 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 separation of diagnosed or suspected COVID-19 patients from others. Remote triage and consultations became the default, with adapted face-to-face contact used only when clinically necessary. This study aimed to identify the modified face-to-face delivery models used nationwide in spring/summer 2020. Information was also sought concerning COVID-19 outbreaks linked to English general practice. Methods: In June 2020, a survey was sent by email to the 135 Clinical Commissioning Groups (CCGs) in England to identify local organisation of face-to-face general practice consultations since March 2020. An email was sent to Public Health England (PHE) requesting data on COVID-19 outbreaks linked to general practice. Results: All CCGs responded. Between March and July 2020, separation of COVID-19 patients from others was achieved using combinations of the following models: zoned surgeries (reported by 47% of CCGs), where COVID-19 and other patients were separated within their own practice; 'hot' or 'cold' hubs (reported by 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 (reported by 70% of CCGs). One of seven combinations of these models was used across each CCG, with some flexibility shown according to changing demand through hub availability. PHE data indicated 25 possible or confirmed COVID-19 outbreaks or clusters in English general practice to July 31st 2020. 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 impacts on staff and patients, together with learning from investigations into confirmed COVID-19 outbreaks, may both aid future pandemic management and identify beneficial elements for practice beyond this.