by Kelly Cheng, Medical Student, University of Bristol
“Cancelled due to COVID-19” – a rare opportunity to practise lifesaving pre-hospital emergency medicine skills in the French Alps was abruptly transformed into another cancellation email, as with many other glorious plans for 2020. Before I knew it, hospital placements had also been suspended until further notice. Instead, I found myself back home, huddled before my laptop, about to embark on a 6-week long student choice project working with highly-experienced academics for the first time – over Zoom, of course.
In this post, I share my experience as a third year medical student undertaking a research project alongside Dr Lorna Duncan from the Centre of Academic Primary Care (CAPC), and explore the methods we used to successfully gather primary data from all regions of England amid a national lockdown. Ironically, the chance to carry out a project focused on the COVID-19 outbreak itself was all too tempting.
The challenge – exploring how general practice has changed during the pandemic
The COVID-19 pandemic has undoubtedly led to a disruption in the research community, having forced many researchers to work remotely and even re-designing their data collection methods to comply with public health guidance.
Aside from our working habits, the global medical landscape has also shifted dramatically in order to continue providing healthcare during the pandemic. Through our screens, we have witnessed lockdown and social distancing measures unfold, the building of more hospital capacity, and the Government’s attempt to ensure procurement of diagnostic, protective, and therapeutic tools to meet the ongoing demand – but during this crisis, what has happened to general practice?
In the rise of the pandemic, NHS England issued guidance or all GPs to adopt a telephone-first triage system, allowing most patients to be managed remotely wherever clinically appropriate, thus reducing the need for face-to-face consultations to minimise the spread of infection.
Although this approach has accelerated the use of virtual consultations, there will always remain a need for face-to-face services in some cases, such as for the delivery of vaccinations, health conditions requiring a physical examination, patients who are housebound, as well as those who lack the appropriate technological infrastructure to access online consultations.
Our ‘Hot and Cold Hubs’ project aims to explore the models being used across England to continue allowing face-to-face assessment of patients in primary care during the pandemic. We are especially interested in the use of ‘hot’ and ‘cold’ primary care hubs – designated sites that permit the assessment of patients presenting with COVID-19 symptoms, and non-COVID-19 symptoms, respectively.
Primary care hubs were initially developed to increase capacity in, or enhance access to, general practice by accepting patients from multiple different practices. Prior to COVID-19, they were commonly used as ‘Extended Access Hubs’: sites which see patients during early mornings, evenings, weekends, and bank holidays when their usual GP practice is closed. However, the novel use of ‘hot’ and ‘cold’ hubs during the pandemic remains to be explored.
How can we gather data under a national lockdown?
There are several ways of collecting data remotely, from simple telephone calls, to virtual face to face interviews, to online surveys. For our project, we required a method that would enable the rapid delivery of our research questions to GPs, whilst also guaranteeing a high yield of responses.
The method we used involved sending a survey to all 135 clinical commissioning groups (CCGs) in England, requesting specific information under the Freedom of Information (FOI) Act 2000. The purpose of this Act is to provide any member of the public access to information held by public authorities, who are obliged to disclose certain information about their activities upon written requests.
When used responsibly, mindful of the extra work generated for others, the FOI Act can be a useful tool for obtaining information efficiently for a well-prepared set of research questions. Moreover, by collecting data in this way, we can technically fulfil our research aims from anywhere in the world by using just one tool: a laptop with an internet connection. Within the 20-working-days response window required by the Act, over 90% of FOI responses were obtained.
As I now work on the analysis phase of my project, with plans to publish our findings, I wonder about the wider implications of this data: a comparison of the service models used across England during the peak of this pandemic will provide insight into the extent to which primary care has re-modelled on a national scale to combat the crisis.
Our findings could also provide information for CCGs and healthcare providers when optimising their face-to-face GP services as we transition into the next phase of the pandemic, particularly as we head towards the winter months. And I find myself looking longer-term too, asking whether, after this crisis finally happens, will the way we consult our GP be changed for the better?
One thing is for sure, the French Alps will still be there for me to explore.