OpenSAFELY NHS Service Restoration Observatory 1: primary care clinical activity in England during the first wave of COVID-19

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.

Keywords: COVID-19; electronic health records; general practice; primary health care.

Figure 1.

Recording of codes grouped under ‘haematology’ across TPP practices in England (January 2019 to September 2020). The group includes CTV3 codes that begin with ‘42’ and is not necessarily an exhaustive collection of every activity related to haematology. The top five codes represented within this group are listed under the graph. CTV3 = Clinical Terms Version 3. IDR = interdecile range. k = thousand. m = million.

Figure 2.

Recording of grouped subsets of pathology codes across TPP practices in England (January 2019 to September 2020). a) ‘Serum cholesterol (& level)’. The group includes CTV3 codes that begin with ‘44P’ and is not necessarily an exhaustive collection of every activity related to serum cholesterol testing. b) ‘Blood coagulation test’. The group includes CTV3 codes that begin with ‘42Q’ and is not necessarily an exhaustive collection of every activity related to blood coagulation testing. The top five codes represented within this group are listed under the graph. CTV3 = Clinical Terms Version 3. HDL = high-density lipoprotein. IDR = interdecile range. INR = international normalised ratio. k = thousand. LDL = low-density lipoprotein. m = million.

Figure 3.

Recording of codes grouped under ‘respiratory symptoms’ across TPP practices in England (January 2019 to September 2020). The group includes CTV3 codes that begin with ‘17’ and is not necessarily an exhaustive collection of every activity related to respiratory symptoms. The top five codes represented within this group are listed under the graph. CTV3 = Clinical Terms Version 3. IDR = interdecile range. k = thousand. m = million.

Figure 4.

Recording of selected individual codes related to respiratory infections across TPP practices in England (January 2019 to September 2020). a) Viral upper respiratory tract infection, b) infection of lower respiratory tract, and c) suspected COVID-19. These were the most common codes identified for these activities, but other codes may also be used to record the same or similar activities. DR = interdecile range. k = thousand. m = million.

Figure 5.

Recording of codes grouped under ‘chronic obstructive lung disease’ across TPP practices in England (January 2019 to September 2020). The group includes CTV3 codes that begin with ‘H3’ and is not necessarily an exhaustive collection of every activity related to chronic obstructive lung disease. The top five codes represented within this group are listed under the graph. CTV3 = Clinical Terms Version 3. IDR = interdecile range. k = thousand. m = million.

Figure 6.

Recording of selected individual codes related to annual reviews for long-term respiratory conditions across TPP practices in England (January 2019 to September 2020): a) chronic obstructive pulmonary disease annual review, b) asthma annual review, and (c) asthma control test. These were the most common codes identified for these activities, but other codes may also be used to record the same or similar activities. IDR = interdecile range. k = thousand. m = million.