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European primary care rapidly adapted during the COVID-19 pandemic by deciding how to transform care delivery, despite limited training and resources, reports the first pan European qualitative study in eight countries.

Amsterdam street sign showing direction to COVID-19 testing location. Translation of Dutch text on yellow sign: " COVID-19 teststreet". © Shutterstock

Since December 2019, when the first cases of COVID-19 were detected in Wuhan, healthcare systems across the world have been challenged to meet the demand for clinical care related to COVID-19 and non-COVID-19 health needs. Primary care had a crucial role in responding to the COVID-19 pandemic as the first point of patient contact and the gatekeeper to secondary care. Services have had to react rapidly to provide care for both COVID-19 and non-COVID-19 patients while protecting all patients and professionals.

While we had some understanding of the challenges facing primary care professionals (PCPs) during other pandemics, most research was commonly retrospective, meaning reports were clouded by knowledge of how an outbreak evolved.

In February 2020, the Rapid European COVID-19  Emergency Response Research (RECOVER) project led by Professor Herman Goossens from the University of Antwerp,) was funded by the European Union, bringing together 14 partners in eight countries. RECOVER was one of the 18 projects that the European Union has funded in response to the COVID-19 pandemic, with the aim to improve the EU response to future epidemics and pandemics by bringing together international clinical researchers, epidemiologists, virologists, social scientists and laboratory technicians. Nested within this was our own project focusing on primary care and led by University of Oxford and University of Antwerp.

Rapidly set up in eight European countries, including England, Belgium, the Netherlands, Ireland, Sweden, Germany, Poland and Greece, our study explored the experiences of primary care healthcare professionals working during the first wave of the COVID-19 pandemic. We found that PCPs had to make their own decisions on how to rapidly transform services in relation to COVID-19 and non-COVID-19 care. Despite being overwhelmed with guidance from multiple official sources, and ever-changing and sometimes contradictory information, they reported lacking access to practical training. Consequently, PCPs turned to their colleagues for moral support and information to try to quickly adjust to new ways of working, including remote care, and to deal with uncertainty, leading to variation in care.

While all countries quickly moved to providing the majority of consultations remotely, one of the key differences seemed to be whether countries set up places where PCPs could see suspected COVID-19 patients. All countries, apart from Poland, initially set up processes to manage the majority of (suspected) COVID-19 patients within general practices. This meant having to set up procedures to manage patients safely within practices, without much practical help. With time Belgium, the Netherlands, England and Ireland organised ‘COVID hubs’. This meant that PCPs had to, or chose to, take on additional roles in these settings, which affected workload. In addition, there were differences in who organised these hubs and how much involvement PCPs had in organising them.

We also found that PCPs showed great resilience, despite difficulties. PCPs turned to their colleagues for moral support and information to try to quickly adjust to new ways of working, including remote care, and to deal with uncertainty. While daily communication within teams brought a sense of solidarity and togetherness, for some individuals it was not sufficient. The negative impact of working in the pandemic on mental health is now well documented, however with limited focus on this topic in primary care.

Our study highlights that PCPs rapidly transformed primary care delivery despite a number of challenges. Representation of primary care at policy level and engagement with local primary care champions has been missing, yet it is crucial to facilitate easy and coordinated access to practical information on how to adapt services, ongoing training, and access to appropriate mental health support services for PCPs. Preservation of autonomy and responsiveness of primary care are critical to preserve the ability for rapid transformation in any future crisis of care delivery.

The study co-leads, Professor Sibyl Anthierens and Dr Sarah Tonkin-Crine, who led the study, highlighted that “our work is not only relevant to inform preparedness for future pandemics, but also during the ongoing health emergency. Our social science team held fortnightly teleconferences with a social science lead in the European Centre for Disease Prevention and Control (ECD) to share findings from our RECOVER work to inform rapid policy development”.

Overall, the study highlighted both unique as well as more universal challenges facing PCPS in different European countries. It is important to acknowledge that primary care has shown a great resilience in responding to the pandemic and continuing provision of both COVID and non-COVID related care.

Read more about the project in the British Journal of General Practice

 

Study team: Sarah Tokin-Crine (University of Oxford Work Package Lead), Sibyl Anthierens (University of Antwerp Work Package Lead), Marta Wanat (Lead Researcher)

Podcast

Marta Wanat speaks to the BJGP about this study in BJGP Interviews Episode 36

 

Opinions expressed are those of the author/s and not of the University of Oxford. Readers' comments will be moderated - see our guidelines for further information.

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