Maintaining face-to-face contact during the COVID-19 pandemic: a longitudinal qualitative investigation in UK primary care

Andrew Turner; Anne Scott; Jeremy Horwood; Chris Salisbury; Rachel Denholm; Lauren Scott; Geeta Iyer; John Macleod; Mairead Murphy

doi:10.3399/BJGPO.2021.0036

Article Figures & Data

Tables

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Table 1. GP practice and participant characteristics

GP practice	Patient list size^a	IMDquintile^b	Interview participants
Round 113–27 May	Round 228 May–13 Jun	Round 315 Jun–2 Jul	Round 43 Jul–27 Jul
1	Medium–large	1	GP1, PM1	GP1	GP1	NM1
2	Small–medium	2	GP2, PM2	GP2	GP2	GP2
3	Medium	3	GP3, PM3	NM9	GP3	NM9
4	Medium–large	5	GP4	GP4	GP4	NM2
5	Small	1	GP5, PM4	0	GP5	NM3
6	Very large	5	GP6, PM5	GP6	GP6	GP6
7	Medium	5	GP7	GP7	GP7	GP7
8	Small–medium	5	GP8, PM6	GP8	NM4	GP8
9	Very large	5	GP9	GP9	GP9	NM5
10	Small–medium	5	GP10, PM7	GP10	GP10	GP10
11	Small	1	GP11	GP11	GP11	GP11
12	Very large	3	GP12	GP12	GP12	0
13	Small	5	GP13	GP13	GP13	GP13
14	Medium	5	GP14, PM8	GP14	GP14	NM6
15	Small	5	0	GP15	GP15	GP15
16	Small	3	0	GP16, PM9	0	GP16, PM9, NM7
17	Small–medium	3	0	GP17, PM10	GP17	GP17
18	Small	1	0	GP18, PM11	GP18	GP18
19	Small–medium	2	0	GP19	GP19	GP19
20	Medium	2	0	GP20	GP20	GP20
21	Small	1	0	GP21	GP21	NM8
Total interviews			22	23	20	22

a Small:<10 000 patients; small–medium: 10 000–15 000 patients; medium: 15 000–20 000 patients; medium–large: 20 000–25 000 patients; large: 25 000–30 000 patients; very large: >30 000 patients. ^bIndex of Multiple Deprivation (IMD) quintile 1 = most deprived and 5 = most affluent.
GP = general practitioner. IMD = Index of Multiple Deprivation. PM = practice manager. NM = nurse manager, advanced nurse practitioner, or senior nurse.

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Table 2. Measures taken by practices to make face-to-face contact possible

Measures taken by practices^a	Examples
Zones
Physical zoning	Areas of buildings (‘red zones’) used only for suspected COVID-19 patients.Areas of buildings (‘green zones’) used only for patients not suspected of having COVID-19.
Temporal zoning	Shielded patients seen first thing in the morning, before any other patients enter the building.
Building modifications
One-way systems	Routes within practices that avoid staff and patients meeting in corridors where distancing cannot be maintained.
Use of multiple entrances and exits	Side entrances used for access to ‘red zone’, minimising interaction between suspected COVID-19 patients and other patients, and reducing the amount of space necessary to create red zones.
Repurposed spaces	Stripping bare clinic rooms for easier cleaning and semi-permanent changes to buildings (new flooring to expand clinical spaces, new walls to divide larger clinical rooms).
Home visits
Home visits	Shielded or vulnerable patients visited by GPs and nurses, for acute and routine care.
Outside spaces
Use of practice car parks or gardens	Sections of car parks used as waiting or treatment areas.
Rationalising appointment processes
Longer appointments	Adding 5 minutes before and after treatment-room appointments to allow staff to change into PPE beforehand and clean room afterwards.
Consolidation of face-to-face tasks	Opportunistically doing patients’ blood tests or reviews of long-term conditions if they visit the practice for other reasons.
Segmentation of reviews of long-term conditions	Conducting only essential physical exams or observations face to face, then completing review remotely.

^aThis table is derived from the interview data and summarises the various measures that were described by staff. PPE = personal protective equipment.

Supplementary Data

BJGPO.2021.0036_Supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.