The impact of COVID-19 lockdowns on primary care contact among vulnerable populations in England: a controlled interrupted time series study

Background UK COVID-19 lockdowns significantly affected primary care access and delivery. Little is known about whether lockdowns disproportionally impacted vulnerable groups, including people who misuse substances, domestic violence or abuse victims, those with intellectual disability, and children with safeguarding concerns.

Aim To evaluate the impact of UK COVID-19 lockdowns on primary care contact rates among vulnerable groups.

Design & setting Natural experimental design using all registered patients in the OpenSAFELY platform.

Method With approval from NHS England, we conducted controlled interrupted time-series analyses on 24million patients in England between September2019-September2021.

Results Pre-pandemic, primary care consultation rates were 110.1 per 1000 patients per week. Following the initiation of the first lockdown (23/03/2020), there was a large reduction of 29-61 contacts per 1000 patients per week among vulnerable and general population groups. For patients with alcohol misuse, aged ≥14 years with intellectual disability, and children with safeguarding concerns, this reduction was significantly more extreme than corresponding general populations (relative rate difference -23.8 [95% confidence interval -39.8,-7.7], -24.6 [-38.8,-10.5], and -15.4 [-26.9,-3.8], respectively). Following the final lockdown (29/03/2021), all groups had consulting rates exceeding pre-pandemic rates (with increases more marked in vulnerable populations), except those only including children.

Conclusion Analyses suggested a larger short-term impact of the first COVID-19 lockdown on primary care contact for some vulnerable groups, compared to the general population; differential impacts persisted through subsequent lockdowns and beyond for some vulnerable groups. There is a need to examine drivers of these differences to enable more equitable primary care access and provision.