Management and patient safety of complex elderly patients in primary care during the COVID-19 pandemic in the UK-Qualitative assessment

PLoS One. 2021 Mar 29;16(3):e0248387. doi: 10.1371/journal.pone.0248387. eCollection 2021.


Objectives: The study aims to investigate GPs' experiences of how UK COVID-19 policies have affected the management and safety of complex elderly patients, who suffer from multimorbidity, at the primary care level in North West London (NWL).

Design: This is a service evaluation adopting a qualitative approach.

Setting: Individual semi-structured interviews were conducted between 6 and 22 May 2020, 2 months after the introduction of the UK COVID-19 Action Plan, allowing GPs to adapt to the new changes and reflect on their impact.

Participants: Fourteen GPs working in NWL were interviewed, until data saturation was reached.

Outcome measures: The impact of COVID-19 policies on the management and safety of complex elderly patients in primary care from the GPs' perspective.

Results: Participants' average experience was fourteen years working in primary care for the NHS. They stated that COVID-19 policies have affected primary care at three levels, patients' behaviour, work conditions, and clinical practice. GPs reflected on the impact through five major themes; four of which have been adapted from the Safety Attitudes Questionnaire (SAQ) framework, changes in primary care (at the three levels mentioned above), involvement of GPs in policy making, communication and coordination (with patients and in between medical teams), stressors and worries; in addition to a fifth theme to conclude the GPs' suggestions for improvement (either proposed mitigation strategies, or existing actions that showed relative success). A participant used an expression of "infodemic" to describe the GPs' everyday pressure of receiving new policy updates with their subsequent changes in practice.

Conclusion: The COVID-19 pandemic has affected all levels of the health system in the UK, particularly primary care. Based on the GPs' perspective in NWL, changes to practice have offered opportunities to maintain safe healthcare as well as possible drawbacks that should be of concern.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Attitude of Health Personnel
  • COVID-19 / epidemiology
  • COVID-19 / pathology
  • COVID-19 / prevention & control*
  • COVID-19 / virology
  • General Practitioners / psychology*
  • Health Policy
  • Humans
  • Interviews as Topic
  • Pandemics
  • Patient Safety*
  • Policy Making
  • Primary Health Care*
  • Qualitative Research
  • SARS-CoV-2 / isolation & purification
  • United Kingdom / epidemiology

Grant support

This work was supported by the National Institute for Health Research (NIHR), program grants for applied research, grant number: PSTRC-2016-004. We are grateful for support from the National Institute for Health Research (NIHR) under the Applied Health Research (ARC) programme for North West London and the Imperial NIHR Biomedical Research Centre. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.