GPs in England’s most deprived areas at higher risk of death from Covid-19

New research from the Health Foundation reveals that one in three (32.7 per cent) general practitioners (GPs) who singlehandedly manage a GP practice are at high risk of death from COVID-19.

The independent charity estimates that this could potentially leave 710,043 patients without face-to-face appointments with their GPs if those at high risk take the difficult decision to limit direct patient contact.

Across England, at least eight per cent (3,632) of GPs are deemed at ‘high risk’ of death from COVID-19. NHS England guidance suggests that NHS staff at potentially higher risk from COVID-19 are risk assessed and have their activities adjusted accordingly, including ceasing face-to-face patient contact. Factors including age, sex and ethnicity can all contribute to greater risk of death from COVID-19.

To try to keep patients and staff safe, GPs have shifted to doing a greater proportion of their consultations by phone, video or email. But not everything can be done over the phone and some patients need face-to-face appointments. NHS England has been clear that all practices must provide these where clinically necessary.

If GPs at high risk of COVID-19 do not see patients face-to-face then the impacts of this shift in care will be more sharply felt in the most deprived areas of England. GPs at very high risk of death from COVID-19 are more than three times as likely to be working in the most deprived regions. This is even more exaggerated for single-handed GP practices, which are far more likely to be located in areas of high deprivation. Single-handed practices run by a GP at high or very high risk from COVID-19 are more than four times as likely to be located in the most deprived areas of the country than the most affluent. These factors all risk worsening health inequalities already exacerbated by COVID-19.

The analysis also found that London may be particularly affected if GPs at high risk from COVID-19 restrict their patient-facing activities. The capital has the highest proportion of GPs at very high risk and of single-handed GP surgeries run by a GP at very high risk.

The Health Foundation is calling for national and regional decision makers to provide additional support to keep GPs at high risk from COVID-19 and their patients safe and healthy:

• CCGs must ensure that they are aware of gaps in face-to-face provision of core general practice services in their localities.
• CCGs must work with practices and primary care networks to make sure that where gaps are identified, arrangements are made so that all patients have access to face-to-face appointments, if needed, and without endangering GPs.
• Additional and ongoing funding must be made available for costs associated with providing this cover.

Dr Rebecca Fisher, Senior Policy Fellow at the Health Foundation and a practicing General Practitioner, said: "The ongoing risk of COVID-19 to the safety of both patients and GPs means that hundreds of thousands of people may find it much harder to get a face-to-face GP appointment. It’s particularly worrying that GPs at higher risk from COVID-19 are far more likely to be working in areas of high deprivation. Those are precisely the areas with the greatest health need, the biggest burden from COVID-19, and an existing under-supply of GPs relative to need. Unless urgent action is taken this could become another way in which poorer communities become further disadvantaged, and risks further widening health inequalities."

Other key findings from the research:

• Almost one in 10 GP practices (9.4 per cent or 639 out of 6,771) are run by a single GP. These practices serve 2,497,159 patients and are particularly vulnerable to COVID-19 related disruption should the single-handed GP fall ill or die of COVID-19.
• Locum GPs, who might be employed to cover GP absences, are also disproportionately at risk from COVID-19. Less than 10 per cent of the GP workforce are locums, but locums make up 17 per cent of GPs at very high risk from COVID-19.

The latest guidance from NHS England advises that face-to-face consultations should continue to be made available alongside remote consultations at all surgeries. All requests for GP appointments should be triaged and in some cases, a face-to-face consultation may still be indicated, for example when a physical examination is required or if patients are unable to be supported to use or communicate via remote technologies.

* Read the research report here

* The Health Foundation https://www.health.org.uk/

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