OpenSAFELY NHS Service Restoration Observatory 2: changes in primary care clinical activity in England during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has disrupted healthcare activity across a broad range of clinical services. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible. AIM: To describe changes in the volume and variation of coded clinical activity in general practice across six clinical areas: cardiovascular disease, diabetes, mental health, female and reproductive health, screening and related procedures, and processes related to medication. DESIGN AND SETTING: With the approval of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY. METHOD: Common primary care activities were analysed using Clinical Terms Version 3 codes and keyword searches from January 2019 to December 2020, presenting median and deciles of code usage across practices per month. RESULTS: Substantial and widespread changes in clinical activity in primary care were identified since the onset of the COVID-19 pandemic, with generally good recovery by December 2020. A few exceptions showed poor recovery and warrant further investigation, such as mental health (for example, for 'Depression interim review' the median occurrences across practices in December 2020 was down by 41.6% compared with December 2019). CONCLUSION: Granular NHS general practice data at population-scale can be used to monitor disruptions to healthcare services and guide the development of mitigation strategies. The authors are now developing real-time monitoring dashboards for the key measures identified in this study, as well as further studies using primary care data to monitor and mitigate the indirect health impacts of COVID-19 on the NHS.

Barriers and enablers to pharmacists' involvement in a novel immunisation programme.

Aim: Pharmacists are involved in immunisation programmes for a variety of diseases. However, some patient populations may be considered at high risk of complications from vaccination and are excluded from these programmes. The study aimed to explore pharmacists' roles in a vaccination programme to identify factors that influence their involvement. Methods: Phenomenological qualitative semi-structured interviews were conducted online with a convenience sample of pharmacists working in a COVID-19 vaccination centre in January and February 2021, by a single researcher. Recordings of the interviews were transcribed automatically, manually quality checked and thematically analysed using NVivo Version 1 by all authors. Data were repeatedly read to identify what pharmacists did and how they did it. Results: Seventeen pharmacists were interviewed, and transcript analysis identified 1) What pharmacists did in the Vaccination Centre, 2) Barriers to involvement in the Vaccination Centre and 3) Enablers to being involved in the Vaccination Centre. Key findings indicate pharmacists adopted the roles of information counsellors, supporting patients with vaccine hesitancy, making autonomous prescribing decisions as well as documenting product administration and manipulation. Limited free time at work and desk-based roles for senior pharmacists were barriers to taking on a patient-facing role. National recognition of pharmacists' skills, access to information through official and unofficial networks and a sense of duty, or zeitgeist, enabled pharmacists' to be involved. Discussion: Pharmacists can support immunisation for patients during pandemics if given appropriate autonomy and recognition. Further work is needed to explore how pharmacists may be recognised for their work and use information obtained through informal networks.