How COVID-19 lockdowns affected access to GP services for vulnerable groups

Some of the most vulnerable people in society were less able to access GP care during the COVID-19 pandemic compared to the general population, according to new research published in BJGP Open. The study, led by researchers from the Universities of Bristol, Oxford and Glasgow, also found those effects continued long after lockdowns ended.

The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) funded study looked at GP healthcare records from around 24 million people in England.

The researchers examined how GP consultation rates changed for groups already known to be at risk of poorer health. These included people with alcohol or drug problems, people experiencing domestic abuse, those with learning disabilities, and children at risk of harm.

Before the pandemic, there were around 110 GP visits per 1,000 people each week in England. But when the first national lockdown was introduced in March 2020, those numbers dropped sharply. There were on average 40 fewer visits per 1,000 people each week, but up to 61 fewer visits for certain groups.

While GP visits fell across the board, the study found that some vulnerable groups were hit harder than others. People with alcohol misuse issues, individuals aged 14 and over with learning disabilities, and children with safeguarding concerns all saw much steeper drops in access to care than the general population.

After the final lockdown ended in March 2021, GP visit rates increased and even exceeded pre-pandemic levels for most groups. However, children with safeguarding concerns remained an exception, with their access to GP care still lagging behind.

Researchers say the findings highlight the need to investigate why these disparities occurred and how they can be addressed, to reduce health inequalities in the future.

Dr Scott Walter, lead author of the study, said:

“GP services changed virtually overnight during the pandemic, with more remote consultations and fewer face-to-face appointments. But these changes didn’t affect everyone equally.

“Whilst the innovative and imaginative changes that GPs made to ensure continued access to care amongst their patients benefitted many, not all benefitted equally. In fact, several groups who were already disadvantaged may have had this disadvantage exacerbated.

“We need to better understand what drove this unequal access so we can make GP care more accessible in the long term for those who need it most.”

The study used data accessed through the OpenSAFELY platform, which allows secure analysis of health records while protecting patient privacy. It was supported by the Centre for Academic Primary Care at the University of Bristol.