New research reveals a significant drop in the general practice diagnosis of several common health conditions in Salford from March to May 2020

Electronic health records of approximately a quarter of a million people were analysed to identify the impact of COVID-19 on general practice (primary care) by a patient safety research centre between 1st March and 31st May 2020.

According to the research published in The Lancet Public Health, for many common physical and mental health conditions, there has been a significant reduction in the rate of initial diagnoses compared to the expected levels for this time period. The biggest reductions were for mental health conditions and Type 2 diabetes as there were half the expected number of diagnoses.

For malignant cancer the reduction was 16 per cent for the time period analysed, but for the month of May there was a drop of 44 per cent. For circulatory system diseases such as stroke, heart failure and coronary heart disease there has been a reduction in diagnoses of 43 per cent.

The research, published in the paper, ‘Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study’, was conducted by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC). The centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust.

The study used 10 years’ worth of data for Salford to create statistical models which gave predicted levels of new diagnoses for the health conditions identified in general practice to be routine.

Richard Williams, research lead for the study at the GM PSTRC, said: “We were aware that GP practices have been reporting a drop in the number of patients seeking medical help since the start of the COVID-19 pandemic. Thanks to electronic health records it is possible to investigate whether this is true across a large urban area like Salford. Importantly our research has revealed which conditions people are not seeking medical attention for. This means that, potentially, there are high numbers of people living with undiagnosed Type 2 diabetes, mental health conditions and circulatory system failure.”

Richard will join internationally renowned experts in a special Lancet journals session to present this work at the European Society of Clinical Microbiology and Infectious Diseases Conference on Coronavirus disease (ECCVID), taking place online 23-25 September.

Dr Owain Thomas, GP at a practice in Salford, said: “The research from the GM PSTRC looking at the diagnosis of physical and mental health conditions in primary care during the pandemic in Salford is so significant because it quantifies the effect COVID-19 is having on the diagnosis of routine health conditions in General Practice. Since the initial lockdown in March the whole way in which patients consult with their practice has changed – there has been a dramatic shift away from face to face consultations to keep everyone safe from the spread of COVID-19. However, it is important to recognise the unintended consequences of reducing patient contact with primary care face to face services. The conclusions of this research are a vital part in our understanding of the overall impact of Covid-19, the conditions we have looked at are usually many months or years in the making so the reduction in new diagnoses does not represent a reduction in the burden of these diseases, more the fact that they have not yet been formally recognised. This will have an impact individually on those patients – the longer a patient goes undiagnosed, the more complications they are likely to suffer. As we move forwards careful thought will be needed to plan services to find and support those patients who have not yet been diagnosed.”

Nav Kapur, Professor of Psychiatry at The University of Manchester and lead for the mental health work at the PSTRC, said: “One of the great strengths of the GM PSTRC is the opportunity to look at safety across different settings and clinical conditions. For me the reduction in mental health diagnoses and consultations was particularly striking. Going forward, I think there are two urgent priorities. First, to understand why this has happened and second to monitor and mitigate the consequences of reduced healthcare use”

Richard Williams, concludes: “It is vital that healthcare services use the findings in our research to proactively prioritise diagnosing patients who may be living with conditions which could be dangerous if left untreated. This will help to avoid health services become swamped when people feel confident enough to return to healthcare settings.”

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