OpenSAFELY NHS Service Restoration Observatory 1: Primary care clinical activity in England during the first wave of COVID-19

The OpenSAFELY Collaborative

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Background The COVID-19 pandemic has disrupted healthcare activity. 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 the volume and variation of coded clinical activity in general practice, taking respiratory disease and laboratory procedures as examples. Design and setting Working on behalf of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY. Method Activity using Clinical Terms Version 3 codes and keyword searches from January 2019 to September 2020 are described. Results Activity recorded in general practice declined during the pandemic, but largely recovered by September. There was a large drop in coded activity for laboratory tests, with broad recovery to pre-pandemic levels by September. One exception was the international normalised ratio test, with a smaller reduction (median tests per 1000 patients in 2020: February 8.0; April 6.2; September 6.9). The pattern of recording for respiratory symptoms was less affected, following an expected seasonal pattern and classified as 'no change'. Respiratory infections exhibited a sustained drop, not returning to pre-pandemic levels by September. Asthma reviews experienced a small drop but recovered, whereas chronic obstructive pulmonary disease reviews remained below baseline. Conclusion An open-source software framework was delivered to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September, with some important tests less affected and recording of respiratory disease codes was mixed.

Original languageEnglish
Pages (from-to)E63-E74
JournalBritish Journal of General Practice
Issue number714
Publication statusPublished - 31 Dec 2021
Externally publishedYes

Bibliographical note

Funding Information:
All authors have completed the ICMJE uniform disclosure form at coi_disclosure.pdf and declare the following: Ben Goldacre has received research funding from the Laura and John Arnold Foundation, the NIHR, the NIHR School of Primary Care Research, the NIHR Oxford Biomedical Research Centre, the Mohn Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK (HDRUK), the Health Foundation, and the World Health Organization; he also receives personal income from speaking and writing for lay audiences on the misuse of science. Krishnan Bhaskaran holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society (reference: 107731/Z/15/Z). Helen I McDonald is funded by the NIHR Health Protection Research Unit in Immunisation, a partnership between Public Health England and London School of Hygiene & Tropical Medicine. Angel YS Wong holds a fellowship from the British Heart Foundation. Elizabeth J Williamson holds grants from the Medical Research Council. Rohini Mathur holds a Sir Henry Wellcome Fellowship funded by the Wellcome Trust (reference: 201375/Z/16/Z). Harriet Forbes holds a UKRI fellowship. Ian J Douglas has received unrestricted research grants and holds shares in GlaxoSmithKline. All other authors have declared no competing interests.

Funding Information:
This work was supported by the Medical Research Council (reference: MR/V015737/1). TPP provided technical expertise and infrastructure within their data centre pro bono in the context of a national emergency. The OpenSAFELY software platform is supported by a Wellcome Discretionary Award. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The views expressed are those of the authors and not necessarily those of the National Institute for Health Research (NIHR), NHS England, Public Health England, or the Department of Health and Social Care.

Publisher Copyright:
© The Authors


  • COVID-19
  • Electronic health records
  • General practice
  • Primary health care

ASJC Scopus subject areas

  • Family Practice


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