GPs diagnosed significantly fewer common physical and mental health conditions during the three-month lockdown in 2020, according to analysis published today.
Analysis of about 250,000 electronic health records between 1 March and 31 May 2020 by researchers at the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC) found the biggest reductions were for mental health conditions and Type 2 diabetes, with half the expected number of diagnoses.
Writing in today’s (24 September 2020) edition of The Lancet Public Health, the researchers reveal that there was a 16% drop in diagnoses for malignant cancer in the three-month period, but a 44% drop in May alone. There was a 43% drop in diagnoses for circulatory system diseases such as stroke, heart failure and coronary heart disease.
The study used 10 years’ worth of data for Salford to create statistical models that gave predicted levels of new diagnoses for the routine health conditions that are identified by GPs.
Lead researcher Richard Williams, of the GM PSTRC, is to present the findings to internationally renowned experts in a special Lancet journals session at the European Society of Clinical Microbiology and Infectious Diseases Conference on Coronavirus disease (ECCVID), taking place online 23-25 September.
“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,” he said. “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.”
Dr Owain Thomas, GP at a practice in Salford, said: “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.”
Professor Nav Kapur, Professor of Psychiatry at The University of Manchester and lead for the mental health work at the PSTRC, said the findings brought into focus two main issues: why this has happened and how the situation can be monitored to mitigate the consequences of reduced healthcare use.
The Royal College of GPs blamed the reduction in diagnoses in a slump in demand for routine consultations during the period of lockdown. Chair Professor Martin Marshall said: “The fall in consultations is likely due to a number of factors, including patients having concerns about accessing GP services due to fear of contracting the virus or overburdening NHS services – and a desire to follow official messaging to stay at home to help stop the spread of COVID-19. Many specialist services were also restricted, so GPs might not have always been able to make referrals except in urgent cases.
“General practice has been open throughout the pandemic – and as a College we’ve worked to get the message out that stay at home guidance does not include when seeking medical care. Demand for routine GP consultations has increased since the end of May and are now at near-normal levels for this time of year. During a pandemic, other health conditions do not cease to exist, and we’ve seen from health crises in the past that there are sometimes more deaths from conditions unrelated to the pandemic than the virus causing the pandemic itself. As GPs and our teams approach a likely second wave of COVID-19, we do not want to see this happen and we urge patients who have concerns about their health to seek medical assistance, particularly if they have signs that could indicate serious conditions, such as cancer.”