Clare Gerada: We must not rush back to business as usualBMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2860 (Published 21 July 2020) Cite this as: BMJ 2020;370:m2860
All rapid responses
Amongst a plethora of articles on covid-19 in the BMJ of 25 July 2020 we hear that there is a need for targeted use of information to assess the impact of the pandemic, and assist the overstretched GP (Gerada C. BMJ 2020;370:m2860).
Accurate information is needed to guide primary care which has mounting challenges to provide a response to increasing clinical and organisational demands. While there is big data from many sources, (NHS https://www.england.nhs.uk/contact-us/privacy-notice/how-we-use-your-inf...) there is not only insufficient research from primary care, but a glaring lack of structured quality improvement programmes for covid-19 in primary care.
Existing databases have the potential to provide reports on covid-19 from national to regional to practices to groups of patients to individuals. The Optimum Patient Care (OPC) social enterprise company provides quality improvement programmes for chronic disease for over 700 practices in UK using anonymised routinely collected clinical data which is securely gathered and stored in the OPC research database, currently containing nine million patient records. In a new academic initiative, partnering with several Universities, a national covid-19 quality improvement programme and research database is being launched.
The quality improvement programme starts with improving data quality. Patients are asked to complete a questionnaire on their current health, covid-19 symptoms, tests and outcomes which will update the records. Patients will also be pre-consented to be approached for future research.
The database will be used to answer a range of epidemiological and therapeutic and shielding research questions utilising current routine data combined from questionnaires and the primary care records. Projects are in the pipeline to identify the at-risk groups and how they compare to existing NHS guidance on shielding; to determine whether existing therapies protect from or augment the damage from covid-19. We would welcome researchers to contribute, collaborate to or run prospective and retrospective projects on the database.
Big challenges require simple, smart solutions; this is an opportunity to conduct collaborative, rapid, responsive research into the pandemic while supporting clinicians in primary care.
Rupert Jones, Steven Julious, Dermot Ryan, Francis Appiageyi, David Price
Competing interests: Dr Rupert Jones declares grants from AstraZeneca, GSK, and Novartis; and personal fees for consultancy, speakers fees, or travel support from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Nutricia, Optimum Patient Care, OPRI, and Pfizer. Prof Steven Julious declares no conflict of interest. Dr Dermot Ryan reports personal fees for advisory board work from GSK and Trudell Medical; for advisory board work and lectures from AZ; for lectures from Mylan and Chiesi, and for consultancy from Optimum Patient Care. Dr Francis Appiageyi is an employee of Optimum Patient Care Prof David Price has board membership with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Teva Pharmaceuticals, Thermofisher; consultancy agreements with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mylan, Mundipharma, Novartis, Pfizer, Teva Pharmaceuticals, Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mylan, Mundipharma, Novartis, Pfizer, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Teva Pharmaceuticals, Theravance, UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Teva Pharmaceuticals; payment for the development of educational materials from Mundipharma, Novartis; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, Novartis, Thermofisher; funding for patient enrolment or completion of research from Novartis; stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); and is peer reviewer for grant committees of the Efficacy and Mechanism Evaluation programme, and Health Technology Assessment.
Re: Clare Gerada: We must not rush back to business as usual; are some BAME doctors being treated 'less favourably' during this pandemic?
If “many locum GPs have lost their livelihood”, then I am not sure, Gerada’s argument that we “must not rush the process of getting back to business”  would withstand logical scrutiny given those GPs surely want to restore their livelihood as soon as possible. Perhaps, Gerada was excluding locum GPs when she was proposing a “must not rush” approach.
I think, it is reasonable to infer the group classified as “IMGs” are actually doctors from BAME backgrounds, thus not surprising at all that referrals have gone up to “25%” from the pre-pandemic “13%”. There could be a number of reasons for such substantial increase in referrals; it is possible that some BAME doctors are being treated less favourably than others during this pandemic causing a higher level of personal stress than in pre-pandemic times.
In fact, an allegation of differential treatment during the threatened swine flu pandemic in 2009 by a Black doctor reached the Court of Appeal in 2015. So it should not be surprising if similar issues have already arisen during this actual pandemic causing undue stress and consequent ill-health leading to a substantial rise in referrals of BAME doctors to NHS Practitioner Health.
 BMJ 2020;370:m2860
Competing interests: No competing interests