Intended for healthcare professionals


Pandemic threatens primary care for long term conditions

BMJ 2020; 371 doi: (Published 05 October 2020) Cite this as: BMJ 2020;371:m3793

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  1. Louis S Levene, honorary lecturer1,
  2. Samuel Seidu, primary care research fellow in diabetes1,
  3. Trish Greenhalgh, professor of primary care health sciences2,
  4. Kamlesh Khunti, professor of primary care diabetes and vascular medicine1
  1. 1Diabetes Research Centre, University of Leicester, Leicester, UK
  2. 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to: K Khunti kk22{at}

Change is required to ensure effective care during and after covid-19

During the height of the covid-19 pandemic, attention was diverted away from primary care’s key roles in early detection of disease and management of long term conditions. However, the core primary healthcare functions of accessible first contact, comprehensiveness, coordination, continuity, and person centredness were challenged even before this.1 General practices’ workloads have steadily risen in the past decade. In England between 2010-11 and 2019, the overall number of consultations per registered patient each year rose from 4.29 to 5.1723 in a growing population.

Comparing April to August 2020 with the same period in 2019, the total number of general practice appointments in England fell by 20.8%, from 120.66 million to 95.52 million.4 Although these statistics should be treated cautiously, they suggest that substantially fewer planned care appointments took place in 2020. The resulting backlog, combined with the prioritisation of covid-19 in secondary care, has led to further shortfalls in the care of non-covid illness.

Between 27 March and 5 June 2020, most excess mortality was associated with covid-19.5 However, delays in diagnosis and suboptimal management of …

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