The impact of occupational risk from COVID on GP supply in England: A cross-sectional study

Objectives

To identify the risk of general practitioner mortality from COVID and the impact of measures to mitigate this risk on the level and socioeconomic distribution of primary care provision in the English NHS

Design

Cross sectional study

Setting

All GP practices providing primary care under the NHS in England

Participants

45,858 GPs and 6,771 GP practices in the English NHS

Main outcome measures

Numbers of high-risk GPs, high-risk single-handed GP practices, patients associated with these high-risk single-handed practices and the regional and socioeconomic distribution of each. Mortality rates from COVID by age, sex and ethnicity were used to attribute risk to GPs and the Index of Multiple Deprivation was used to determine socioeconomic distributions of the outcomes.

Results

Of 45,858 GPs in our sample 3,632 (7.9%) were classified as high risk or very high risk. Of 6,771 GP practices in our sample 639 (9.4%) were identified as single-handed practices and of these 209 (32.7%) were run by a GP at high or very high risk. These 209 single-handed practices care for 710,043 patients. GPs at the highest levels of risk from COVID, and single-handed practices run by high-risk GPs were concentrated in the most deprived neighbourhoods in the country. London had the highest proportion of both GPs and single-handed GP practices at very high risk of COVID mortality with 1,160 patients per 100,000 population registered to these practices.

Conclusions

A significant proportion of GPs working in England, particularly those serving patients in the most deprived neighbourhoods, are at high risk of dying from COVID. Many of these GPs run single-handed practices. These GPs are particularly concentrated in London. There is an opportunity to provide additional support to mitigate COVID risk for GPs, GP practices and their patients. Failure to do so will likely exacerbate existing health inequalities.

What is already known

• Known risk factors for morbidity and mortality from COVID-19 include age, sex, ethnicity and certain underlying health conditions.

• NHS England have suggested that NHS staff who may be at higher risk from COVID are risk assessed and have their activities adjusted accordingly, including ceasing face to face patient contact.

What this study adds

• This study applies risk scoring to calculate the number of GPs practicing in England who are likely to be at high or very high risk of death from COVID. We examine the potential effect of removing GPs at high or very high risk from COVID from face to face patient contacts, estimating the number of GPs and patients likely to be affected, and relating this to deprivation and geography.

• We estimate that of 45,858 GPs in our sample, 2,253 (4.9%) were classified as high risk, and 1,379 (3%) as very high risk from COVID. These are likely to be conservative estimates.

• GPs at high risk of COVID are more likely to work in areas of high socioeconomic deprivation.

• Almost one in three single-handed GP practices (32.7%, or 209 out of 639) is run by a GP we estimate to be at high or very high risk from COVID. If these GPs did not see patients face to face, 710,043 patients would be left without face to face GP appointments. Single-handed GP practices in areas of high socioeconomic deprivation are more likely to be run by GPs at higher risk of COVID.