Disparities in the use of remote general practice consultations: learning from the COVID-19 pandemic, an analysis of 19 million electronic health records using OpenSAFELY

Background

Digital technologies are crucial to drive the needed improvement in NHS primary care delivery and access. The impact of these digital interventions on health inequalities remains a critical area of concern and uncertainty. Transition to digital primary care services was rapidly accelerated during the COVID-19 pandemic. We explored what can be learnt from this transition to digital access by examining the patterns of remote general practice consultation before and after the pandemic and the influence of age, gender, social deprivation, and ethnicity on these patterns.

Methods

This is a longitudinal study in primary care settings involving data from19 million men and women aged 18 + years registered with general practices in England between January 2019 and February 2022 using the OpenSAFELY platform. The main outcome was remote consultation (telephone, video, or electronic) of all appointments recorded by GPs. Binomial regression models including marginal effect probabilities were used to analyse the proportion of remote consultations in all appointments. Covariates including age, gender, deprivation, and ethnicity were adjusted for in the models.

Results

Remote consultations increased from 10.1 million per annum (March 2019 to March 2020) to 32.7 million per annum during the pandemic (March 2020 to March 2022). Pre-pandemic, 85 + year olds had the highest probability of remote consultation (0.133, 95% CI [0.132–0.133]). In the pandemic period, the probability of remote consultation increased for all age groups with those aged 18–49 years having the highest probability of remote consultation and those aged 85 + having the second highest probability. Men were less likely to have remote consultations than women pre-pandemic and in the 2 years after the pandemic started. Before the pandemic, the most affluent group (5th deprivation quintiles) had the lowest probability of having consultation being held remotely (0.086, 95% CI [0.086–0.086]), a trend that was maintained through the first 2 years of the pandemic. White ethnic group had the highest probabilities of remote consultations across the study period.

Conclusions

There were significant variations in remote consultations by age, gender, socioeconomic group, and ethnicity during the pandemic. These factors should be considered when planning access to services especially for vulnerable patients.