Primary care is the crucial but severely overlooked answer to managing public health during this pandemic and beyond.
Writer: Lia Bote
Editor: Maddie Wigmore-Sykes
Artist: Sophie Maho Chan
The fragility of our healthcare system is one of the many long-standing issues highlighted by the pandemic. At the time of writing, there have been over one million COVID-19 deaths around the world, and much of the virus’ pathogenicity is still yet to be understood. Recently, it has been shown that pre-existing conditions can double or triple the risk of fatality, with 94% of COVID-19 deaths in the US occurring in patients with other comorbidities. How, then, can we accurately identify and minimise the risk from these pre-existing conditions? The answer lies in primary care.
Primary care acts as a patient’s first point of contact with the health system. It encompasses early diagnosis, direct management of both acute and chronic conditions, disease prevention, and health education. Primary care physicians (PCPs) can also refer their patients to secondary or tertiary care for specialist management.
As such, primary care is vital in ensuring that patients can sustainably manage both their physical and mental health, and remain knowledgeable about how best to do this. Unfortunately, it is also often overlooked. In a study led by Professor Stephen Morris from the Department of Public Health and Primary Care at the University of Cambridge, it was found that areas in England with a greater density of general practitioners (GPs) had significantly better quality of healthcare. Despite this, general practice is still severely underfunded, with GPs providing 90% of patient contact but only receiving 10% of the NHS budget.
The need for comprehensive primary care has become even more important during the pandemic. The World Health Organization stresses the role of primary care in early diagnosis of both COVID-19 and pre-existing conditions that contribute to increased risk. PCPs can also help with differentiating COVID-19 from other respiratory symptoms to reduce hospitalisation burden, and with making sure that people are informed about the virus and proper hygiene measures.
However, COVID-19 policy measures both in the UK and globally place a higher focus on secondary care for patients with more severe symptoms. GP consultations have been reduced by about 30%, and diagnostic tests usually administered by PCPs also fell by over 80% during the first wave of infection in the UK. This may relate to a range of factors: GPs being advised to delay routine referrals so hospitals have more capacity for severe COVID-19 cases, patients being worried about visiting GP clinics, or the availability of alternatives, such as telephone consultations, which may be helpful but not always sufficient.
As a result, the severe consequences of the chronic neglect of primary care are especially evident during the pandemic. The comorbidities that contribute to high fatalities can go undetected and untreated, and many COVID-19 patients do not even visit their doctors, resulting in 30% of COVID-19 fatalities in the UK occurring outside of hospitals. Worryingly, these consequences may not just be felt in the present; the poor control of chronic conditions, the rise in mental illness, and the health impacts of widening socioeconomic disparities are only a few of the pandemic’s many long-term consequences.
Rebuilding our primary care system to be more robust in the long term involves intervention at every level. Public policy must align with and recognise the importance of primary care in protecting society, for example with mass vaccination programmes and established supply chains for hospital protective equipment. With successes like the eradication of wild poliovirus in Africa just this year, the value of such measures cannot be ignored. Integration at the community level has been a successful practice in many countries, with community health providers working hand-in-hand with GPs in diagnostics and health promotion. Prevention must also be prioritised: GPs work closely with their patients to assess risk factors in relation to long-term outcomes, the importance of which is clearly underscored by COVID-19. Ultimately, strengthening our primary care system is essential not only in curbing this pandemic, but also in helping to ensure that we are equipped for whatever comes next.