Chart of the week: Patients' use of urgent care has changed over the pandemic – but long-term impact unclear

Each week we present analysis of data in chart form to illustrate some key issues and invite discussion. This week, as a whole-country lockdown takes hold, Sarah Scobie takes a look at patients' use of urgent care services to ask how regular patterns of use have held up since Covid-19 arrived – and what we might expect for the future.

Chart of the week

Published: 06/11/2020

The first wave of the Covid-19 pandemic saw significant changes in health services.  NHS hospitals grappled to refocus services to support Covid-19 patients, and patients adapted to new services including the 111 online symptom checker, and phone-first services from their GP practice.

However, trends in urgent care activity from the previous March up to September 2020 show that the change in use of urgent care is in some ways less dramatic than early headlines indicated, but also potentially more significant in terms of long-term shifts in use of health care. 

GP practice appointments are the first point of contact for patients requiring same-day treatment, and this remained the case throughout the pandemic. Numbers of appointments dipped in April and May 2020, but jumped back in June.  The dip in August 2020 mirrors previous years, when both patients and GP practice staff take holidays.

In the first wave of Covid-19 cases, patients were encouraged to contact 111 in the first instance, resulting in a 70% increase in calls between February and March 2020.  111 calls increased between July and September, but we did not see the dramatic rise which occurred in March. 

A&E attendances plummeted in April.  Numbers recovered during the summer, but have not returned to previous levels.  It’s not clear whether this represents a long-term shift in how patients seek treatment, or whether patients are steering clear of hospitals due to concern about Covid-19.

The volume of ambulance service incidents increased in some areas in the first wave, with notable increases in London.  But overall numbers of incidents have remained relatively stable.  This might reflect constrained capacity for this service.

While levels of same-day contact with services remained remarkably stable over the pandemic, particularly in primary care, we also know that some people found care difficult to access.

As we go into a second wave of Covid-19 this winter, the usual measures of winter pressures, such as waiting times in A&E, aren’t going to tell the whole story. Changes in the organisation of services such as asking patients to book A&E appointments via NHS 111, and shifts in patients’ habits in seeking care as a result of worries about Covid-19, could result in long-term moves away from face-to-face services, particularly those provided in hospital.