Diagnoses of common physical and mental health conditions in primary care fell by up to half during the peak of the Covid-19 pandemic, a study has found.
The study examined anonymised electronic health records of roughly 250,000 people in Salford, Greater Manchester, between 1 March and 31 May, to identify the impact of Covid-19 on primary care services and patient health.
It found that the rate of initial diagnoses for mental health conditions fell by 50% during this period – from 2,147 in previous years to 1,073.
Similarly, there were 135 fewer type 2 diabetes diagnoses (a 49% reduction), and 456 fewer diagnoses of circulatory system diseases (43% reduction).
The number of first prescriptions of associated medications for these conditions was also lower than in previous years, the study found.
It also found that malignant cancer diagnoses fell by 16% over the entire period, but for the month of May, there was a 44% drop compared to expected levels.
The report said these findings suggest a large number of patients have undiagnosed conditions, and therefore a ‘rebound in future workload could be imminent’ for general practice, as patients with undiagnosed conditions or delayed diagnosis begin to present again.
Primary and secondary care services ‘should prioritise the diagnosis and treatment of these patients to mitigate potential indirect harms to protect public health,’ the report said.
The researchers concluded that people may have avoided attending healthcare facilities because of concerns about catching Covid-19, or due to a misconception that the NHS was only available for patients with the virus. But they added that diagnostic capacity might also have been reduced, following the NHS’ decision to postpone most elective operations in March.
‘The widespread shift in primary care to remote consultations might have affected how clinicians do consultations, and patients without the ability to participate in video consultations, [such as] those with no access to a smartphone, computer, or the internet might not have received any care,’ the report said.
‘Careful thought needed moving forward’
Nav Kapur, psychiatry professor at the University of Manchester, said: ‘For me the reduction in mental health diagnoses and consultations was particularly striking. Going forward, I think there are two urgent priorities. First, to understand why this has happened and second to monitor and mitigate the consequences of reduced healthcare use.’
Dr Owain Thomas, a Salford GP, said: ‘[This] research is so significant because it quantifies the effect Covid-19 is having on the diagnosis of routine health conditions in general practice. Since the initial lockdown in March, the whole way in which patients consult with their practice has changed – there has been a dramatic shift away from face-to-face consultations to keep everyone safe from the spread of Covid-19.’
He added: ‘However, it is important to recognise the unintended consequences of reducing patient contact with primary care face-to-face services. The conclusions of this research are a vital part in our understanding of the overall impact of Covid-19, the conditions we have looked at are usually many months or years in the making, so the reduction in new diagnoses does not represent a reduction in the burden of these diseases, more the fact that they have not yet been formally recognised.
‘This will have an impact individually on those patients – the longer a patient goes undiagnosed, the more complications they are likely to suffer. As we move forwards careful thought will be needed to plan services to find and support those patients who have not yet been diagnosed.’
