Nearly all COVID-19 infections linked to general practices in South West England during the pandemic occurred in staff rather than patients, according to research by the University of Bristol and UK Health Security Agency (UKHSA). Outbreaks were often driven by practical challenges in implementing infection prevention and control (IPC) guidance.
The study, funded by the Elizabeth Blackwell Institute for Health Research at the University of Bristol and the Wellcome Trust, analysed all COVID‑19 incidents reported to UKHSA in South West England between March 2020 and April 2022 that were linked to general practice settings.
Despite widespread changes to service delivery during the pandemic, including fewer face‑to‑face appointments, 609 incidents linked to English general practice were reported nationally. The study analysed the 62 incidents in South West England in detail. These included 42 outbreaks, 10 clusters and 10 single‑case exposures.
Staff most affected, patients largely protected
Across all outbreaks studied, 95% of the 210 confirmed COVID‑19 cases were among general practice staff, with just one patient case identified. The researchers suggest this reflects the success of measures to protect patients, such as shorter visits and separation of those with COVID-19 from others during in‑person consultations. However, it also highlights greater vulnerability among staff, particularly during interactions with colleagues.
In over 70% of outbreaks, at least one IPC breach was identified. The most common issues included:
- breakdowns in social distancing between staff
- inconsistent or inappropriate use of personal protective equipment (PPE)
- staff working across multiple sites
- staff attending work while symptomatic or after known exposure.
IPC measures were sometimes more rigorously applied during staff–patient contact than during staff‑to‑staff interactions, possibly due to perceptions that colleagues posed less risk.
Guidance often impractical in GP settings
Crucially however, IPC breaches were often not due to disregard for guidance, but because guidance was difficult to implement in real‑world GP environments. The study identified challenges such as:
- small or shared premises that limited social distancing
- poor ventilation
- shared facilities with other organisations
- insufficient IT equipment to enable appropriate off-site working.
The authors also note that primary care‑specific IPC guidance was limited, and that the global lack of recognition of the importance of airborne transmission early in the pandemic may have contributed to outbreaks.
Significant impact on services
Although no deaths and only two hospitalisations were reported in the incidents studied, the impact on service delivery was substantial. Staff illness and isolation requirements led to temporary practice closures or reduced services at 13 GP sites, sometimes lasting up to two weeks.
Smaller practices were especially affected, and even one case could leave them unable to operate safely.
Dr Lorna Duncan from the Centre for Academic Primary Care, University of Bristol, lead author, said: “General practice responded rapidly to protect patients during the pandemic, and this study shows that those measures were largely effective. However, our findings also demonstrate how vulnerable GP teams were to staff‑to‑staff transmission, particularly where guidance was difficult to apply in constrained buildings and busy working environments. Future pandemic planning must better reflect the realities of primary care if we are to protect staff and maintain essential services.”
Lessons for future pandemic planning
The study concludes that primary care faced distinct and under‑recognised challenges during the COVID‑19 pandemic, similar to those seen in community healthcare globally.
The authors call for stronger inclusion of primary care in pandemic planning, with recommendations including:
- upgrading GP buildings to improve ventilation and workspace configurations
- investing in IT infrastructure to support remote working
- developing contingency plans for staff shortages and site closures
- providing tailored IPC guidance and training for different GP staff roles.
They argue that addressing these issues is essential to protect staff wellbeing and maintain access to essential primary care services during future public health emergencies.
Dr Jonathan Roberts, Consultant in Health Protection in the South West Health Protection Team, UKHSA and co-author of the paper, said: “It was vital to keep primary care services accessible during the pandemic response, yet its specific risks were often overlooked. This study helps explain why GP teams experienced staff cases and outbreaks, and why future planning must recognise the unique pressures of these settings.”
Paper: Identification of challenges to implementation of infection control guidance in primary care during COVID-19 incidents: Lessons for pandemic planning. Lorna J Duncan, Jade Meadows and Jonathan Roberts. Published in Public Health.