Cancer in the time of COVID: Qualitative study of primary care practice and cancer suspicion during the first three UK lockdowns of the COVID-19 pandemic
Friedemann Smith C., Nicholson BD., Hirst Y., Fleming S., Bankhead C.
Background. The COVID-19 pandemic has profoundly affected UK primary care, and as a result the route to cancer diagnosis for many patients. Aim. To explore how the pandemic affected primary care practice, in particular cancer suspicion, referral, and diagnosis, and how this experience evolved as the pandemic progressed. Design and Setting. Seventeen qualitative interviews carried out remotely with primary care staff. Methods. Staff from practices that expressed an interest in trialling an electronic safety-netting tool were invited to participate. Remote, semi-structured interviews were conducted September 2020 to March 2021. Data analysis followed a thematic analysis and mind-mapping approach. Results. The first lockdown was described as providing time to make adjustments to allow remote and minimal contact consultations but caused concerns over undetected cancers. These concerns were realised Summer and Autumn 2020 as our participants began to see higher rates of late stage cancer presentation. During the second and third lockdowns patients seemed more willing to consult. This combined with usual winter pressures, demands of the vaccine programme, and surging levels of COVID-19 meant that the third lockdown was the most difficult. New ways of working were seen as positive when they streamlined services but also unsafe if they prevented GPs from accessing all relevant information and resulted in delayed cancer diagnoses. Conclusion. The post-pandemic recovery of cancer care is dependent on the recovery of primary care. The COVID-19 pandemic has highlighted and exacerbated vulnerabilities in primary care but has also provided new ways of working that may help the recovery.