Changes in English NHS outpatient activity during the early Covid-19 period

ABSTRACT Objective To describe changes in NHS outpatient activity connected to the Covid-19 pandemic Design Nationwide population-based retrospective study Setting England, UK, 31 December 2018 to 25 October 2020 Data source Outpatient Hospital Episode Statistics data Results Between early March and late October 2020, there was a total reduction of 16.6 million outpatient attendances compared to the same period in 2019, equivalent to a 27% decline. The largest weekly drop of 48% relative to 2019 occurred the week beginning 30 March. Activity recovered more slowly than it fell, and by the end of the study period remained 16% lower than the equivalent week in 2019. Changes in patterns of attendances were broadly similar across most patient characteristic groups. There was a substantial increase in the proportion of attendances taking place remotely, peaking at more than one in three during April and May 2020. Differences were observed in trends of remote consultations between age and sex categories, ethnic groups, and proxy deprivation levels. There was also substantial variation in overall activity and use of remote consultations by clinical specialty. Conclusions The large increase in remote outpatient consultations during the early Covid-19 period, variations in remote care use by specialty as well as proxy deprivation and ethnic groups all suggest a need to evaluate the impact of these changes particularly in light of national policy to encourage greater use of remote consultations. SUMMARY BOX What is already known on this topic Numbers of outpatient attendances in England have increased substantially over recent years. Historically, the vast majority of attendances have been face-to-face, with remote consultations accounting for ∼4% of all attendances. The emergence of the Covid-19 pandemic in 2020 had a large impact on outpatient services in English hospitals, and on health services more generally in England and around the world. What this study adds There were significant differences by clinical specialty in changes to patterns of attendances and remote consultations. Changes in the volume of outpatient attendances as a result of responses to the pandemic were broadly similar across patient groups. However, there were marked differences across patient groups in trends in remote consultations.