Background The COVID-19 lockdowns in the UK impacted the way healthcare was accessed and delivered. This includes primary care where the shift to digital consultations was accelerated in addition to restrictions on in-person attendance. This is known to have impacted patients in different ways depending on their health condition. However, the immediate and long-term impacts on primary care access among groups considered vulnerable is unknown, despite the potential for the lockdowns to exacerbate existing barriers to healthcare access. We aimed to evaluate the impact of national COVID-19 related lockdowns on rates of primary care contact among vulnerable populations in England.

Methods With the approval of NHS England, we used a controlled interrupted time series approach applied to routinely collected primary care data to analyse lockdown-related changes in primary care access for people with issues of substance misuse or dependence, those who had experienced domestic violence or abuse, people with intellectual disability and children with safeguarding concerns. For each vulnerable population, the rest of the population was treated as a comparison group. We used data on 24 million registered patients from a sample of 40% of general practices (GP) in England between September 2019 and September 2021. We treated the first lockdown period as an exposure of interest, then separately looked at the combined second and third lockdown period. We analysed the weekly rate of GP contacts.

Results The overall rate of GP contact dropped by about 30% at the outset of the first UK lockdown and gradually returned to pre-pandemic levels over a six-month period after the end of the strictest lockdown period. In contrast, for vulnerable population the lockdown-related decreases in contact ranged from 7% to 25%. Vulnerable populations with higher pre-pandemic GP contact rates were the least affected by the lockdowns, particularly those with opioid dependence or drug misuse issues. There was no consistent evidence that the second and third lockdowns affected GP contact rates.

Conclusion Groups with high pre-pandemic GP contact rates were less impacted by the COVID-19 lockdowns. Existing support systems for vulnerable populations likely mitigated the impact of lockdowns on GP access. The study highlights the importance of ongoing support systems for lessening the adverse effect of disruptions such as lockdowns, but also the need for continued service provision.