Impact and inequalities of winter pressures in primary care: providing the evidence base for mitigation strategies

Background In England, primary care provision is unequally distributed by socioeconomic status and ethnicity, as is prevalence of chronic disease, uptake of vaccination, and impact of infectious disease epidemics. These inequalities likely synergise resulting in unequal impacts on healthcare and patient health during epidemics of common winter-seasonal respiratory viruses. This project will generate a comprehensive examination of winter pressures in primary care in England, their consequences, predictability and potential mitigations, to help address underlying health inequalities arising from winter pressures. Research Questions 1. What causes winter pressure in primary care and how do we measure onset, duration and intensity of pressure? 2. What are the consequences of primary care winter pressures for severe health events? 3. Can we predict which practices are vulnerable to winter pressures? 4. How can vaccination be used equitably to mitigate winter pressures? Objectives 1. Identify how winter pressures are experienced in primary care and by patients, whether by changes in care received, diagnoses, or appointments. Develop ways to identify when a practice starts to experience pressure, and determine if those are the same for all practices, and if pressures affect people and practices equally by socioeconomic status and ethnicity. 2. Establish if pressure in primary care has downstream impacts on secondary care use, patient health, mortality, and if those effects are distributed equally. 3. Determine what factors predict when and how much pressure a practice is under to help identify routes to relieve that pressure. 4. Develop evidence-based strategies for using vaccines against major winter viruses that contribute to winter pressures, to prevent pressure in general practice and increase health equality. Each objective will be addressed by a workpackage (WP). Methods WP 1: We will conduct a comprehensive analysis of winter pressures, including the patient, practice and disease factors that generate them, and use a range of practice-level metrics to identify when practices begin to experience excess pressures and how intense they are. WP 2: We will use advanced statistical methods to estimate the secondary care use, severe outcomes and mortality resulting from pressures in primary care, to establish if pressure in primary care has downstream consequences on these factors and on inequalities. WP 3: We will develop state-of-the-art prediction models for winter pressures at a practice, and test those models during the study period to identify the factors associated with when and how much pressure a practice is under. WP 4: We will use innovative transmission modelling and cost-effectiveness analysis of potential vaccination strategies that could mitigate respiratory epidemics to generate evidence-based strategies to prevent pressure in general practice and increase health equality. Impact and dissemination Taken together, this project will provide a detailed and comprehensive examination of winter pressures in primary care: identifying pressures, detecting the consequences, predicting onset and intensity, and developing strategies to mitigate. Our findings will be shared with decisionmakers in the UK to help provide cost-effective patient care.