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Project #47:
OpenSAFELY NHS Service Restoration Observatory 1: describing trends and variation in primary care clinical activity for 23.3 million patients in England during the first wave of COVID-19


The COVID-19 pandemic has disrupted healthcare activity. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible.

We aimed to describe the volume and variation of coded clinical activity in general practice across the whole population in OpenSAFELY-TPP between January 2019-September 2020, taking respiratory disease and laboratory procedures as examples.

We found that activity recorded in general practice declined during the pandemic, but largely recovered by September 2020. There was a large drop in coded activity for laboratory tests, with broad recovery to pre-pandemic levels by September. One exception was International Normalised Ratio test, with a smaller reduction. The pattern of recording for respiratory symptoms was less affected, following an expected seasonal pattern and classified as “no change”. Respiratory infections exhibited a sustained drop not returning to pre-pandemic levels by September. Asthma reviews experienced a small drop but recovered, while COPD reviews remained below baseline.

In conclusion: We delivered an open source software framework to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVID-19 pandemic led to a substantial change in healthcare activity.


  • Study leads: Helen Curtis
  • Organisation: University of Oxford and London School of Hygiene and Tropical Medicine