Background The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) is one of Europe’s oldest sentinel systems, working with the UK Health Security Agency (UKHSA) and its predecessor bodies for 55 years. Its surveillance report now runs twice weekly, supplemented by online observatories. In addition to conducting sentinel surveillance from a nationally representative group of practices, the RSC is now also providing data for syndromic surveillance. Objective The aim of this study was to describe the cohort profile at the start of the 2021-2022 surveillance season and recent changes to our surveillance practice. Methods The RSC’s pseudonymized primary care data, linked to hospital and other data, are held in the Oxford-RCGP Clinical Informatics Digital Hub, a Trusted Research Environment. We describe the RSC’s cohort profile as of September 2021, divided into a Primary Care Sentinel Cohort (PCSC)—collecting virological and serological specimens—and a larger group of syndromic surveillance general practices (SSGPs). We report changes to our sampling strategy that brings the RSC into alignment with European Centre for Disease Control guidance and then compare our cohort’s sociodemographic characteristics with Office for National Statistics data. We further describe influenza and COVID-19 vaccine coverage for the 2020-2021 season (week 40 of 2020 to week 39 of 2021), with the latter differentiated by vaccine brand. Finally, we report COVID-19–related outcomes in terms of hospitalization, intensive care unit (ICU) admission, and death. Results As a response to COVID-19, the RSC grew from just over 500 PCSC practices in 2019 to 1879 practices in 2021 (PCSC, n=938; SSGP, n=1203). This represents 28.6% of English general practices and 30.59% (17,299,780/56,550,136) of the population. In the reporting period, the PCSC collected >8000 virology and >23,000 serology samples. The RSC population was broadly representative of the national population in terms of age, gender, ethnicity, National Health Service Region, socioeconomic status, obesity, and smoking habit. The RSC captured vaccine coverage data for influenza (n=5.4 million) and COVID-19, reporting dose one (n=11.9 million), two (n=11 million), and three (n=0.4 million) for the latter as well as brand-specific uptake data (AstraZeneca vaccine, n=11.6 million; Pfizer, n=10.8 million; and Moderna, n=0.7 million). The median (IQR) number of COVID-19 hospitalizations and ICU admissions was 1181 (559-1559) and 115 (50-174) per week, respectively. Conclusions The RSC is broadly representative of the national population; its PCSC is geographically representative and its SSGPs are newly supporting UKHSA syndromic surveillance efforts. The network captures vaccine coverage and has expanded from reporting primary care attendances to providing data on onward hospital outcomes and deaths. The challenge remains to increase virological and serological sampling to monitor the effectiveness and waning of all vaccines available in a timely manner.

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Objective: While the COVID-19 pandemic provided a global stimulus for digital health capacity, its development has often been inequitable, short-term in planning, and lacking in health system coherence. Inclusive digital health and the development of resilient health systems are broad outcomes that require a systematic approach to achieving them. This paper from the IMIA Primary Care Informatics Working Group (WG) provides necessary first steps for the design of a digital primary care system that can support system equity and resilience. Methods: We report on digital capability and growth in maturity in four key areas: (1) Vaccination/Prevention, (2) Disease management, (3) Surveillance, and (4) Pandemic preparedness for Australia, Canada, and the United Kingdom (data from England). Our comparison looks at seasonal influenza management prior to COVID-19 (2019-20) compared to COVID-19 (winter 2020 onwards). Results: All three countries showed growth in digital maturity from the 2019-20 management of influenza to the 2020-21 year and the management of the COVID-19 pandemic. However, the degree of progress was sporadic and uneven and has led to issues of system inequity across populations. Conclusion: The opportunity to use the lessons learned from COVID-19 should not be wasted. A digital health infrastructure is not enough on its own to drive health system transformation and to achieve desired outcomes such as system equity and resilience. We must define specific measures to track the growth of digital maturity, including standardized and fit-for-context data that is shared accurately across the health and socioeconomic sectors.

BACKGROUND The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) is one of Europe’s oldest sentinel systems, working with the UK Health Security Agency (UKHSA) and its predecessor bodies for 55 years. Its surveillance report now runs twice weekly, supplemented by online observatories. In addition to conducting sentinel surveillance from a nationally representative group of practices, the RSC is now also providing data for syndromic surveillance. OBJECTIVE Describe the cohort profile at the start of the 2021-2022 surveillance season and changes to our surveillance practice. METHODS The RSC’s pseudonymised primary care data, linked to hospital and other data, are held in the Oxford-RCGP Clinical Informatics Digital Hub (ORCHID), a trusted research environment (TRE). We describe the RSC’s cohort profile as of September 2021, divided into a primary care sentinel cohort (PCSC) - collecting virological and serological specimens - and a larger group of syndromic surveillance general practices (SSGP). We report changes to our sampling strategy that brings the RSC into alignment with European Centre for Disease Control (ECDC) guidance and then compare our cohort sociodemographic characteristics with Office for National Statistics (ONS) data. We describe influenza and COVID-19 vaccine coverage for the 2020-21 season (week 40, 2020 to week 39 2021), the latter differentiated by vaccine brand. Finally, we report COVID-19 related outcomes in terms of hospitalisation, intensive care unit (ICU) admission, and death. RESULTS As a response to COVID-19, RSC grew from just over 500 PCSC practices in 2019 to 1,879 practices (PCSC=938, SSGP=1,203). This represents 28.6% of English general practices and 31% of the population (N=17,560,196). In the reporting period, the PCSC collected >8,000 virology and >23,000 samples. The RSC population was found to be broadly representative of the national population in terms of age, gender, ethnicity, NHS Region, socioeconomic status, obesity and smoking habit. The RSC captured vaccine coverage data for influenza (n=5.4m), and COVID-19; reporting dose one, (n=11.9m), two (n=11m) and three (n=0.4m) for the latter as well as brand-specific uptake data (AstraZeneca vaccine [n=11.6m], Pfizer [n=10.8m] and Moderna [N=0.7m]). The median (and interquartile ranges) for COVID Hospitalisation and ICU admissions for COVID, were 1181/week (559-1559/week) and 115/week (50-174/week) respectively. CONCLUSIONS The RSC is broadly representative of the national population, its PCSC is geographically representative. Its SSGPs are newly supporting UKHSA syndromic surveillance efforts. The network captures vaccine coverage and has expanded from reporting primary care attendances to hospital outcomes and death. The challenge remains to increase virological and serological sampling to monitor the effectiveness, and waning of the increasing range of vaccines available in a timely manner.

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