Background To date, research on the indirect impact of the COVID-19 pandemic on the health of the population and the health-care system is scarce. We aimed to investigate the indirect effect of the COVID-19 pandemic on general practice health-care usage, and the subsequent diagnoses of common physical and mental health conditions in a deprived UK population. Methods We did a retrospective cohort study using routinely collected primary care data that was recorded in the Salford Integrated Record between Jan 1, 2010, and May 31, 2020. We extracted the weekly number of clinical codes entered into patient records overall, and for six high-level categories: symptoms and observations, diagnoses, prescriptions, operations and procedures, laboratory tests, and other diagnostic procedures. Negative binomial regression models were applied to monthly counts of first diagnoses of common conditions (common mental health problems, cardiovascular and cerebrovascular disease, type 2 diabetes, and cancer), and corresponding first prescriptions of medications indicative of these conditions. We used these models to predict the expected numbers of first diagnoses and first prescriptions between March 1 and May 31, 2020, which were then compared with the observed numbers for the same time period. Findings Between March 1 and May 31, 2020, 1073 first diagnoses of common mental health problems were reported compared with 2147 expected cases (95% CI 1821 to 2489) based on preceding years, representing a 50·0% reduction (95% CI 41·1 to 56·9). Compared with expected numbers, 456 fewer diagnoses of circulatory system diseases (43·3% reduction, 95% CI 29·6 to 53·5), and 135 fewer type 2 diabetes diagnoses (49·0% reduction, 23·8 to 63·1) were observed. The number of first prescriptions of associated medications was also lower than expected for the same time period. However, the gap between observed and expected cancer diagnoses (31 fewer; 16·0% reduction, −18·1 to 36·6) during this time period was not statistically significant. Interpretation In this deprived urban population, diagnoses of common conditions decreased substantially between March and May 2020, suggesting a large number of patients have undiagnosed conditions. A rebound in future workload could be imminent as COVID-19 restrictions ease and patients with undiagnosed conditions or delayed diagnosis present to primary and secondary health-care services. Such services should prioritise the diagnosis and treatment of these patients to mitigate potential indirect harms to protect public health. Funding National Institute of Health Research.

Neck of femur (NOF) fracture patients have significant 30-day mortality. The incidence of NOF fractures remained high during the coronavirus disease 2019 (COVID-19) pandemic in the United Kingdom. Consequently, numerous cases were complicated with concurrent severe acute respiratory syndrome coronavirus 2 infection. We performed a systematic review and meta-analysis of all studies from the United Kingdom related to NOF fractures and 30-day mortality outcomes during the pandemic.A systematic review and meta-analysis was performed and reported as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two reviewers independently searched on Medline for studies that were published between the 1st of March 2020 and the 1st of November 2020 in the United Kingdom. The following outcomes were compared: 30-day mortality, time to surgery, and anaesthetic risk.A total of five articles were included in this review. In total, 286 patients with NOF fractures and COVID-19 infection were identified, with 30-day mortality ranging from 30.5% to 50% (odds ratio = 6.02; 95% confidence interval = 4.10-8.85; χ 2 = 4.82; I 2 = 58%). Increased time to surgery due to COVID-19-related delays was also noted for the majority of patients in some studies. Mortality scores (Charlson Comorbidity Index, Nottingham Hip Fracture Score) failed to accurately predict the mortality risk.Concurrent infection of COVID-19 in patients with NOF fractures increases the 30-day mortality sixfold compared to the COVID-19-negative group. Efforts should be made to optimise time to surgery as well as consideration of postoperative care in higher dependency units. Future updates in mortality predicting scores should include COVID-19 infection as a significant factor.

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Following caesarean section (CS), women are now routinely discharged earlier (often on the day after surgery) with simple analgesia only, in line with current PROSPECT guidance to minimise opioid use. 1 We aimed to review patients presenting to their GP for stronger analgesia soon after discharge and establish associations that may predict additional analgesic requirements.Methods: All CS at our hospital in 2019 were included. Retrospective review of community pharmacy electronic records identified those who received a new GP prescription within 2 weeks of discharge for: opioids, lidocaine and gabapentinoids. Discharge prescriptions were reviewed alongside patient characteristics. These data were then compared with the remainder of CS in 2019. Logistic regression was used to examine any associations with community analgesia prescriptions.Results: In 2019, 1081 CS were performed and 77 (7.1%) women received a GP prescription within 2 weeks for additional strong analgesia: weak opioids 69 (90.7%), strong opioids 3 (3.6%) gabapentinoids 3 (3.6%) and lidocaine patch 2 (2.3%). Sixteen (21%) women were not prescribed a NSAID on discharge and 34 (44.2%) had a postoperative complication diagnosed: infection 21 (27.3%), psychiatric 10 (13%), others 3 (3.9%). Patient characteristics found to have no association with additional analgesia included: pre-op haemoglobin, number of previous CS, type of anaesthesia, grade of surgeon, urgency of CS and blood loss. Data for women with increased likelihood of requiring additional analgesia are presented in the Table . Discussion: From these data we found that a small proportion of women receive additional analgesia following discharge and simple analgesia appears to be adequate for the majority. However, inability to take NSAIDs may be an indication to consider the use of weak opioids on discharge. The correlation of raised BMI and smoking with increased analgesic requirements may be explained by the associated increased risk of wound infection causing pain. Using this methodology on a multicentre population in the future may more clearly elucidate associations to guide discharge prescribing.