Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study

Abstract

Objective When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change. Design Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September–December 2020, the second round from January–April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2–4 months apart. To analyze the data, we used thematic analysis. Results The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. Conclusions Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response. Key Points Facing the COVID-19 pandemic, the primary health care service in Norway had to reorganize to ensure safe patient treatment and maintain infection control. Several GPs experienced challenges in collaboration with the municipalities. There is a need for clarification of responsibilities between GPs and the municipality.

How general practitioners used job crafting strategies during the COVID-19 pandemic in Sweden

“…GPs shaped their task boundaries [ 17 ], and the room for manoeuvre they had meant that they performed work tasks they normally did not do. Consistent with previous studies carried out during the COVID-19 pandemic [ 7 , 11 ], GPs proved their ability to improvise and use creative strategies. GPs in our study felt that they managed problems as they arose and tried to fight the pandemic to the best of their ability.…”

“…In our study, GPs describe how they took charge of how care would be organised and implemented. Consistent with previous research [ 11 ], some GPs stated that during the COVID-19 pandemic they became the ‘new leaders’ within the healthcare organisation. Cognitive crafting can involve viewing work tasks as an important part of a larger whole, which also influences how employees approach their jobs [ 17 ].…”

“…At the beginning of the pandemic some GPs stated that there was a lack of specific guidelines for how COVID-19 should be managed within primary healthcare [ 10 ], while others struggled with changing, confusing and sometimes also conflicting recommendations from different authorities [ 4 , 7 ]. During the pandemic, GPs proved their ability to improvise and apply creative strategies [ 7 , 11 ], and this helped them to provide safe care to patients.…”

Differences between Rural and Urban Practices in the Response to the COVID-19 Pandemic: Outcomes from the PRICOV-19 Study in 38 Countries

“…General practitioners (GPs) played a crucial role in the fight against the COVID-19 pandemic. However, they have experienced many barriers to fulfilling this role and many domains of quality of care have been affected [ 4 , 5 , 6 ]. For example, a scoping review revealed that healthcare access and utilization for both COVID and non-COVID-19 services decreased almost universally, across both higher- and lower-income countries [ 7 , 8 ].…”

Symptoms, symptom severity, and contact with primary health care among nonhospitalized COVID-19 patients: a Norwegian web-based survey

“…In Norway, 95% of patients with RTIs are normally handled in general practice, comprising about 15% of all consultations [ 6 ]. After the lockdown in March 2020, follow-up of patients with COVID-19 outside hospitals was organized by the municipalities and varied between them, with nurse- and/or general practitioner-lead (GP) follow-up being the most common [ 7 , 8 ]. Routines for additional follow-up after the initial management varied but were often based on telephone calls or video consultations by the GP or dedicated primary health care personnel, regularly for a given time period, or until clinical recovery.…”