This was the first large-scale study to explore whether there has been a change in overall physical and mental health, and in non-COVID-related access to primary care, during the pandemic. It flags up an urgent need for policymakers and healthcare providers to prepare to deal with high levels of unmet need.


The UK response to the pandemic necessarily involved dramatic changes in all areas of society and a refocusing of finite healthcare resources. This inevitably affected non-COVID related health and healthcare. However, lack of data on the scale of the problem, or about which areas of health and care were affected, have stood in the way of effective mitigation.


This open access paper, made possible by support from HDR UK and published in Lancet Digital Health in February, 2021, began quantifying the problem. It used anonymised health records, covering around 10 million patients, mainly from England, to calculate the weekly number of primary care contacts for a wide range of acute physical and mental health conditions between 2017-2020.

The researchers, led by Dr Kathryn Mansfield, an assistant professor in the London School of Hygiene Department of Non-communicable Disease Epidemiology, have provided insights across a wide number of conditions. Their work took in anxiety, depression, self-harm, severe mental illness, eating disorders, obsessive-compulsive disorders, acute alcohol-related events, asthma exacerbations, chronic obstructive pulmonary disease exacerbations, acute cardiovascular events and diabetic emergencies.

Dr Mansfield emphasises that one of the main strengths of the research was that it was genuine team science, involving around 20 people with varied expertise.

Lessons learnt

The findings showed that, with few exceptions, primary care contacts for the conditions studied dropped dramatically after population-wide restrictions were introduced in March 2020. One example is that by July 2020 there were 43,900 per million fewer contacts for COPD patients experiencing exacerbations than would have been expected in previous year.

The team is cautious in its interpretation – pointing out that in some cases the fall in contacts may reflect an actual reduction in need. However, they point to other surveys that report increases in many mental health conditions during, and sometimes related to, the pandemic. There is also concern that people may only be seeking help for physical and mental health issues at a later stage than before the pandemic.

Impact and outcomes

The research has major implications for healthcare planning and provision. It suggests high levels of pent up demand and the possibility that many people who did not seek help over the past year will start seeking GP and other primary care support. In some cases their conditions will be at a more advanced stage.

Insights from the Impact Committee

The paper was selected by the HDR UK Impact Committee judges for its capacity to influence policy and practise and the high standards of research, enabling better treatment and improved public health.