%0 Journal Article %A Helen J Curtis %A Brian MacKenna %A Richard Croker %A Peter Inglesby %A Alex J Walker %A Jessica Morley %A Amir Mehrkar %A Caroline E Morton %A Seb Bacon %A George Hickman %A Chris Bates %A David Evans %A Tom Ward %A Jonathan Cockburn %A Simon Davy %A Krishnan Bhaskaran %A Anna Schultze %A Christopher T Rentsch %A Elizabeth J Williamson %A William J Hulme %A Helen McDonald %A Laurie Tomlinson %A Rohini Mathur %A Henry Drysdale %A Rosalind M Eggo %A Kevin Wing %A Angel YS Wong %A Harriet Forbes %A John Parry %A Frank Hester %A Sam Harper %A Stephen JW Evans %A Ian Douglas %A Liam Smeeth %A Ben Goldacre %T 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 %D 2021 %R 10.3399/BJGP.2021.0380 %J British Journal of General Practice %P BJGP.2021.0380 %X Background: 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. Aims: Describe the volume and variation of coded clinical activity in general practice, taking respiratory disease and laboratory procedures as examples. Design and setting: Working on behalf of NHS England, we conducted a cohort study of 23.8 million patient records in general practice, in-situ using OpenSAFELY. Methods: We describe activity using CTV3 codes and keyword searches from January 2019-September 2020. Results: Activity recorded in general practice declined during the pandemic, but largely recovered by September. 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(median tests per1000 patients in 2020:February 8.0;April 6.2;September 7.0). 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. Conclusions: We delivered an open source software framework to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September, with some important tests less affected whilst recording of respiratory disease codes was mixed. %U https://bjgp.org/content/bjgp/early/2021/09/24/BJGP.2021.0380.full.pdf