GPs' experiences of the COVID-19 pandemic – a focus group study

Major burden, but high self-efficacy

The GPs described the pandemic as a major burden, but felt that they coped well and derived satisfaction from how they had managed to find good solutions to addressing the challenges. They described the situation as particularly challenging at the start of the pandemic, when the GP practices were overwhelmed by the large number of enquiries from the public and the need to adapt quickly to the ongoing and extensive changes. The pressure on GP practices was mainly a result of the large volume of telephone enquiries at the start of the pandemic. Many patients cancelled their appointments, both out of fear of being infected and out of consideration for the doctors. Several GPs found that their appointment diaries were almost empty in the first weeks. The patients gradually returned, but by then most GP practices had introduced infection control measures that reduced physical patient contact. Although there was less direct contact in certain periods, the level of activity increased overall.

Some GPs disagreed with the infection control measures and feared losing a large portion of their income when they had to reduce the number of consultations. In addition, the work involved in reorganisation did not generate income for the self-employed doctors, as only patient contact was remunerated.

Getting patients to accept the new ways of working took time, and several of the GPs found it challenging. The GPs had different views on the value of video consultations. It was agreed that video consultation was best suited for certain patient groups, particularly younger people who were more familiar with the technology. Some patients considered video consultations to be positive, and asked that it be continued.

Several GPs expressed concern that the reduction in patient contact would lead to serious illnesses not being discovered and treated. Some went through their patient lists and visited their patients at home to ensure they were receiving the health care they needed:

All GP practices were pushed to breaking point during the first phase of the pandemic. The pressure eased somewhat when the local authorities introduced external testing and helplines. This freed up time for the GPs to carry out more of their regular duties. The GP practices had managed to continue functioning during the first acute phase, but it took its toll on the staff.

Our focus group participants considered it natural that GPs coped with the challenges during the pandemic. For most, their self-efficacy and sense of responsibility towards the patients was so implicit that it was not something they gave much thought to. Several of the doctors described the ability to cope as a core value in the GP service.

Some doctors described self-efficacy expectancy in light of the GP's role in emergency public health preparedness and their sense of ownership of events that affect the public.

Being self-employed and their large degree of self-determination were highlighted as key factors for being able to quickly reorganise the GP service during the pandemic.

In addition to the individual sense of responsibility for their practice, several GPs emphasised how the comradeship at their practice was a strength. The doctors received support and shared information in regular meetings with colleagues. Information letters from the Norwegian Medical Association and online discussion groups reinforced the collective self-efficacy.

The GPs also felt that society expected them to be able to cope with the crisis. Some doctors perceived this expectation as unreasonable. They explained how the acute crisis had come on top of an existing chronic crisis, in which the GP service is constantly expected to take on more work without receiving more resources. They found that one of the disadvantages of their ability to cope was that it camouflaged the strain on the service.