Table 3 Shows literal excerpts from the interviews and focus groups

Theme 1. The need to reorganise traditional roles

Category 1.1

Emergence of teamwork

Nobody stopped at just their responsibilities – you always did more and tried harder, it was a moral imperative – we all disinfected ceilings, walls… We've done all sorts – we have worked together, the rigid structure of tiers was gone – I have felt very supported, everyone involved themselves fully (RUF-25, physiotherapist)

At first, we were all rowing in the same direction, a fantastic team, cohesive, really united – however, over time it started to crack, and you could feel it, because it was getting heavy – I mean, everything COVID is heavy, and it affects all the teams, the good ones and those where relationships were not so good or were poor (Nurse, focus group-3)

Category 1.2

Triage: a problem for PCTs

There was a strange feeling regarding the door, because at the beginning it was shut for good – like "nobody is coming in here", without really knowing what we were to do – because we've closed the door, and now what? (Nurse, focus group- 3)

We were told "you have to organise a triage", so we brought a table downstairs, we organised some shifts, and so on. And everybody had to make do as well as they could – the lack of protection, of resources, because you almost had to find your own resources – (UN-24, nurse)

You are more alert now, I spend my days asking things I should not know about – I am not a healthcare professional, but I need to ask people about COVID symptoms so I can refer them to my colleagues (UAD-6, administrative staff)

In the hospital, everything is more guarded… There is an access control point, with a security guard, which is important, and janitors to take your temperature and limit access for accompanying persons. The hospital is more organised, a lot more, here we had to do it… Primary care hasn't – well, it hasn't been as well looked after as it should have been (UN-13, nurse)

Category 1.3

“Everything is COVID”: Some responsibilities neglected

It has been let down, yes… Health education was something we did a lot of, programs about smoking, about polymedication – we used to do small group meetings, perhaps once a year for each subject, or sessions with information stands near the door, but all that had to stop, of course – we haven't done any of that (UN-4, nurse)

I can do nothing, or rather, I do what I do, but I feel that so much passes me by… I cannot work properly like this – it feels like we just muddle through (RM-21, practice manager)

My main takeaway is that nursing in primary care is a giant with feet of clay – our activity went under, we stopped doing all the things we used to do, despite these being what we really should have done… Also the feeling of unity, because in my team there was unity, the first months we were all in it together – but then, we should be looking out for patients who are at home, having a hard time, losing relatives, or with hospitalised relatives that they cannot phone – we have to do it. We haven't been able to do it, although it is something we should have done (Nurse focus group-3)

Theme 2. The need to implement a new primary care delivery model

Category 2.1

Self-management in primary care centres

The feeling was… that we mostly had to rely on ourselves (UN-14, nurse)

Our only resources were those of the health centre – nothing more (UM-23, practice manager)

It is very sad to have people waiting in the street […] it rained, and people were there with their umbrellas, in the street, a lady with her crutch, a man with a walking frame. Really, it is very upsetting. But there wasn’t enough time to start thinking "let's see what we can do to sort this out, let's see what we can do, because in two days it's going to be icy" (Nurse, focus group-3)

Category 2.2

The limits of telephone consultations

There will be two kinds of patients, the smart ones and the rest – and either they survive, they adapt, or they are going to be left behind (Nurse, focus group-1)

The way they come through the door, how they move, their agility, the abilities they possess – I am already doing a neurological assessment. [With telephone consultations] you lose people's spontaneity when they ask for something that they might not even know what it is, and when you see them, when you examine them, sometimes you find issues that were not what they were asking about to start with. So you are missing that freshness, the possibilities it opens for diagnosis… You have to make the most of technology for what it is worth, but it should not be an excuse, nor a limit or a shield to protect us. Medicine is about direct engagement with the patients, and there is no other way around it (RM-20, practice manager)

Category 2.3

Pandemic opportunities

It has helped to identify things that we were doing wrong… It is not necessary to check the blood pressure every month, or give appointments for repeat prescriptions… We have identified things that we were not doing correctly (UN-8, nursing manager)

To be honest, I am working a lot better now… Of course, now I have half an hour for each patient, which before I did not have. […] The pandemic has been beneficial for me – I can do my work a lot better, because I have the time – Now I can say that what I do is truly useful, that I know what I am doing (UF-6, physiotherapist)

[…] and we have noticed that primary care is always prescribing specialist referrals, many of them unnecessary – but the specialists do not cancel them, and the population have high expectations and care demands – the ophthalmologist says I have to be checked every six months but it has been more than I year, I am very worried – but you can see that they are alright (UM-20, practice manager)