Table 2 Pandemic-related changes on practice level and subjective evaluation of changes by medical assistants

Workload

Increase in workload (due to e.g., increased telephone traffic, E-mail traffic, performance of swab tests, administration of vaccinations, bureaucracy)

Negative: Unbalanced distribution of additional workload between MAs and GPs or between MAs: MAs with childcare obligations spared from additional work and new tasks mostly assigned to MAs with higher mental capacity.

Increase in working hours (e.g., working overtime, giving up free days, working on weekends)

Not explicitly mentioned.

Occupational tasks

Variety of new tasks such as organizational tasks (e.g., organizing contactless transfer of receipts), tasks related to COVID swab tests (e.g., performing tests, checking testing eligibility), tasks related to COVID vaccinations (e.g., organizing and administering vaccinations, vaccinations in elderly homes and addiction clinics) and psychological tasks (e.g., calming worried patients)

Positive: MAs excited about new tasks and spending days outside the practice (e.g., performing tests at schools)

Negative: Difficulties performing new tasks (e.g., counselling of patients without having relevant information, arranging vaccinations without knowing when and which vaccines will be delivered, high time expenditure for arranging vaccination appointments)

Increased need of constantly keeping up to date with colleagues

Negative: Part-time working MAs felt disadvantaged in keeping up to date (compared to full-time MAs)

Negative: Face masks hampered communication for MAs with hearing disability

Hygiene measures

Implementation of comprehensive hygiene measures (e.g., use of PPE, installing acrylic glass panels at registration desks, temporal relocation of the waiting area outside practice rooms, reducing waiting room seats)

Positive: Wearing PPE made MAs less anxious about a possible infection

Negative: Insufficient supply with PPE and masks did not fit properly

Work organization

Separation of infectious patients from others (e.g., different appointment hours, separate treatment rooms)

Negative: Management of patients is exhausting (e.g., frequent doorbell sounds, letting in patients individually)

Implementation of tools to manage COVID patients (e.g., checklist to ask patients about symptoms on the phone, marking potentially infectious patients in the practice system)

Negative: High number of aspects to be considered and kept in mind

Reduction of patient numbers in practice (e.g., patients asked to wait outside, mandatory appointment scheduling, pre-selection of patients on the phone)

Positive: Appointment scheduling facilitated planning of work days

Positive: Reduction of patient numbers brings silence to practice rooms

Drop of high-risk medical procedures (e.g., lung function testing)

Not explicitly mentioned.

Change in frequency of team meetings (either drop of meetings or increase in weekly meetings)

Positive: New team meetings kept all practice members up to date

Stronger practice emphasis on e-mail communication, video consultations, creation of a new practice web page

Positive: Video consultations for elderly home residents prevent the risk of infecting vulnerable patients

Positive: Video consultations reduce number of patients in practice rooms and provide infection protection for practice staff

Structural and personnel factors

Higher demand of personnel due to increase in workload

Negative: Difficulties attracting new staff (general practices viewed as unattractive employers during pandemic)

Less demand of personnel due to a decrease in workload

Negative: Worry of MAs of becoming laid off

Break room converted to an additional treatment room

Negative: No break room anymore for e.g., lunch breaks

Practice software unable to keep up to date with frequent changes

Negative: MAs have to manually enter new information into the system