Background A substantial reduction in GP-recorded self-harm occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown . Aim To examine the impact of COVID-19 on clinical management within three months of an episode of self-harm . Design and setting Prospective cohort study using data from the UK Clinical Practice Research Datalink . Method We compared cohorts of patients with an index self-harm episode recorded during a pre-pandemic period (10th March-10th June, 2010-2019) versus the COVID-19 first-wave period (10th March-10th June 2020). Patients were followed up for three months to capture psychotropic medication prescribing, GP/practice nurse consultation and referral to mental health services . Results 48,739 episodes of self-harm were recorded during the pre-pandemic period and 4,238 during the first-wave COVID-19 period . Similar proportions were prescribed psychotropic medication within 3 months in the pre-pandemic (54.0 %) and COVID-19 first-wave (54.9 %) cohorts . Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs. 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (3.4 %) was around half of that in the pre-pandemic cohort (6.5 %). Conclusion Despite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to pre-pandemic levels . However, the reduced likelihood of referral to mental health services warrants attention . Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.