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COVID-19 vaccine programme : “Logistical Challenges” for GP Practices

As more details on the DES for a GP vaccination programme was released last week, NHS England has said there will be “logistical challenges” for GP Practices to deliver to the public after confirming that some potential vaccines will need to be stored at -70 degrees, presenting some issues for GP Practices to keep them at these temperatures.

Sir Simon Stevens, Chief Executive of NHS England, said that with over 200 vaccines currently in development, he was hopeful that “one or more of those available” would be ready for a national rollout from the beginning of 2021.

Practices taking part in the DES are expected to be prepared for a 1st December start, although the actual start date will depend on when the MHRA has approved a viable vaccine. A trial at Oxford University has said that there is a “small chance” that their vaccine will be ready before Christmas.

Delivering the vaccine at scale

The plan would see GPs along with pharmacists and other primary care teams roll out a vaccination programme within their primary care networks. There has also been the suggestion of mass vaccination centres using the Nightingale hospitals as well as other locations, and what Stevens described as “roving teams” who will prioritise care homes, social care staff, and other vulnerable groups.

The national ‘call and recall’ system will be used to contact patients (practices can use their own call and recall systems if they wish); patients can choose to attend either their local general practice-led designated site or a regional immunisation service. If they choose the local site, practices will contact patients to book an appropriate time.

There are two vaccines to administer – once the first has been done, patients need to be under clinical observation for 15 minutes, then need to book their second appointment (which needs to be done by the same provider).

By making this programme available as a Directly Enhanced Service, it ensures that all individuals delivering the services will have indemnity under the clinical negligence scheme for general practice.

Funding the Programme

NHS England announced on Friday (as part of the DES) that they will provide £150m ‘to expand general practice capacity’ up until March 2021 but will be expected to do this from their own workforce. Payments for the vaccine will be £12.58 each, with two doses per patient. Initially, the payment would be made on completion of the final dose, but the BMA has stated that if it is not possible to administer the second dose, the first dose can be claimed

This high-scale plan would mean that GP Practices would need to deliver nearly a thousand vaccinations over a 7-day period per site, within the vaccine’s maximum five-day expiration. The DES also specified that it expected practices to deliver them over a seven-day week and over bank holidays between 8am-8pm from their allocated vaccination site. If the vaccine is available in December, this would mean opening all through the Christmas and New Year period.

Flu vaccinations will still continue through November and December, and to date over 3 million have been administered. The BMA has written to the Care Quality Commission to request that they hold any planned inspections over this period to avoid undue pressures on primary care.

However, it is important to state that there has been no officially published DES and the information available so far has been through press releases and draft guidance. News this week is that the government has bought 40m doses of Pfizer/BioNTech’s vaccine that is claimed to be ‘90% effective’ against the coronavirus, with 10 million doses already manufactured and available by the end of the year.

In Monday’s Coronavirus Update, Boris Johnson stressed the need for caution about the vaccine breakthrough – any vaccines will still need to go through the JCVI and MHRA testing and licensing process, and if they are not approved then there will be no vaccination programme.

What we know so far

  • PCNs must nominate a practice to lead the vaccination programme by November 13th. If a PCN has over 100k patients, then they can choose more than one location.
  • Practices will be assessed by their CCG on whether they meet the criteria to be a nominated site (including vaccine storage and handling, workforce, data collection, reporting, and aftercare).
  • Practices could be confirmed by 16th Nov and potentially have a finalised DES in place by 23rd
  • Practices will be paid £12.58 per vaccination delivered. It is expected there will be two doses per patient, with the first payment guaranteed.
  • Sites will be open from 8am to 8pm 7 days a week and available throughout bank holidays
  • Patients who are aged 85+, care home residents, social care staff, and other vulnerable groups are expected to be among the first to receive the vaccinations.
  • Vaccinations will likely be in 1,000 dose vials and will need to be administered within 5 days.
  • The vaccine will be delivered in 2 doses and to be stored at -70C.
  • Along with this, the DES mentions that patients should be ‘observed’ post-vaccination for 15 minutes.
  • Practices will need to deliver a minimum of 975 vaccinations over a 7-day period (975 in each batch delivered to practices)
  • All staff involved in vaccinations will need to take online training provided by Public Health England or Health Education England.
  • Those administering the vaccine will be from the Practice’s own staff – however, they can use the Bring Back Staff scheme and GP returners to recruit additional staff if needed

Prioritising the vulnerable and highest risk patients

Eligible patients will be confirmed soon, but it is expected they will follow flu groups;

  • all over the age of 50
  • Patients at high risk
  • Care home residents and staff
  • All health and care workers (health and care staff likely to get it from their employer instead of general practice).

The Joint Committee on Vaccination and Immunisation (JCVI) has said care home residents and staff were among those who should be prioritised - others should be assessed based on their age and risk. This comes after they had examined data on those at greatest exposure or highest risk of death.

At present, the interim guidance on who should get the vaccination first is as follows;

  • Older adults in a care home and care home workers
  • All those aged 80 and over and health and social care workers
  • Anyone 75 years of age and over
  • People aged 70 and over
  • All those aged 65 and over
  • High-risk adults under 65 years of age
  • Moderate-risk adults under 65 years of age
  • All those aged 60 and over
  • All those 55 and over
  • All those aged 50 and over
  • The rest of the population, with priority yet to be determined.

 


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