December 4, 2020

GPs in England will scale back care to deliver Covid vaccines – The Guardian

https://www.theguardian.com/world/2020/nov/10/gps-in-england-will-scale-back-care-to-deliver-covid-vaccines

GP services will be cut back well into 2021 so family doctors can immunise millions of people against coronavirus at new seven-day-a-week clinics, NHS England has said.

Health leaders warned that surgeries will not be able to offer their full range of care for patients from next month as doctors and nurses will be immersed in administering jabs at more than 1,200 mass vaccination centres across England, potentially including sports halls, conference centres and open air venues.

It came as Britain reported 532 new deaths within 28 days of a positive Covid-19 test on Tuesday, the highest daily figure since May. Some 20,412 people tested positive for Covid-19, down slightly from the previous day.

While Covid vaccinations are seen as crucial for allowing a gradual return to normality, there are growing concerns about pressure on an already stretched NHS and the toll on patients after much normal care was suspended during the first wave of the pandemic.

The Department of Health and Social Care has asked the NHS to be ready to deliver the vaccines by 1 December, but the Guardian understands it is unlikely any programme will be ready to roll out by then.

New research by the Health Foundation, published today, found that 4.7 million fewer people in England than usual were referred for a hip or knee replacement or cataract removal between January and August this year, with services closed and patients reluctant to attend hospital.

On Monday the first potential Covid-19 vaccine yielded promising interim results, with global trials showing 90% effectiveness. Britain has bought 40m doses of the Pfizer/BioNTech vaccine, enough to immunise 20m people with two doses each, and hopes to begin rolling them out to the elderly and health care and care home workers within weeks.

NHS England has agreed with the British Medical Association that family doctors will play the lead role in a vaccination drive of a scale and complexity unprecedented in the NHS’s 73-year history, described by the health secretary, Matt Hancock, as a “mammoth logistical operation”.

In a letter to GP leaders confirming the deal, NHS chiefs accept that GP surgeries cannot operate as usual while their doctors are engaged in the immunisation effort. “We also recognise that the additional workload of a Covid-19 vaccination programme may require practices to prioritise clinical activity,” wrote Dr Nikki Kanani, NHS England’s medical director for primary care.

GPs will open at least 1,260 mass vaccination centres across England, 12 hours a day, seven days a week. They will be paid £12.58 each time they or a practice nurse administers one of the two doses every recipient will be expected to have, several weeks apart, of whichever vaccines have been approved by European and British medicines regulators – hoped to include the Pfizer/BioNTech candidate. At least 975 people a week will have one dose at every site.

Hancock announced on Tuesday that primary care services are to be given £150m to help them hire more GPs and expand the help they give patients affected by the disease, including those suffering from “long Covid”. It is unknown how much on top of that GPs will receive for dispensing Covid jabs.

However, doctors’ leaders voiced concern that the NHS does not have enough staff or infrastructure, such as freezers to store vaccines and lorries to transport them, and could become embroiled in the sort of “desperate scramble” for kit seen in the spring with personal protective equipment (PPE) and ventilators.

The head of the Royal College of GPs told the Guardian that widespread shortages of family doctors and the existing strain on surgeries meant hospital doctors would also have to help out.

Under new laws announced by the government, a wider range of healthcare workers – including midwives, paramedics, physiotherapists and pharmacists – are to be allowed to give flu and potentially Covid-19 vaccines.

“The workload and resource pressures that were facing general practice before the pandemic still exist, and they need to be addressed. GPs and our teams won’t be able to deliver this programme alone,” said Prof Martin Marshall, the chair of the college.

“We will need the support of other healthcare professionals in the community, and potentially from secondary [hospital] care colleagues, such as those delivering outpatient services.”

GPs also need “clarity on what work we should stop doing in order to create capacity to deliver the Covid vaccination programme”, he added.

Dr Nick Scriven, a past president of the Society of Acute Medicine, which represents hospital doctors, said NHS bosses and ministers will have to overcome “a series of challenges” to ensure the vaccine rollout succeeds.

“This is very complex stuff. Two jabs, three weeks apart, with people having to recover somewhere for 15 minutes after they have it – that is far more complex than administering the winter flu jab.

“This is an unprecedented undertaking for the NHS and the country. The NHS doesn’t have the kit and logistics to do this today. But it will be able to do it with enough notice. The sheer logistics may mean that the rollout of the vaccine takes longer than people imagine and expect. Perhaps that’s why Boris Johnson on Monday was urging people not to get too carried away.”

Ruth Rankine, director of the Primary Care Network at the NHS Confederation, said patients having less access to GP care because of the immunisation initiative was unavoidable. “Delivery of a vaccination programme on this scale from scratch means business as usual is not feasible, so public expectations will need to be managed at a national level.”

However, a senior Whitehall official said getting the vaccine to where it is needed should not pose problems because NHS England has spent months arranging cold storage transport vehicles. “That stuff definitely is happening,” the source said.

Richard Wilding, a professor of supply chain strategy at Cranfield University, said the NHS would need to acquire significant amounts of dry ice to to store and transport vaccines, as well as specialist containers of sufficiently low temperature. It would also need plentiful supplies of freezers, syringes, needles and PPE for those administering them, he added.

The Department of Health and Social Care (DHSC) has put NHS England in charge of overseeing delivery of the vaccine, which will be expanded next year to the rest of the population. That means that, unlike the sourcing of PPE and ventilators when the pandemic hit, NHS England is responsible for ensuring the drive has enough resources. It is due to publish its deployment plan next week.

A DHSC spokesperson said: “The NHS has vast experience delivering widespread vaccination programmes and an enormous amount of planning has taken place to ensure our health service stands ready to roll out a Covid-19 vaccine.

“This includes putting in place logistical expertise, transport, PPE and an expanded workforce to ensure we can deploy vaccines rapidly once they have met robust standards on safety and effectiveness and been approved by the medicines regulator.”

On Wednesday the European commission will formally authorise for EU member states the purchase of 300m doses of the Pfizer/BioNTech vaccine.