A lead role in defeating the virus

by Richard Vautrey

The discovery of a vaccine for COVID-19 is a major breakthrough and GPs will be on the front line administering it, busier than ever

Location: UK
Published: Thursday 19 November 2020
richard vautrey

The announcement this month that late-stage trials of the Pfizer and Moderna Covid vaccines have found it to be effective in 90 to 95 per cent of patients, has provided the first glimmers of light at the end of what has been a long, dark year.

It suggests that many of the other vaccines in trials could be similarly effective.

The COVID-19 pandemic has tragically claimed more than 50,000 lives in the UK, including many healthcare workers, and has also disrupted and strained the lives of millions of others.

The NHS remains at the forefront of the response to this health crisis, with doctors, nurses and other health professionals going above and beyond in their duty to care for patients and to keep our health service going.

This has been no less true of GPs and their teams with recent NHS data showing a surge of 6.5 million more appointments delivered by practices between August and September.

General practice has been open throughout this dreadful pandemic and continues to be there for our patients.

With the arrival of a vaccine, it will be GPs, practice nurses and other practice colleagues who will be taking a leading role in guiding the nation toward what will hopefully be the beginning of the end of this public health crisis.

Following the negotiations between the BMA and NHS England and Improvement an enhanced service directed by NHSEI under Section 7a of the 2006 NHS Act, has been agreed for general practice to be given the opportunity to lead delivery of the COVID-19 vaccination programme.

Commissioning under S7a allows for speed and flexibility, something that will almost certainly be crucial once additional vaccines are added to the programme.

Under this agreement, GP practices who sign-up to the vaccination roll-out will be encouraged to work with other practices in their areas in delivering vaccinations to high priority patients such as care home residents and staff and the elderly.

As a GP, I understand all too well the huge challenges and pressures our profession has faced in the past eight or nine months, and how this has further exhausted our already limited resources.

It is perfectly understandable therefore that many GPs and practice staff will have concerns as to how they will meet the requirements and new demands posed by the proposed vaccination programme.

We know practices have many questions about the practicalities of delivering these new vaccines at this critical time – not least the cost implications, logistics and staffing requirements – and we will all want to know exactly what and how much external support will be provided.

While early indications suggest that many practices are working towards getting involved in the delivery of this programme it is important to stress that GP surgeries are under no obligation to do this and may have very good reasons why it’s not possible for them, or that they would prefer to work through a local mass vaccination service organised by others.

With a programme of this nature that is so dynamic, and without even having a vaccine that has been through the regulatory system yet, it’s inevitable that this is a rapidly changing situation and details are still being worked out.

The process for vaccinating will not begin until December at the earliest but in all likelihood we expect vaccine availability will initially be limited, meaning vaccinations will only begin in earnest in 2021.

This will allow time for GPs to work together on some of the practicalities as to how they might wish to collaborate going forward, as well as consider how non-COVID-19 patient demand will continue to be met.

Throughout the pandemic, frontline doctors and healthcare staff have had to worry about their health and even put it at risk when caring for patients.

To ensure that this is not an additional burden to the roll-out, practices will be able to vaccinate their own staff and be paid for doing so under the terms of the agreement.

Practices will be able to operate their own call and recall systems for patients if they wish to do so. However, there will also be a national system in place.

Under the agreement, practices will receive an item of service fee of £12.58 per dose, and the vaccine will be provided along with associated materials such as needles, syringes, diluents and personal protective equipment.

We have also secured £150m for general practice, ringfenced until March 2021, and to be used for increasing the capacity of practices. We also expect NHSEI to make available funding comparable to that provided to support the current flu campaign to cover additional costs.

It is clear that, as well as the vaccine programme, GP practices will need to continue to meet the healthcare needs of their patients.

To do this, practices will need to prioritise their work as those involved in vaccinations clearly cannot be in two places at the same time.

We have secured agreement to protect most of the income provided through the Quality Outcomes Framework, meaning that practices can focus on those patients with long-term health conditions who would most benefit from their care without being affected financially.

We expect clinical commissioning groups to take similar steps to provide income protection arrangements for local enhanced services, trusting practices to deliver care within their capacity and capability.

Additionally, primary care networks can redeploy clinical pharmacists and others with the necessary skills for the purpose of delivering COVID-19 vaccinations will not be penalised if doing so affects their obligations around Structured Medication Review and Medicines Optimisation service requirements in the Network Contract DES.

I am under no illusion that implementing a national vaccination campaign, or this scale and complexity will not be an easy task, especially considering the toll the pandemic has taken on frontline health services.

However, I have the utmost confidence that general practice has the experience and the trusting relationship with our local communities crucial to do this, and to do it successfully.

The BMA and its GPs committee will continue to provide you with information and practical guidance as together we work towards ending this pandemic.

Richard Vautrey is BMA GPs committee chair