The SOP now covers both the Pfizer/BioNTech and Oxford/AstraZeneca vaccines. It says: 'Post-observations periods should follow normal arrangements for observation after vaccination and pharmacovigilance, as set out in the Green Book.
'For the COVID vaccine, recipients should be monitored for 15 minutes after vaccination, with a longer observation period when indicated after clinical assessment, as set out in the MHRA statement.'
The Green Book, last updated in December, only mentions that the observation period applies for the Pfizer/BioNTech jab. However, the SOP does not seem to distinguish between the two vaccines, although the MHRA statement it links to refers to the Pfizer vaccine only.
The operating procedure also says that the Oxford vaccine should be used for housebound patients, and in these cases vaccinators are told explicitly to remain in the house for a 15-minute observation period.
GPonline understands that a final decision on whether those given the Oxford vaccine will require observation will be made in the coming days and be based on the experiences of those vaccinated in hospital.
The observation period for the Pfizer/BioNTech vaccine was introduced by the MHRA after three patients suffered adverse reactions on the first day of vaccinations. The change posed a significant challenge for primary care vaccination sites, with many forced into a last minute overhaul of plans.
Housebound patients
Meanwhile an update from the MHRA on 30 December, which is referenced in the SOP, reveals that those patients with a history of severe allergic reaction can now have the Pfizer/BioNTech. The update said that only those with a history of allergic reactions to the ingredients in the vaccine should not be given the jab.
The SOP has also been updated to provide advice on vaccinating housebound patients and additional advice on care homes. It recommends that PCN vaccination sites use the Oxford/AstraZeneca vaccine for housebound patients in light of the fact it is easier to transport and store.
It advises that some housebound patients 'may be able to attend PCN designated sites with assistance and discussion should be held with the family and/or carer to facilitate this process'.
If vaccination does take place in a patient's home, NHS England says that a two-person team attend - a lead vaccinator and a member of staff to provide support. The team should remain at the house for a 15-minute observation period.
Additional payments for care homes
NHS England also recommends that PCN sites use the Oxford/AstraZeneca vaccine in smaller care homes. Sites are already able to order smaller 75-dose packs of the Pfizer/BioNTech vaccine for vaccinations in larger care homes, which they have been using in recent weeks.
Earlier this week the government said that it wanted GPs to vaccinate all care home residents by the end of January. PCNs have been told that they will receive an extra £10 per vaccine dose delivered in care homes, on top of the item of service fee, until the end of January.
The updated SOP provides advice on how PCNs should proceed if there is a COVID-19 outbreak in a care home when vaccines are due to be administered. It says: 'COVID vaccine should be offered to older adults in care homes and their carers, with the aim of achieving high uptake as rapidly as possible. This includes when other residents have been diagnosed as having COVID-19 infection.'
It advises lead vaccinators to conduct a risk assessment in partnership with the care home manager before attending. Further guidance on vaccination in care homes with COVID-19 outbreaks, which was published on 31 December, says that PCNs should consider using vaccinators who have already been immunised if possible. Staff at high-risk from COVID-19 infection should not be included in the vaccination team.
Oxford vaccine
The Oxford/AstraZeneca vaccine will be supplied in packs of 10 vials, with each vial containing eight or 10 doses of the vaccine. The vaccine can be stored between 2 and 8 degrees Celsius for six months. Once opened the vials should be used as quickly as possible and within six hours. The vaccine can be kepy at room temperature during this period if required.
The government has said it hopes to vaccinate 13.9m patients against COVID-19 by mid February.
