Enhanced service contract for GP practices delivering COVID-19 vaccine revealed

GP practices have until midnight on 7 December to sign up to a COVID-19 enhanced service specification that could see practices roll out vaccination from as early as next week.

Photo: Photofusion/Getty Images
Photo: Photofusion/Getty Images

In a letter accompanying the enhanced service specification, NHS England says a 'large number of PCN vaccination sites have now been designated'.

The specification confirms the £12.58 per dose payment for practices delivering the vaccine, along with further detail on funding for set-up costs, logistical support, eligible patients and requirements around staff training and premises.

The enhanced service deal will take effect from 8 December and confirms that practices delivering vaccinations will have at least '10 calendar days' notice before batches of vaccine are delivered.

COVID-19 vaccine

Details of the framework for practices to administer a COVID-19 vaccine come as the government confirmed the UK had become the first western country to approve a vaccine - with the Pfizer/BioNTech vaccine granted approval by the MHRA.

The 10-day notice period suggests the vaccination programme is unlikely to begin earlier than the end of next week - although the accompanying letter says officials will 'aim to give sites seven to 10 days notice'.

The enhanced service deal sets out arrangements for practices to subcontract delivery of vaccinations to another practice within their PCN, and says all practices will have to sign a 'collaboration agreement' setting out details such as how they will work together and share payment for delivering the vaccination programme - with a single lead practice to receive all payments.

The enhanced service will run until 31 August, but could be terminated earlier - and the document makes clear that the specification 'will be updated from time to time as the vaccination programme develops' - with possible changes to eligible cohorts and prioritisation of cohorts. Vaccine availability could lead to some PCN areas being prioritised for deliveries - or told to prioritise use of a particular vaccine.

Vaccine rollout

The NHS England letter, signed by primary care medical director Dr Nikki Kanani and primary care director Ed Waller, says that although designated sites delivering vaccinations will be expected to be available from 8am to 8pm seven days a week, this 'will only be required where the supply of vaccine necessitates this to ensure all of the vaccine available is being used to vaccinate patients as quickly as possible'.

Practices could be expected to remain open over Christmas bank holidays - but the letter says: 'This is not about creating an expectation that teams will be available when vaccine supply does not facilitate these hours, or where volumes supplied do not necessitate them.'

The letter acknowledges concerns over potential cashflow problems for GP practices 'particularly in light of the fact that payment is made following the administration of the second dose'.

GP practices will receive £12.58 per dose of vaccine administered - but will be paid £25.16 per patient only once both doses required have been completed.

GP funding

The letter says: 'We are aware that some PCN groupings are concerned about the cashflow implications of the period between the date that costs start to be incurred and receipt of the first payment for vaccinations administered. We will take action to ensure appropriate cash flow to practices.'

The letter does not make clear what form this 'action' could take, however. A £20m fund is available for one-off setup expenses - although this appears largely aimed at unavoidable costs of hiring premises where existing local NHS facilities cannot be used for the vaccine campaign.

GPonline revealed last week that confirmation of designated sites in some PCN areas had been delayed by NHS England seeking to confirm that locations proposed offered 'good value for money'.

The latest NHS England letter says: 'PCN groupings have been encouraged to use existing estates or premises from which to deliver vaccination clinics. Where not possible, PCN groupings are encouraged to utilise NHS vacant space, which should be free of charge, brokered via your CCG. As a last resort, PCN groupings could hire a community / commercial venue.'

Eligible patients

Details of the enhanced service confirm that practices will be expected to deliver vaccinations to residents and staff at care homes for older people first, with patients aged over 80 and health and social care workers next in line.

Vaccine rollout will continue in five-year age groups down to patients aged over 50 - with high- and moderate-risk adults under 65 coming in between patients over 65 and those aged over 60 - although the Joint Committee on Vaccination and Immunisation is set to issue final guidance shortly on how patients should be prioritised.

Pregnant women, children and under-18s will not be offered the vaccine. Although the specification confirms that patients could in some cases be offered a second dose of a different type of COVID-19 vaccine - it makes clear this should only occur in 'exceptional circumstances' - where a second dose of the same vaccine is not available or the first dose type is unknown.

Details of the service reiterate that doses of COVID-19 vaccine should ideally be administered seven days apart from any other vaccine.

NHS England has also published details of equipment that can be ordered free of charge by practices delivering vaccines from designated sites, and to support roving teams that will be required to carry out vaccinations for housebound patients, those who cannot attend a designated vaccination site and patients in care homes.

Publication of the enhanced service comes just days after GPs at the 2020 England LMCs conference callled for the agreement to be renegotiated, condemning the pace at which GP leaders had been forced to agree the package.

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