Some GPs have warned that designated sites set to start delivering the vaccine from next week could no longer meet the requirement to deliver 975 doses of vaccine within 3.5 days given the requirement to observe patients.
GPonline reported on 10 December that the policy could throw GPs' plans to deliver the vaccine into disarray - and GPs have warned the change will significantly slow the pace at which vaccination can be delivered, change staffing requirements and could require additional equipment.
A standard operating procedure published by NHS England says a trial run of vaccinations took eight minutes per patient - excluding post-vaccination observation.
It estimates that four vaccinators can get through 100 patients in 200 minutes at 8 minutes per jab - fast enough to vaccinate 975 patients in three 12-hour days. But if time per jab rises to 10 minutes, four vaccinators can only just get through enough patients in 3.5 12-hour days - leaving no room for error if patients fail to turn up or if any delays occur.
Some sites that had been planning to deliver vaccinations from next week are simply no longer suitable, GPs have said.
One GP in Kent reacting to the MHRA advice wrote on Twitter: 'We may have to step down the PCN site and the 975 COVID vaccines we were due to give next week. Our site doesn't have capacity for the observation period.'
MHRA guidance change has meant we may have to step down the PCN site & the 975 Covid vaccines we were due to give next week. Our site doesn't have capacity for the observation period ????— Yvette Doc ?? #WearAMask (@yvettedoc50) December 10, 2020
Very sad@Kent_LMC@drguptagaurav @NHSEngland @NikkiKF @pulsetoday @jkaffash @teamgp #teamgp
Other GPs have reported rapidly rethinking the arrangements around numbers of vaccines they planned to deliver per day to factor in the new advice.
Anyone else getting good at 975 times tables??#MathsForGPs— Simon Hodes ??2m?? ?? (@DrSimonHodes) December 10, 2020
this is like the worst 11+ exam question:
You have 975 jabs to give within 3.5 days. If each patient has to wait for 15 minutes, how many staff & rooms do you need to make this happen, working 12 hours a day??#TeamGP
Other GPs across England reported concerns about whether their designated site could cope with the change in requirements.
Northumberland LMC medical secretary Jane Lothian told GPonline that both of the sites set to start delivering vaccines next week in her area could cope with the change because they had fairly large premises.
But she said: 'I can imagine there will be some places that will find this very difficult to accommodate, especially if they are trying to maintain business as usual as well. If you now have to have space for people to sit socially distanced, with someone to observe them for 15 minutes and ask if they are ok as they are about to leave it is a challenge.
'If sites don't have space to accommodate all the people they can vaccinate, they will have to slow down.'
GPC member Dr Peter Holden said the change could slow down the rollout of designated GP sites because GPs would have to rethink how they could deliver vaccinations at the pace required.
'The rate-limiting factor is where can we put people for 15 minutes. In September, we had a marquee set up for flu jabs - but it's too cold now. We have to rethink the speed at which we can deliver.'
GP practices discussed the possibility of a 15-minute observation period last month, because it was initially expected that this would be required due to a risk of patients fainting. But practices were told last month that patients could be told simply not to drive for that period. Dr Holden said the return of the 15-minute wait was a 'major change'.
'When we first talked about a vaccination programme, we all said a 15-minute observation period would be a major problem. You need a sports hall for that. But we thought it was a difficulty that had been removed, people then signed…and it is now back.
'This is a major change in specification - but we can find a way round it.'
Wessex LMCs chief executive Dr Nigel Watson - clinical lead for the COVID-19 vaccination programme in Hampshire - told GPonline that none of the 10 first-wave sites in Hampshire and Isle of Wight had pulled out.
But he said: 'Clearly there is a lot of replanning and redesigning. It’s not just the 15 minutes after and having space to do it - we expect consent will take longer than planned. However there is still a view we need to do this because of number of deaths caused by the pandemic.'
Dr Watson said all of the sites in the area were still planning to deliver 975 doses of vaccine in 3.5 days - and were looking at how this could be managed, with increased clinical supervision.
He said any sites that no longer believed they could deliver the required number of doses to avoid wastage should have a conversation with their CCG.
The Wessex LMC chair admitted it was difficult to say whether fewer practices would have signed up to the COVID-19 enhanced service had they know that the 15-minute observation period was required.
'It's a big hurdle,' he said. Opening longer hours could prove difficult because asking patients aged over 80 to attend late into the evening may prove difficult, he said.
He added: 'GPs are good at finding solutions. But this is the biggest vaccination campaign in history - it was difficult enough anyway. Hopefully the Astra Zeneca/Oxford vaccine will come through soon too.'