A number of sites have confirmed to GPonline that they were asked about delivering additional vaccines next week - as soon as 21 December - as NHS England looks to build on the success of the past few days and maximise population coverage.
NHS England has stressed the decision to take on a further batch of vaccinations for a second week running is optional, but GPs have criticised the request - warning that normal services would suffer and patient safety could be compromised, and highlighting the huge logistical and staffing effort required.
Clinicians have also stressed that the first round of vaccinations were ‘very, very wearing’ for practice staff who need to take time to reflect on their work, and find a sustainable way of delivering a mass vaccination programme over the coming months.
Primary care network leaders (PCN) earlier this week called for the government to provide stronger communication and clearer guidance to ensure GPs and their teams could deliver the COVID vaccination programme effectively.
Clinical director of Kingston PCN in London Dr Richard Van Mellaerts told GPonline that his network declined to take on additional vaccinations next week because of the enormous workload that would be required at short notice.
He said: ‘It would perhaps be physically possible. But the rate limiting steps are around the workforce and calling patients in. That is far more of a barrier than perhaps has been recognised across the system as it’s enormously labour intensive to call 975 older people, who have questions and concerns. I’ve found it’s taken staff up to 15 minutes to book an appointment, and if you multiply that across 975 people, that’s rather a lot of time. So that was a significant thought process.
‘We were able to provide the first batch effectively by devoting the most enormous number of our staff to it, and taking them off normal activities. It's not sustainable to continue to work that way, one at short notice, and two that relentlessly without normal patient service coming to harm. So there does need to be more thought about how general practice can continue to cover those two bases, because otherwise one of them will fall.’
Without sufficient backfill of staff, Dr Van Mellaerts warned that diabetic checks, COPD checks and annual flu vaccinations would all suffer, in addition to the number of appointments practices could offer. He stressed that general practice could not continue to be ‘all things to all people’ if teams weren’t supported.
‘We’ve got to take stock once people have had their second vaccine, so we can plan for the next step. There needs to be more effective planning because things are being done far too quickly, which is stretching the whole system to breaking point. We need to adjust the system into something sustainable because working at this break-neck speed is not sustainable in the long term’
He added: ‘General practice on the whole is up for doing this, but we need the support of NHS England to do so, and telling us at the last minute is not being as supportive as we could be. It is really important that these difficulties are acknowledged and there is sufficient investment in time, money and people to maintain the service we have as I do not think it’s acceptable that we start cutting back at normal general service because people continue to get ill.
One GP criticised health bosses lack of foresight in asking practices to take on additional vaccinations at very short notice - warning of the mammoth workload that had been involved so far.
Now they've said we can have another 975 vaccines at the weekend!!!— Yvette Doc ?? #WearAMask (@yvettedoc50) December 16, 2020
We have GP work to do-all of us. This has been a mammoth undertaking-3 weeks time will be fine thanks.
What are they thinking? ??????@NHSEngland @NikkiKF @DrSimonHodes @Kent_LMC @pulsetoday #TeamGP
Another GP from the north east of England agreed that it would be difficult to run normal services while taking on an extra 975 vaccines next week. She said: ‘I’m with you on this one… there is nobody to do our job whilst we are out of practice. My practice is losing 90-120 GP appointments next week whilst we are vaccinating. Where are the patients going to go..?’
NHS director of primary care Dr Nikki Kanani stressed that delivering extra vaccines next week was optional for practices in a tweet. She said: '[We] are thinking if you’d like to and are able to, please do more. You don’t have to! Just trying to get good population coverage.'
‘They’ are thinking if you’d like to and are able to, please do more. You don’t have to! Just trying to get good population coverage ????— Dr Nikita Kanani (@NikkiKF) December 16, 2020
An NHS England spokesperson said: 'General practices who have indicated that they have capacity to deliver a second batch of the vaccine to patients can request a second batch to be delivered next week. This is not mandatory and should be arranged only if it is safe and practical to do so.'
Almost 138,000 people in the UK received a first dose of COVID-19 vaccine by the end of Tuesday 15 December - the first full day of GP participation in the vaccine rollout in England - according to official figures. However, poor communication and logistics failures have piled unnecessary extra pressure on GPs struggling to roll out, with some practices for to rescheduled hundreds of appointments due to late deliveries.