GPs hit out over 'unrealistic expectations' in COVID-19 vaccine plans

GPs have warned of 'unrealistic expectations' over delivery of COVID-19 vaccination in general practice - with vaccination set to take as much as four times longer than flu jabs during the pandemic.

COVID-19 vaccine (Photo: Catherine Falls Commercial/Getty Images)
COVID-19 vaccine (Photo: Catherine Falls Commercial/Getty Images)

The pressure group Doctors Association UK (DAUK) has warned that the complex process involved in delivering the first COVID-19 vaccinations likely to become available in the UK has 'not been adequately taken into account, setting unrealistic expectations of the numbers vaccinated each week'.

The group has called for upfront funding to hire venues, recruit extra staff, improve GP premises, purchase equipment for transporting and storing vaccines - and for better funding to cover the costs of administering a complex vaccine at a designated site and to housebound or nursing home patients.

GP leaders have warned that they expect vaccinating patients against COVID-19 to take three to four times as long per patient as flu jabs have taken during the pandemic. They have also called for urgent clarification over plans for the extended flu campaign amid ongoing uncertainty over the rollout of vaccination to millions of patients outside the usual at-risk cohorts.

COVID-19 vaccination

General practice will also be taking on the colossal task of a COVID-19 vaccination campaign against a backdrop of existing heavy workload - with analysis by one LMC suggesting GPs at an average practice are currently working 50 hours more per week than they were a year ago.

Plans published last week suggest practices selected to deliver COVID-19 vaccination will be expected to deliver 975 vaccines within a five-day period. For a practice opening from 8am to 8pm - as NHS England has suggested designated practices in each primary care network (PCN) area will be expected to do - this suggests one vaccine will need to be delivered around every four minutes on average across five days.

The pandemic has slowed the process of delivering vaccines - with RCGP guidance earlier this year suggesting flu vaccines would take at least twice as long as usual, with time per patient rising from 1-3 minutes per person to 'at least four minutes'.

Some practices have been able to bring this down, but GPs have told GPonline that given added complexity, delivering COVID-19 vaccines could take three to four times longer per patient.

Complex process

Practices have been told that with the Pfizer/BioNTech vaccine - the first to report phase three trial results, which showed 90% efficacy - deliveries will come in a package containing 975 doses, made up of 195 vials of five doses each.

Regulations on distribution of medicines prevent these vials being spread out between practices in each area - hence the need initially for a single practice to lead the vaccination campaign in each local area. LMCs have been told that in future smaller batches may be available - and eventually doses in pre-filled syringes once more vaccine is available.

Initially, however, practices will need to dilute and draw up doses of the COVID-19 vaccine into syringes, with diluted vaccine lasting just six hours. An anticipated 15-minute post-vaccination observation period that would have meant practices finding space to keep several patients at a time waiting, socially distanced, now looks to have been dropped - with patients instead to be advised not to drive for 15 minutes.

DAUK warns that given the complexity of the COVID-19 vaccination process, practices will need more support than has currently been offered.

GP funding

A statement from the group says: 'We have seen the significant funds that the government has pumped into other areas including the private sector, for services such as Track and Trace. The funding that has been allocated from current plans is hugely insufficient and significantly lower in comparison.'

DAUK GP committee member Dr Lizzie Toberty said: 'A vaccine delivery programme is vital for the country to recover from the pandemic. Primary care is the best-placed service with the expertise and knowledge to deliver the vaccine safely and efficiently.

'However, there must be adequate resources made available to do this. We urgently need funding to renovate buildings, provide adequate PPE, and enough staff to administer the vaccine safely. It must also be recognised that primary care needs to continue all of our vital, routine work too.

'We must prevent a repetition of the mistakes this country has suffered as a consequence of the underperforming Test and Trace programme. The current plans are not sufficient to give GPs a fighting chance to participate effectively in the vaccine programme.'

Enhanced service

The group has also called for greater transparency over research data to help clinicians inform themselves and their patients - and for co-ordination between primary care and wider plans to deliver vaccines from mass vaccination sites in future.

A final specification for the COVID-19 vaccination enhanced service has been promised in late November, and could come as soon as this week.

Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer told GPonline that doctors locally were 'trying to come up with a logical plan' that would bring together support from the local community trust and practices - but pointed out that when 'business as usual' was 50% up compared with last year, NHS England's plan to keep general practice 'fully open and accessible' alongside the COVID-19 vaccination campaign would be challenging.

She called for a national consent service to be set up so that patients could go through permissions in advance by telephone. Dr Bramall-Stainer added: 'From a practical perspective the government has to get a wriggle on letting us know what they will do with patients aged 50-64 in the flu campaign. 'We are now in mid-November and there is still no guidance - it will not help practice teams if they are having to do extra flu clinics over weekends into the new year.'

GP workforce

Wessex LMCs chief executive Dr Nigel Watson said it was right for GPs to be involved in the COVID-19 vaccination campaign, but warned it 'can't be done by the existing workforce' - suggesting returners and other staff would need to be brought in.

NHS England has said extended access capacity can be redirected to support COVID-19 vaccination, and staff employed by PCNs through the additional roles reimbursement scheme could also come into play.

Liverpool LMC medical secretary Dr Rob Barnett told GPonline that many doctors he had spoken to felt it was 'inconceivable' that general practice would not be involved in the COVID-19 vaccination campaign - but that many were concerned about what they were being expected to pack into a 24-hour day.

'Some other aspects of what we do have to give,' he warned. 'There needs to be a lot of discussion locally about how best to manage this and we need to accept a balance. It needs to be left to practices to work out and prioritise what needs to be done how and when.'

He called for NHS leaders to declare publicly that 2021/22 would be a 'year of recovery' for the NHS - with no expectation that services would suddenly return to normal from 1 April 2021.

But he added: 'At the end of the day this has to be done because vaccination plus mass testing - those get us out of the predicament we are in. General practice has to be part of that solution.'

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