In a letter to GP practices setting out changes to the enhanced service package for phase 3 of the vaccination campaign, NHS England says: 'We have considered carefully whether we could support the administration of the COVID-19 booster vaccines at individual practice level. For a number of reasons this is not operationally feasible.'
GP leaders have long called for COVID-19 vaccinations to be made more accessible at individual practice level - and called the decision 'incredibly frustrating'.
BMA GP committee chair Dr Richard Vautrey said: 'It’s incredibly frustrating to see NHS England once again disregard the voice of hardworking GPs, ignoring our calls - specifically by not doing more to enable all practices to give vaccinations from within their own premises if that’s what they wish to do.'
COVID booster jabs
The GP committee chair said freedom to offer jabs at practice level could boost uptake, increase patient confidence and limit the impact on GP practices already 'buckling under intense workload pressure'.
NHS England said its phase 3 plan was 'largely based' on the enhanced service agreements for the first two phases of the COVID-19 vaccination campaign.
The current enhanced service will be extended to 31 October, but practices will not be able to deliver booster vaccinations unless they sign up to the phase 3 agreement - with an opt-in process open until 5pm on Wednesday 28 July 2021. Practices that sign up to the new deal will have their existing phase 1 and 2 contract terminated and deliver all subsequent vaccinations under the phase 3 deal.
The revised package offers practices £12.58 per dose administered, with a £10 supplement for jabs in a care home or other residential setting, or to housebound patients or people in hostels or homeless accommodation who could not have attended a vaccination site.
A letter from NHS England confirms that 'further additional reasonable costs funding' will be available on a similar basis to previous phases of the vaccination campaign, with further guidance to be issued soon. The letter adds that 'additional reasonable costs funding will also be available to general practices delivering flu vaccination in 2021/22'.
The NHS England letter says it ruled out practice level jabs because of the 'need to expand the capacity in the delivery network (to deliver the COVID booster programme alongside the flu programme)', limited numbers of new sites that could be approved over summer, limitations in the supply chain and the possibility that 'the vaccine characteristics will require at scale working'.
Officials said they were working on the basis of JCVI interim advice to enable co-administration of flu and COVID-19 vaccines.
The letter says PCN groupings 'will be expected to deliver the majority of COVID-19 vaccinations from designated sites, but will be permitted to transport and administer some vaccines (where vaccine characteristics allow) from other locations in line with specific requirements set out in the specification'.
NHS England has also set out details of items it will continue to supply as part of the vaccination campaign, including syringes, handwash, waste bags, sharps bins and other items.
Centrally-sourced additional staff will continue to be available to support the programme, and the update promises improvements to data management.
BMA GP committee chair Dr Richard Vautrey said: 'People know that their GP practice is the best place to get routine vaccinations and nothing shows this more than the annual flu campaign and most recently, the COVID-19 vaccination rollout. GPs want and expect to be involved in the COVID-19 booster programme this autumn; it gives patients confidence they can get their booster via their local surgery – especially if this can be done at the same time as flu jabs. Doctors and their teams should be given support and flexibility to take part in a way that works best for their patients.
'So it’s incredibly frustrating to see NHS England once again disregard the voice of hardworking GPs, ignoring our calls - specifically by not doing more to enable all practices to give vaccinations from within their own premises if that’s what they wish to do. If they were able to do so, it could limit the impact of the booster campaign on other important GP services. It would also mean GPs and their teams could offer opportunistic vaccinations to patients attending with other illnesses – a strategy that we know increases uptake for flu jabs.
'Elsewhere in the UK we have seen GPs giving COVID-19 vaccinations from within their surgery buildings, so there is no good reason for it not to happen in England. And while practices should be able to work together in the campaign, this should not be mandated.'
The furious response from the BMA to the phase 3 enhanced service comes just weeks after GP leaders condemned a 'fundamentally flawed' £20m weight management enhanced service offer published by NHS England - and is the latest sign of a major communications breakdown. All formal talks between the BMA and NHS England have now been suspended for two months after GPs delivered a vote of no confidence in health service chiefs.
Dr Vautrey added: 'Practices are buckling under intense workload pressure, with this looking set to increase in the coming months. Yet NHS England once again refuses to give GPs the flexibility to lead in a way that works best for their communities. Instead it is continuing the ‘command and control’ approach seen throughout the pandemic, and today’s communications will do nothing to regain confidence among the profession.
'GPs know that vaccination will continue to be the key to moving out of the pandemic and want to make sure their patients are protected against what is still a deadly disease, but NHS England is making this far more difficult than it needs to be.'