GPs partners subsidising COVID-19 vaccine campaign as bookings drop, GPs warn

GP practices running COVID-19 vaccine clinics may soon be forced to 'chuck in the towel’ as stuttering appointment numbers and high DNAs have left partners subsidising the service, GPs have warned.

Sign pointing to entrance of COVID-19 vaccination hub
COVID-19 vaccination clinics (Photo: coldsnowstorm/Getty Images)

Clinical directors have called on NHS England to share its plans for the future of the campaign, with PCNs reporting daily DNA - 'did not attend' - rates of between 15-33%. One GP said the combined impact of a rise in patients not showing up for appointments and a slump in bookings meant their site was now using as little as half of its available capacity at times.

Increased rates of COVID-19 infection and the reduced severity of the Omicron variant have delayed patients receiving booster jabs or stopped them from turning up at clinics at all, according to GPs.

GPs warned that half-empty vaccine centres are a poor use of staff, while partners risk running the clinics at a loss. They have urged health leaders to reconsider how general practice is involved in the campaign as they consider refocusing on routine care.

Vaccine appointments

Concerns about inappropriate use of staff time come as rising numbers of practices have reported unsustainable workload, leaving teams ‘exhausted’ and the profession in a ‘delicate state’. The RCGP has said the profession is 'working to its limits'.

At the end of last year the government set the target of offering booster vaccinations to all eligible adults before the start of 2022 - a target requiring record-breaking levels of vaccinations to be delivered largely by GP teams.

Although surgeries have stepped up to deliver on this promise - with 1.6m people in the UK receiving a booster or third dose in the final week of 2021- clinical director at Whitewater Loddon PCN in Hampshire Dr Tim Cooper said demand for vaccines had slowed significantly after Christmas and into early 2022.

He said: ‘We're experiencing roughly around a 30% DNA rate each day which has crept up consistently over the last 10 days. We've tried to counter this by offering walk-ins almost every day…but it's not managing to pick up that shortfall. We’re also seeing a massive reduction in bookings - we just can't get people to come in and fill the slots.

GP income

‘Because we’ve operated as six or seven PCNs in a single site, we've always tried to adopt a mass, at-scale model. So our teams are really used to pushing through around 1,200 to 1,500 people a day - but yesterday they did 630.

‘Anecdotally, we're hearing that high rates of COVID-19 infections [have meant that] people eligible to get the vaccine can't come forward for a month now, which means we're going to have this really dribbly trail over the next six weeks, which is really hard to plan clinics for.’

Dr Cooper argued that although staff were keen to keep vaccinating - sending out a roving team and working with council and faith leaders to boost uptake - there had to be a point when practices considered the viability of the campaign.

He said: ‘The way this programme has been contracted through an item of service model is increasingly unhelpful because you can only guarantee an income based on the people you get through the door, which means trying to put people in position and in place - and trying to build the workforce around projections. If the people don't come to the door, then you can't pay your staff.

NHS guidance

‘There is no current guidance about where the campaign is heading and that leaves people on the shop floor like us in a really difficult position. We've got centres that are set up but if we can't get the numbers through or the acuity, we will have to close at some point.’

‘We need to have a really sensible discussion now after this period about what does COVID-19 vaccination look like for the NHS - does it go back towards business as usual general practice, does it get aligned with flu?’ he added.

GPs in other areas tweeted about DNA rates at their vaccine centres, with Coventry GP Dr Grant Ingram warning practices were subsidising the campaign and having to recover costs out of their own pocket.

Dr Ingrams told GPonline: 'It's unclear whether this was just a 'peri-Christmas' holiday effect, or whether it will be ongoing. Obviously [having high levels of DNAs] increases the risk of running clinics at a loss. But we have had a lot of positive feedback from patients who prefer to have their vaccinations done in their own surgery rather than in mass centres.'

GP partner and clinical lead of the Lordship Lane Vaccination Centre in London Dr Russell Hearn said the vaccination centre had also seen a drop-off in bookings, as well as increased DNAs. He said: ‘The prevailing theory in our team is that a lot of appointments were booked quite far in advance, even before Christmas during booster announcements when the overall vaccine machine hadn’t reached the current epic level of provision.

‘One challenge at present is matching supply with demand. I know some centres will be struggling as they have diverted staff to vaccinate from routine work but then there is a high DNA rate. It would be helpful if patients cancelled their appointments to help the NHS run most efficiently whilst delivering amazing care under challenging circumstances.’

Last week NHS England published guidance on how practices could maximise their vaccination output with ten top tips. It advises them to join the National Booking Service (NBS) to maximise potential throughput, in addition to making use of social media to increase public visibility.

Practices can also upload availability of slots to the national NHS walk-in site finder, or CCG and local authority walk-in site finders, it said, to increase engagement. It advises practices to deploy extra volunteers to 'go door-to-door in areas of low uptake to highlight availability of vaccination site.

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