GPs voice fears over COVID vaccination costs as practices commit to ES contract

GPs have expressed concerns over the costs associated with delivering local COVID-19 vaccination campaigns as the deadline passed to sign up to the enhanced service last night.

GPs from across the country have signed up to the contract, with 280 selected sites set to deliver 270,000 doses of COVID-19 vaccine from 14 December. But doubts have been raised over the resources given to practices - with some fearing they could face financial losses.

LMCs have identified ‘significant cashflow concerns’ as GPs must wait until the end of January to receive their first round of funding. They have also highlighted concerns over practices being jointly liable with others in their primary care network (PCN) for 'the programme, the stock of the vaccine, including any financial liability or costs incurred'. 

GP leaders have demanded more detail on funding promised by NHS England to avoid practices facing financial difficulty as they deliver COVID-19 vaccinations.

COVID funding

GP practices will receive £12.58 per dose of vaccine administered - but will be paid £25.16 per patient only once both doses required have been completed, according to the enhanced service contract for GPs published last week.

A £20m fund is also available for one-off setup expenses - although this appears largely aimed at unavoidable costs of hiring premises where existing local NHS facilities cannot be used for the vaccine campaign.

It is uncertain how many practices will sign up to the COVID enhanced service, but several LMCs told GPonline they expected the vast majority to sign up - including Wessex, North Staffordshire and Northumberland. But some GPs have questioned the level of support being given to surgeries.

Watford GP Dr Simon Hodes, a joint PCN lead for his practice, said that GPs were best placed to deliver the COVID-19 vaccine, but argued that sufficient up-front support had to be forthcoming. He said: ‘We all want to help with the vaccine, there is no doubt about that, but we need the staff to do it, we need the infrastructure, and we need the premises to deliver it.

Cash flow issues

‘NHS England are talking about paying us in arrears when the vaccine is given, but we don’t know when that money will come on stream, or if patients will come back for a second jab. In addition to that, we need to make some clinical changes to our practice to make that happen.

‘I think practices that are going to be vaccination centres should be given a package of support now which gives them preparation money to do this… My view is that it’s just been seen as something else we can do, but I think actually it should be seen as another bolt-on service that needs funding properly.’

Kent LMC warned earlier this week in an update to GPs of potential financial difficulties with the ES contract. It highlighted that GP practices would have to guarantee quality broadband and organise security at designated sites, which they said ‘could prove expensive’.

It highlighted the fact that practices would be jointly liable for the programme and the stock of the vaccine, including any financial liability or costs incurred. ‘Let us be clear, no one will make a profit from the COVID vaccination programme. We firmly believe our practices should not make a loss and will continue conversations with the CCG,’ it said.

Destabilising PCNs

The LMC went on to suggest a subcontracting model with general practice could be an alternative model that would ‘significantly alleviate concerns that the delivery would be cost neutral for practices and limit the liability to member practices’.

This idea was also proposed by Cambridgeshire LMC, which highlighted in an letter to practices that funding could be ‘clawed back’ if they do not meet requirements outlined in the ES - warning the contract could have a 'destabilising effect' on PCNs.

Wessex LMCs chief executive Dr Nigel Watson told GPonline that he expected the ‘vast majority’ of practices on his patch to sign up to the COVID vaccine contract. He said: ‘If you use the right staff mix, we believe practices should not make a loss. It will be a real challenge, and we will need to increase the workforce, whether that's with GP returners or others. There is also the £150m covid capacity fund coming to practices as well, which supplements the GP workforce over the winter period.'

Northumberland LMC medical secretary Dr Jane Lothian echoed these comments, she said: 'Most practices will sign up or have signed up. For the ones that are concerned, it is around capacity. If you think of the agonising people did over the network agreements - this is taking it to a whole new level - sharing funding, responsibility for the vaccine, site security, IT, premises, insurance, and some quite complex staff sharing agreements. It does require every practice doing their bit in terms of staff training and so on.'

NHS England has said it is aware of cashflow implications for the period between the start of the vaccination campaign and the first payment, but has said it will 'take action to ensure appropriate cash flow to practices'.

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