This week, the NHS in England began inviting people aged 70 and over, as well as those listed as clinically extremely vulnerable, for COVID-19 vaccination. The campaign expansion came as 10 more mass vaccination centres opened, taking the total to 20.
But GPs have questioned this strategy, arguing that limited supplies of COVID-19 vaccine are preventing them from maximising the number of jabs they can offer to patients in priority groups.
The government has admitted repeatedly that supply remains the 'rate limiting factor' for the COVID-19 vaccination campaign, which aims to complete 15m jabs by mid-February UK-wide.
COVID-19 vaccine supply
Some GPs have labelled the mass vaccination centres a ‘political stunt’, arguing that they are less appropriate for elderly patients and others on the vaccine priority list who would prefer to be vaccinated at local sites.
GPonline understands that GPs attending NHS England's primary care webinar last week were told that officials hope to move from the current 'push' system, where vaccines are sent out as they become available, to a 'pull' system, where GPs are able to request vaccine stock, within the next few weeks.
However, until this shift occurs, GPs have said that if any parts of the vaccination system have more doses than they can administer these should be redirected immediately to GP sites.
A total of 3.7m patients in England have received at least a first dose of COVID-19 vaccine, including more than half of patients aged over 80 - allthough rollout has slowed in recent days.
GPs have warned that limited vaccine supplies arriving at primary care networks (PCN) is slowing down their work. Clinical director of Kingston PCN in London Dr Richard Van Mellaerts told GPonline that the vaccination site he is working at, which covers 100,000 patients, upscaled its operation only to be hampered by lack of vaccines.
'Perverse' distribution system
He said: ‘We could be doing 2,000 patients a day, easily. And, yet it looks like we're being penalised for our success and only getting around 800 vaccines a week. There are communications going around that our supply is predicated on the number of remaining over 80s. Now obviously, if we'd been efficient and got through all these people, then we're going to be allocated far less.
‘I absolutely believe in providing equity across the country, for all of our patients, but it seems utterly perverse, when you've got one part of the system which is starting to work effectively and providing vaccinations at scale, for it to be cut back to such an extent it's only able to provide a fraction of what it can do.’
Dr Van Mellaerts welcomed the rollout of a mass vaccination centre in his area, but warned it must not disrupt the efforts of local clinics. He said: ‘I'm absolutely all for it. But if we are slowed down to a walking pace by the strangulation of supply, the worry is that this happens in order to allow other parts of the system to flourish.
‘So the concern and anxiety is that general practice, and therefore our patients, are being disadvantaged in order to allow the mass vaccination sites and other parts of the system to look better. And this becomes more of a political management [issue] than actually providing effective patient care - and allowing those parts of the system which are working well to be strangled by a lack of supply.’
Redistribute surplus vaccine
The London-based GP said that goodwill shown by local partners and volunteers to help run clinics could evaporate because of the stop-start nature of the work. He stressed it would be hugely beneficial to have more certainty around deliveries.
'If you have a site that is receiving more frequent deliveries than they [can deliver], we should redirect them to those sites that are able to provide the most vaccinations per day. We should be incentivising the most effective and efficient parts of the system, and not penalising them,' he said.
Kent LMC medical director Dr John Allingham reported a similar situation, revealing that GP-led clinics were operating at a fraction of what they could deliver. He said: ‘We've got some very good, very efficient centres up and running, who can go a lot faster than their vaccine supply. But they're being held back by vaccine supply.
'For example, Whitstable Medical Practice has a drive-through model and has the capacity for 2,000 patients a week at their drive-through centre but they're getting 800 vaccines a week. [But they] have not delivered to all of their over-80s yet because they're a practice with a population of more than 40,000 patients. If they had been given the vaccine in greater supply, they could have done it.'
'Diluting' vaccine supply
Dr Allingham proposed GP-led sites should be allowed to get on with the job, using the systems and relationships they already have with patients to clear priority groups. He suggested that the rollout of mass vaccination centres, which he thought premature, was ‘diluting vaccine supply’.
'My overarching point is that we should be looking at what we can do with what we've already got up and running. I personally believe that we will get the cohorts that need to be hit first done quicker if you let the GPs get on with it, because it would be done closer to home.
‘I think the at-risk cohorts are going to have a higher uptake if they're delivered by the GP surgery. Imagine that you're an elderly person, you trust your doctor, you trust your surgery. Do you trust the letter that arrives out of the blue that says you will have to travel halfway around London to get your jab? You're probably going to be less trusting.’
He added: ‘When you've seen the pain that people have gone through to set these clinics up, and we're now going: "Please, we can go faster, we can really nail this". Some people are saying that they can do their whole town in two weeks, just give us the vaccine.’
At a Downing Street press conference on Monday, Matt Hancock said: ‘We’re prioritising the supply of the vaccine into those parts of the country that need to complete the over-80s. Supply is the rate limiting factor – the NHS has brilliantly been able to deliver the amount of supply that we have available ready to go out.’
Last week the BMA asked the government for reassurance that vaccine supply will keep up with demand across GP-led clinics, and it asked for clarification on how GPs would work alongside mass vaccination centres. GPs have reported problems with the delivery of COVID vaccines as orders have been pushed back multiple times or cancelled at short notice - forcing surgeries to reschedule or cancel appointments.