BMA leaders warned this week that general practice would need 'substantial support' to deliver an accelerated COVID-19 booster campaign in the face of growing concern over the Omicron variant.
BMA GP committee chair Dr Farah Jameel called for more detail on how practices would be freed up to dedicate more time to the accelerated booster campaign, warning on 1 December that as things stood, the profession simply did not have the 'staff or spare capacity to manage the additional numbers of patients expected to come forward for boosters alongside all the non-COVID care and assessments their contracts have bound them to do'.
NHS England announced earlier this week that the basic fee per jab would increase to £15, and that CQC inspections would be paused.
In a letter to practices on 3 December, NHS England chief executive Amanda Pritchard confirmed further steps to ease pressure on practices such as part-suspension of QOF, a halt to some enhanced services work and suspension of some targets under the Investment and Impact Fund (IIF).
The sign-up window for the current phase of the vaccination campaign has been reopened to allow PCNs that have opted out to rejoin if they wish to do so.
BMA GP committee chair Dr Farah Jameel said the changes announced by NHS England offered some recognition of limited capacity in general practice. She said practices were determined to step up in the midst of a 'national emergency' - but could not do 'everything for everyone all of the time'.
The NHS England letter, co-signed by NHS England medical director for primary care Dr Nikki Kanani, says: 'We recognise the pressure all local services are under, however as the secretary of state for health and social care has said, the "new national mission" is to increase vaccine capacity.
'There are no supply challenges with either the Moderna or Pfizer booster stocks, therefore all vaccination sites are now asked to load their [national booking service] calendars to the end of January, where possible.'
Given the 'scale of effort required in primary care', the letter confirms measures 'to support all PCN-led local vaccination services', including moves to create capacity and financial support.
The letter says: 'Creating capacity within primary care will be enabled by the following: If participating in the vaccination programme, income protection for the minor surgery DES will apply from 1 December 2021 until 31 March 2022.
'Local commissioners should make the monthly payments to practices for the minor surgery DES that they made for the corresponding period from 1 December 2018 to 31 March 2019. No contract enforcement will be taken where no activity is done under the minor surgery additional service from 1 December 2021 to 31 March 2022. Capacity released must be redeployed to vaccination'.
The letter adds that where contractors consider it clinically appropriate, routine health checks for over-75s and newly registered patients can be deferred until 31 March 2022.
It adds that QOF indicators including 'vaccination, cervical screening, register indicators and those related to optimal prescribing' will continue to operate and be paid on the basis of practice performance.
However, other targets will pause, with income protected in line with 'historical practice performance' in a similar way to last year. The letter adds, however: 'To be eligible for income protection, practices will need to agree with their commissioner a plan that will set out how QOF care will be delivered wherever possible but with priority according to clinical risk, and accounting for inequalities.'
IIF targets for flu immunisation and 'completed work on appointment recording and categorisation' will be paid as normal, NHS England confirmed, while remaining indicators will be suspended and the funding repurposed.
The letter confirms that 'the majority of the funding allocated to these suspended indicators will instead be allocated to PCNs via a PCN support payment, on a weighted patient basis, subject to confirmation from the PCN that it will be reinvested into services or workforce'. Any funding left over will fund an incentive scheme to support PCNs where practices are fully participating in COVID-19 vaccination.
Meanwhile, the minimum threshold for medication reviews under the dispensing services quality scheme has been lowered from a requirement for 10% of dispensing patients to be reviewed to 7.5% - with practices expected to prioritise 'patients who they consider to be higher-risk or would benefit most from a review'.
The letter says increased fees per jab are intented to help sites attract and retain staff, outlines additional funding for clinical director time and a supplement for jabs administered to patients with severe immunosuppression. It confirms that CQC inspections will only continue in the form of 'risk-based assessment...where deemed critical to safety and quality'.
Dr Jameel said: 'GPs and their teams want to do all they can to protect and look after their communities, focusing on those most in need. This means finely balancing the clear national priority to deliver booster vaccinations to as many people as possible with ensuring that people who need care and treatment from their GP practice and the wider NHS continue to receive it.
'With a finite number of staff and hours in the day, and while GPs and their teams will want to step up and do all they can in the midst of this national emergency, there must be a recognition that they cannot do everything for everyone all of the time.
'Today’s changes begin to recognise this, and we hope that, by removing some of the more bureaucratic and target-based requirements within practices’ contracts, that staff’s time can be freed up to get more jabs into arms, while allowing practices to focus on patients who need their attention the most.
'Patients need to know that if they are unwell or have concerning symptoms and need to receive care from their practice they will continue to be prioritised and GP teams will continue doing their very best to keep their sickest patients safe in every way they can and know how.'