PCNs press ahead with second dose of Pfizer jab as minister backs local discretion

GPs across England are providing second doses of the Pfizer/BioNTech COVID-19 vaccine to patients despite NHS England calls to cancel them, GPonline can reveal - as a minister admitted the decision was a matter for local discretion.

Pfizer/BioNTech vaccine (Photo: Thomas Kienzle/AFP/Getty Images)
Pfizer/BioNTech vaccine (Photo: Thomas Kienzle/AFP/Getty Images)

GP-led sites delivering COVID-19 vaccination were originally instructed to book patients in for a second dose of the Pfizer/BioNTech vaccine three weeks after their initial jab.

However, the Joint Committee for Vaccination and Immunisation (JCVI) last week advised that 'delivery of the first dose to as many eligible individuals as possible should be initially prioritised over delivery of a second vaccine dose' to maximise the 'short-term impact' of the vaccination programme.

GP leaders said last-minute rescheduling of appointments for vulnerable patients was ‘grossly unfair’ to both patients and staff - arguing that it would be almost impossible to achieve in the time available, and promised to support practices choosing to honour appointments.

COVID-19 vaccination

Guidance from NHS England during a webinar on 5 January confirmed plans to 'delay all second doses until 12 weeks after the first dose', and said 'second dose patient appointments already booked need to be cancelled and rearranged'.

However, GPonline has confirmed that a number of GP vaccination sites have decided to honour promises made to patients by vaccinating them with a second dose of the jab, with some having done so already this week. They argue that rescheduling appointments would have been a logistical nightmare and a breach of trust with patients.

Confirmation that some sites are pressing ahead with second doses came as the government's minister for vaccine delivery Nadhim Zahawi told the BBC's Today programme on 6 January it was 'right' for local sites to decide whether to press ahead with second doses.

He said: 'They will make those decisions ultimately on the local circumstances and they are right to have that ability.'

Second dose

Co-clinical director of Wokingham North PCN Dr Rupa Joshi said uptake for the first round of jabs had been ‘phenomenal’, with the network - covering 63,000 patients - managing to vaccinate just shy of 2,000 people.

Dr Joshi said her PCN, which runs two vaccination sites, would offer patients a second jab despite the updated guidance. She said: ‘It’s a controversial decision, and I totally agree with the national guidance that we should be spreading the load as quickly as possible to protect as many patients as possible.

‘But, logistically, it just wasn’t possible for us to phone 2,000 patients [and reschedule their appointments] - many of this group don’t have mobile phone numbers. Also, we did "wave one" and "wave two" all in one week, so to ask our staff to work over the bank holiday and the weekend [would have been unfair]. They had already worked so hard before Christmas and they really deserved a break.

‘The other thing was that we had made a commitment to patients, they had signed something and we consented for them to get two vaccines on those dates and it’s really difficult to go back on that consent, and how it would affect patient trusts us as well.’

The Wokingham GP revealed that her PCN would continue to offer other patients their first jabs alongside second doses of the vaccination, running a seperate clinic this week.

GP-patient trust

Watford GP Dr Simon Hodes, who is a joint PCN lead for his practice, told GPonline that the four practices in his PCN had ‘unanimously agreed’ to give patients a second dose of the vaccine.

He said: ‘We felt that on an ethical basis these patients had consented to a second vaccine at three weeks, and this group of patients are largely over 80 and are very frail and have arranged transport to come into us. We booked all of them in for their repeat jab and felt that it would be unfair to cancel them, which inconveniences them and their carers or families.

‘In addition, these messages are not done by text message, a lot of them are by phone calls. We spent the better part of three or four days booking in these appointments, so to cancel them would take an equivalent amount of time and probably longer because there would be lots of follow-up questions about why we had cancelled the second jab and when they would get a second appointment.’

Dr Hodes added that the prospect of rescheduling around 1,000 appointments would have been complicated by staff absences. He said: ‘There are a lot of staff on holiday, we have three members of staff who have COVID and are off work, and we have several other members self-isolating - this is the reality of it.'

GPs under pressure

West Basildon PCN clinical director and vaccination lead Dr Vishal Sharma said that his PCN had decided to offer second doses to patients as it made sense clinically. He said: ‘This is the group that is most vulnerable, and it’s the target group to hit. The logistical challenge of trying to move them around and disappointing patients, who were expecting to have a second dose, needed to be taken into account.’

Dr Sharma said last-minute changes to vaccination plans had placed unnecessary pressure on GP surgeries. He said: I think it’s incredibly frustrating. I appreciate that the dynamic is changing continuously and the evidence changes, but I think there is a sheer lack of appreciation for the logistical arrangements and the pressure that this puts on the service.’

Last week the BMA argued existing appointments should be honoured and that it would support GPs if they decided to vaccinate those patients who were due to have a second jab next month. A spokesperson told GPonline that it was currently unable to quantify how many practices would honour second doses.

The JCVI has advised that second doses of the Pfizer/BioNTech vaccine can be administered after 3-12 weeks and second doses of the Oxford/Astra Zeneca vaccine after 4-12 weeks to ensure as many people as possible in at-risk groups receive a first dose of the vaccine.

The government is aiming to deliver 13.9m vaccinations across the UK by mid February, and GPs in England have been asked to complete vaccination of nearly 250,000 care home patients by the end of this month.

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