Plan to strip vaccination role from GP practices could threaten routine care

Plans to deliver COVID-19 and other vaccines outside of general practice through a national vaccination service are a ‘potential public health issue’ and could disrupt routine primary care provision, GPs have warned.

COVID-19 vaccination (Photo: Jasmin Merdan/Getty Images)

Health and social care secretary Sajid Javid has suggested that a national vaccination service would be set up to deliver COVID-19 and other vaccinations to ensure GPs can focus on their 'regular work' now and in the future after their efforts with the booster campaign.

Mr Javid told MPs that the government could not call on GPs every time they wanted to encourage people to be protected against COVID-19 - and implied that using the GP workforce for other vaccinations was not a good use of staff.

But GPs have warned that a national vaccine service could lead to lower vaccination rates, higher rates of infectious diseases and wider health inequalities - and say using a private contractor to deliver jabs would be 'a waste of money' and that GPs can deliver jabs with adequate funding.

COVID-19 vaccinations

GPs leading vaccination campaigns have argued that moving the service outside of general practice could see them struggle to provide current levels of service, because funding for delivery of vaccinations such as the annual flu jab campaign are baked into practice budgets and used to employ staff all year round.

GP practices delivered 55.3m COVID-19 vaccination appointments last year on top of 311.5m routine appointments. Practice staff also vaccinated a record 81.4% of patients aged over 65 against flu. In December GPs were instructed to focus on delivering COVID-19 booster jabs, but have been told they should now 'restore routine services'.

How COVID-19 vaccinations are rolled out in future and by whom is currently unclear. But Gateshead and South Tyneside LMC representative Dr Paul Evans said general practice should continue to have a role amid suggestions of a national vaccine service.

He said: ‘There's a potential public health issue here because we GPs are very, very good at knowing our patients. There's been countless examples all over the country of patients who are ambivalent or even really quite hesitant about vaccination for both COVID-19, but also for things like MMR and routine childhood vaccination, and flu.

Public health

‘A lot of flu vaccinations get done because GPs who patients trust have put in the time to talk to them and work through their concerns - and we've ended up with populations that are better vaccinated as a consequence, with fewer preventable deaths as a result of that.

‘We are also willing to ensure that mobility issues for example are not a barrier to vaccination. On previous form, larger vaccination centres were not willing or able to accommodate for this, meaning people couldn't get vaccinated...the national vaccine service could be a waste of money that would widen health inequalities and lead to lower vaccination rates and higher infectious disease rates.’

Dr Evans added that funding from vaccines, particularly the flu vaccine, was essential to the smooth running of general practice services and would have to be placed into the global sum if GPs were relieved of this duty.

On flu vaccine funding, he said: ‘Financially, this is money that GP surgeries have long budgeted for. Flu vaccine money is part of the running costs of GP surgeries, we factor in our staffing based upon projected income and that's a large part of it. If that's suddenly going to be taken away, we've then got to look at the impact that has on our ability to provide the services we currently provide.

Global sum

‘I think it would be sensible [to replace the money in the global sum]. But I still think taking vaccines out of general practice would be a terrible idea because of the fact that we do it so well and we're really good at it.’

In 2018, the responsibility for providing vaccinations and immunisations was taken away from Scottish GP practices and moved to health boards - although practices are still delivering some during the 'transitional phase'. All historic income from vaccinations including enhanced services however will transfer into GPs' global sum from 1 April 2022.

Watford GP and LMC rep Dr Simon Hodes said it was important to consider the duality of vaccine appointments in giving jabs and checking in on patients. He said: ‘On the one hand you'd say, "Yeah, that's great because it takes workload away from GPs". But on the downside, when you get a jab with a GP you're not just getting a jab, you're getting a more holistic health check because we've got the full healthcare record available and we know the backgrounds of the patients.

‘We can offer other jabs if they're eligible, we can offer health promotion and screening - they might be due a blood pressure check or a diabetes check and we can ask them to book that in while they're there. Whereas a third party organisation - whoever they are - will only be offering a jab. They will literally stick a needle in their arm and they'll be gone.

Fragmented care

‘My own personal view would be that you are better off properly funding it and giving the jabs through general practice and to bring that income through into PCNs or through practices so that we can provide more holistic care to patients.

‘I can't believe there's someone who is more efficient than general practice, because we've already got the buildings, we've got the equipment, we've got the computers and we've got all the staff. You've got PCNs covering 30,000 to 50,000 patients throughout England anyway. Surely that infrastructure is there, why create another parallel service? It fragments the NHS.’

A spokesperson from campaign group GP Survival, said: ‘Taking vaccinations out of general practice would essentially provide a solution to a problem that doesn’t exist. GPs and their teams have delivered the majority of COVID vaccinations throughout the pandemic on top of managing a 17% increase in appointments.

‘The move would lead to the fragmentation of care, with a risk of information not reaching GP records in time - not to mention confusion for patients - and it could draw staff away from an already depleted primary care workforce.

‘With a large number of GPs providing flu jabs for patients each year, it may result in a loss of income for surgeries. This would be less than ideal as this income can be and is often used by teams in the overall running of practices. Only general practice has the flexibility and rapid response capabilities to scale up and down urgent vaccination needs, and this is where the responsibility should remain.’

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