GPs set to get £2 per patient in new push on commissioning
If vaccine ordering is taken away from GPs, is it one less thing to worry about or a bureaucratic nightmare?
By Emma Wilkinson
Vaccine shortages, angry recriminations and fears of a disease pandemic this year's flu campaign has been even more difficult than usual.
The Government has hardly helped by choosing to make GPs the scapegoats, blaming them for failing to order sufficient vaccine and doling it out to the 'worried well'.
Now the Department of Health has set in motion an 'urgent review' of arrangements for the flu campaign which could take responsibility for ordering vaccine supplies out of the hands of GPs.
The department currently secures vaccines for the UK, but it is up to individual practices to order their own supplies. But while officials say all options are now on the table, they are likely to want to take greater control of the procedures for vaccine purchasing and distribution.
Northern Ireland this year set a precedent for a central ordering and distribution system, after officials took away responsibility for placing orders from community pharmacists following a disastrous shortage last winter (see box, right).
Dr Eugene Deeny, chair of Western LMC, Northern Ireland, said there were benefits to the central ordering system similar to that used in the childhood vaccine programme.
'My understanding is that we haven't had a real problem this year. It is one less thing to worry about,' he said.
Some GPs and practice managers would welcome a central system as a way of reducing the financial risk to practices. Dr Guy Watkins, chief executive of Cambridge LMC, said: 'There are practices that have been burned by having unused stock left over.'
Margaret Hooper, practice manager in Lowestoft, Suffolk, agreed. 'If we buy too many we end up wasting vaccine and spending money we can't recoup.
'That restricts it to the regular customers and doesn't allow for anyone else who comes along. If the vaccine came from [Government distributor] Farillon there would be no pressure on us to use practice money.'
Astrid Bannister, flu co-ordinator for Watford and Three Rivers PCT, said she would be open to the idea of a central system. 'As long as sufficient stock is ordered I do not foresee any problems.
'But my concern would be that practices would have little control over how much they could order. Also there is the issue of discounts practices receive.'
The potential loss of practice profits is an important issue, argues Jane Solomon, who organises a large discount buying group in Berkshire, Buckinghamshire and Oxfordshire, which managed this year to secure a profit of £5.60 a dose.
Ms Solomon, director of development and liaison for the LMC, said: 'GPs have been doing it for years and doing it very well. They are businesses that need the profit from flu vaccine.'
GPs are also sceptical that the department could be trusted to order vaccines centrally, pointing to its incompetence this year in adding carers to target groups after vaccine orders had been placed.
Dr James Gillgrass, chief executive of Surrey and Sussex LMC, is convinced this poor planning was a major contributor to the 'under-ordering' of vaccines by GPs.
'The Government introduc-ed two new categories in August and there was no way you could order additional vaccine at that point. We haven't had any problems up until this year so I think the system does work.'
Dr Michael Taylor, chair of the Small Practices Association, said a central system would be a bureaucratic nightmare. 'I'm certain in terms of estimating demand no one is better placed than GPs to do it. The system works brilliantly,' he added.
Dr Raina Patel, a GP in Stockport, said: 'This year has been a very unusual year. [The system] does work well. The Government can't plan for GPs. They would still rely on us [for numbers].'
Another option the department will consider would be to hand PCTs responsibility for ordering vaccine from manufacturers.
Jenny Greenfield, flu co-ordinator for Sussex Downs and Weald PCT, said some PCTs were already making vaccine arran-gements on behalf of GPs but didn't think it was the answer.
'We don't want to go down the route of PCTs buying in. Where would we keep it all? GPs should be responsible for their own stock.'
Whatever the outcome, the current review will have to move quickly as practices are already considering next year's orders, a job made all the more difficult after the heightened demand of recent months.
'Someone is going to have to take the bull by the horns,' said Mrs Hooper.
NI saves with central orders
The Department of Health in Northern Ireland claims it has saved £1.50 per flu vaccine and avoided the shortages elsewhere by switching to a central ordering system.
It decided on the change after it emerged during last year's Chiron-affected delays that 80 per cent of pharmacists were ordering supplies from the company.
Gerry Dorian, deputy principal in the Health Protection Team at the Department of Health, Social Services and Public Safety, said: 'We feel more in control. Our system worked very well and I'm sure there are lessons that can be learnt.
'We had some left over so we released vaccine to Wales and England.'
Options for flu vaccine ordering
· Practices continue to buy directly from manufacturers either through groups or individually
· PCTs take responsibility for purchase and distribution of vaccines
· The Department of Health takes over purchase and distribution of vaccines