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Vaccination mandate may hit practice workforce



From April, all practice staff who have direct patient contact must be fully vaccinated for Covid, report Caitlin Tilley and Emma Wilkinson 

It had been in the offing for a while, but the Government’s confirmation that it will be compulsory for all frontline NHS staff to be fully vaccinated against Covid-19 could have serious implications for many practices.

The mandate covers all clinical staff but also non-clinical workers who have direct, face-to-face contact with patients, including receptionists and cleaners. They will be given until April to have both their jabs, health secretary Sajid Javid told Parliament last month.

This will allow time for the health sector to put the measures in place and ‘help minimise risks to workforce capacity over the winter period’, the Government said, as well as bringing NHS staff in line with those working in the care sector.

Healthcare workers will be expected to provide evidence that they have been fully vaccinated although there will be ‘limited exceptions’. It will be for the CQC to ensure compliance and in the worst-case scenarios, they could withdraw registration for practices with unvaccinated staff – effectively shutting them down. 

Mr Javid told MPs: ‘We must avoid preventable harm and protect patients in the NHS, protect colleagues in the NHS, and of course protect the NHS itself.

‘Only colleagues who can show they’re fully vaccinated against Covid-19 can be employed or engaged in those settings.’

NHS England has since issued guidance asking practices to talk to unvaccinated staff. 

‘We ask organisations to ask line managers to have supportive one-to-one conversations with unvaccinated staff to identify reasons for vaccine hesitancy and provide information that will support them to make an informed decision about the vaccine,’ the guidance says. 

It also asks commissioners to support practices, ‘particularly where uptake is lower’.

Figures suggest more than 93% of NHS frontline staff have had one dose and 90% are double jabbed. But that leaves 103,000 unvaccinated workers, the Government says. It would not say how many of those are in primary care. 

Chair of Greater Manchester LMCs Dr Amir Hannan says there are ‘very few’ practice staff in his area who have yet to be vaccinated, but it will be important to understand what extra level of support is needed to help practices ‘remain viable if there is a risk to them’. 

He adds: ‘It is important staff are protected and practices are resilient and can face the threat of Covid-19 as best they can. Vaccination of staff is a critical part of the defence we have.’

But even a small number of unvaccinated staff could have an effect. Concerns have been raised that mandating vaccination could backfire and lead some staff to leave their jobs at a time when the NHS is facing major workforce pressures. 

There could also be logistical and organisational problems for practices if employees refuse to be vaccinated. The Government has previously said GPs and specialists must ‘clinically review’ each and every application for a Covid vaccination exemption.

Tower Hamlets LMC chair Dr Jackie Applebee says she believes people should be ‘encouraged not coerced’ and ‘should not lose their livelihood’ as a result of refusing vaccination. 

While it is important to protect patients, she adds, the vaccine ‘can’t be the only show in town… wearing masks, social distancing and properly ventilated indoor spaces are just as important’. 

‘The NHS is already struggling with a workforce shortage and can ill afford to lose staff who have not been vaccinated.’

Former GP and chair of the BMA Public Health Committee Dr Peter English says: ‘Other countries that have implemented mandatory vaccination of healthcare workers have not, as far as I am aware, seen major staff losses, and I would hope that would apply in the NHS.’

But he adds: ‘Before legislating, I would hope we’ll have already done all we can to win over the small minority of as-yet unvaccinated staff.’

In announcing its final plans, the Government said it had decided not to introduce mandatory flu vaccination ‘at this time’ but would review this next year.

The regulations only apply to England. Scotland and Wales have not made any proposals to make Covid jabs compulsory for NHS workers or care home staff. Northern Ireland has announced a consultation on the issue.

Employment lawyer: ‘Talk to staff now and consider their welfare’

Ffion Jenkins, a solicitor at Rubric Law, says: ‘With the proposed vaccination mandate for general practice, it will be important to think practically about how to create a smooth transition.

‘Now is the time to talk to your staff, understand their reasons for choosing not to be vaccinated and have an open discussion about what this may mean for their role. Evidently, it will be important to consider the welfare of your employees, especially those who cannot be vaccinated as they are exempt.

‘Arguably, a GP who is unvaccinated could be dismissed. However, always seek legal advice before taking any action. It would be wise to check for alternative roles, engage in consultations, and be very cautious before choosing to dismiss employees who aren’t vaccinated. 

‘If you dismiss an employee unfairly then you will run the risk of them pursuing you in the employment tribunals.’