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GP practice facing investigation into how it used up leftover Covid vaccine


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A GP practice is under investigation for administering leftover doses of the Pfizer Covid vaccine to patients outside current eligible cohorts.

NHS Derby and Derbyshire CCG held an investigation last week into a Derbyshire practice’s decision to vaccinate a local football player to avoid vaccine wastage in the last week of January.

The CCG told Pulse it was not a ‘formal’ investigation but that it has shared the report with NHS England, and the practice is expecting an outcome of the investigation.

It comes as NHS England last week updated its guidance to confirm that coronavirus vaccines should not be given to patients outside eligible cohorts.

Previously, it had said that GPs could offer Covid jabs outside the eligible priority cohorts if there is a ‘risk’ of vaccine wastage.

In a statement shared on its website earlier this month, Stubley Medical Centre in Dronfield said it ‘stands by’ its decision to vaccinate patients outside the cohorts as a ‘last resort’ to avoid vaccine wastage.

The vaccination site has ‘not thrown a single dose away’ to date, thanks to operating a reserve list of patients listed by ‘clinical priority’, it added.

The practice said: ‘At the end of every busy vaccination clinic, as is the case elsewhere, it is often the case that we have a small number of vaccines drawn up that we are very reluctant to throw away.   

‘We have a list of possible recipients ready to call. This is a wide range of patients, starting with the existing target groups and listed in clinical priority.’

It added: ‘A further group is at increased risk but may not fall into the current target groups, they are there because they have made reasoned representations to us to be considered as reserves. 

‘This final group of patients are a last resort before the vaccine would have to be thrown away and they need to be able to respond instantly if called.’

A ‘small number’ of Chesterfield FC employees who had ‘existing conditions with consultant letters requesting their vaccination’ are included on the reserve list, the practice said.

It added: ‘One, who lived close to the surgery, attended without such correspondence at the very end a vaccine clinic and a decision was taken to use the vaccine rather than throw it away. We stand by this decision.’

The practice has been working with the football club on plans for a drive-through vaccination service at the Technique Stadium, it said.

Stubley Medical Centre added that it is ‘justifiably proud’ of its performance since the start of the Covid vaccination campaign, with high uptake achieved across priority groups including 100% of over 80s, care home residents and housebound patients.

It said: ‘By careful use of the vaccine product in accordance with approved guidelines, we have managed to vaccinate more than 5,000 more people than for whom the vaccine quantity supplied to us was originally intended.

‘It is probable that a number of extra lives therefore may have been saved by our rapid response to the callup, and our efficiency.’

U-turning wastage guidance has been a source of contention throughout the vaccination programme, with unclear guidance creating a catch-22 situation that has led some sites to throw vaccines away.

Last week, new guidance said that Covid vaccines ‘should not be given to people outside of cohorts one to six’ but only to those from eligible cohorts on reserve lists – contradicting advice given last month.

But this week, an update to the enhanced service again said vaccination ‘will be permitted to patients outside of the announced cohort’ where ‘clinically appropriate’, there are ‘exceptional circumstances’ and vaccine ‘would otherwise have been wasted’.

When approached for comment, NHS England refused to clarify the guidance.

Dr Peter Flann, Chesterfield and Dronfield PCN clinical director, told Pulse: ‘My perspective is that the investigation never should have taken place, and that we have not done anything out of the ordinary.

‘We’re talking about two people who received a vaccine at the end of a clinic when the vaccine would have been wasted. Considering that we have provided around 35,000 vaccines in the PCN… It is rather disproportionate that two vaccines are questioned.’

He added: ‘We weren’t happy that an investigation was underway in any way at all. We provided the vaccines in the same circumstances as anyone else would have done – if the priority is not to waste the vaccine.’

An NHS Derby and Derbyshire CCG spokesperson said: ‘We have been working with all providers of vaccinations to ensure that the programme is delivered in line with the clear national policy on vaccinations. We are reviewing this particular issue with the local vaccination service concerned.’

READERS' COMMENTS [29]

Azeem Majeed 24 February, 2021 10:47 am

This is a pointless investigation. If the choice is to give a vaccine dose leftover at the end of a session to someone, even if they are outside a priority group, or to throw it away, the decision must be to always use the vaccine. No Covid-19 vaccine must ever be discarded. Of course, practices should have a reserve list of eligible patients who they can call at short notice but if no one is able to attend the clinic, the vaccine must be used.

Reply moderated
Michael Mullineux 24 February, 2021 11:07 am

Completely with Dr Flann: coercive micromanagement and a jobsworth attitude so typical of many CCG acolytes and NHSE. Rather than congratulating on a job seemingly well done, focusing on utterly inconsequential minutiae. Might have the effect of saying over to you to mange and deliver …

Reply moderated
Anthony Everington 24 February, 2021 11:41 am

There is nothing worse than wasting a vaccination and all vaccination centres I know have back up groups of patients who can come in at the last minute to avoid this. This investigation is innapropriate use of CCG managerial time. They should be thanking this centres for the thousands of vaccinations given.
At the beginning of the vaccination programme it was apparent that you could get 6 vaccinations out of a designated 5 vaccination Pfizer vial. It took the centre 2-3 weeks to change their guidance. Maybe that and a number of other central failures should be investigated, rather than investigating those on the ground who are getting on and doing an amazing job.
As a CCG chair, I am embarrassed to read about what this CCG has done.

Reply moderated
Dermot Ryan 24 February, 2021 12:05 pm

What a complete waste of time.
But it is hard for CCGs to ever think up something useful to do.
Some things never change.

Reply moderated
Bob Hodges 24 February, 2021 12:09 pm

Of course, the practice could just say ‘if you can do better yourself over to you, otherwise feck off’.

Merlin Wyltt 24 February, 2021 12:14 pm

Don’t risk getting into trouble–just chuck it all away

Reply moderated
Bradley Pearl 24 February, 2021 1:15 pm

Firstly these guidelines have been drawn up on the hoof. It’s all one big experiment until we have the evidence to back it up. Secondly knowing when to break guidelines with clinical justification is an overarching skill of our profession. We should be justifiably outraged that public money is being wasted on yet more bureaucratic nonsense instead of congratulating these professionals on doing a good job

Reply moderated
Mahesh Kamdar 24 February, 2021 2:02 pm

Talk about wasting money and resources, this is a typical example.
It must be a bunch of first class idiots to think about this investigation.
Practice which made the decision should receive the highest praise.

Reply moderated
Daniel Henderson 24 February, 2021 2:07 pm

This is bonkers. The guidance 2 weeks ago said vaccine sites could vaccinate outside cohorts. Now it says different. OK, stick to the ever changing rules, if you can’t get anyone in the cohorts to come last minute then what…..chuck it? Proper pen pushing. Let GPs just get on with it.

Reply moderated
Jeremy Platt 24 February, 2021 2:17 pm

What a lot of nonsense. It’s always better to immunize someone rather than no one. NHSE probably just want to emphasize that they expect top cohort people to be done first, and want to ensure that the practice concerned has a system of, as it were, “reserves” to call upon first. Surely they wouldn’t prefer wastage. May be just the way it’s been reported.

Patrufini Duffy 24 February, 2021 3:52 pm

World leading – the CCG and NHSE, an incomparable 5* blame game service.

Andy Hughes 24 February, 2021 6:21 pm

Should be a new slogan, “ Boris says Chuck it”

David jenkins 24 February, 2021 7:01 pm

they should down tools, and say to the ccg “we are working flat out to do this. we cannot waste clinical time dealing with non clinical drivel like this. if that’s your attitude, either do it yourself, or get someone else” – and then explain to the great british public why the nosey-parker-brigade have prevented them from continuing to immunise them.

“very sorry, but it’s not our fault we’ve been prevented from working – here is the number of the chair of the ccg/pct/whatever that has caused this problem”!

Ceri Donaghy 24 February, 2021 8:33 pm

It’s a bad thing not to waste vaccines?
Speechless!

John Cahill 24 February, 2021 9:04 pm

Has anyone wondered what to do if there are 2 left over Pfizer vials with identical BN with 0.15 ml in each and an eligible patient presents at the end of the day?

Ceri Donaghy 24 February, 2021 9:23 pm

I wouldn’t mix the vials, but we have got more than 10 doses out of one of the Oxford vials, sometimes 12, comfortably We have not wasted them. We have a back up list to call on, and it’s been appreciated.
If this is wrong, I don’t know what to say.

Anthony Gould 25 February, 2021 12:26 am

Independent Contractors ??!!

David Banner 25 February, 2021 9:13 am

Who was the pathetic, snivelling, jumped up jobsworth little creep that grassed the vaccination centre to the CCG? I hope they are proud of themselves. Even in the middle of a heroic if hectic campaign there are always vindictive snakes looking to big themselves up by knocking others down. Any sentient being can see that injecting vaccine into any arm trumps binning such a precious resource. We can be disappointed that the CCG decided to informally investigate, but the real culprit here is the odious snitch.

David jenkins 25 February, 2021 11:12 am

what would be really effective is to get a camera crew round to the shop, and film them throwing stuff away rather than do the sensible thing !

if you could get a local celeb, or perhaps a footballer, there with a long face, and his/her sleeve rolled up, then the shit would really hit the fan.

there must be someone who has already handed their notice in who is not afraid of the administrators !

David Jarvis 25 February, 2021 1:08 pm

All over 18’s are entitled we are quite rightly prioritizing. The issue is at the top they would take a bung to give a PPE contract to a mate so assume we are going to take a bung to give a vaccine early. That is how they think at the top.
What a waste of time. No vaccine should be wasted. I would like to see the waste figures for various providers. I dropped a syringe that stuck in the floor like a dart so that was wasted. I was upset by this. I am not upset by the footballer being jabbed. We did a passing security guard one evening and a policeman who had been staioned outside in case of trouble.
Every person vaccine is a win. Happy with priority system as clearly appropriate but this is one in 17 million. Pretty good in my book.

Mansoor Akhtar 25 February, 2021 1:45 pm

Completly agree with my colleagues that useless investigations, micromanging practices like this will undermine already demoralise NHS staff. What a mind to investigate these issues, actually the GP practice to be commended that they have not wasted the leftover vaccine but used it rightly according to their vclinical judgement

Susan Martin 25 February, 2021 5:08 pm

GMC duties of a doctor: 18
You must make good use of the resources available to you.

Just saying.

helen towner 25 February, 2021 5:45 pm

How weird and small minded to start a formal investigation into the use of 2 doses which would have been wasted when the PCN has made 5000 extra doses out of the vials supplied to them!

Samuel Parker 25 February, 2021 6:15 pm

Person who launched this investigation should be named and removed from their job

Anthony Matheson 25 February, 2021 7:02 pm

If I had any leftover doses at the end of a vaccination clinic, if it were the end of the day I’d probably grab the last patient leaving the building and jab them. If there were no patients I would have no hesitation in vaccinating one of the receptionists. After all they meet everyone that enters that front door.

This investigation shows how petty and borderline vindictive the numpties in the ivory towers can be.

Grrrr!

Michael Mullineux 25 February, 2021 11:36 pm

Message to the editor: somewhat mystified how a comment I made on the 24/2 in support of Dr Flann and his team supportinghis contention that their vaccination effiorts deserved praise rather than sanction by CCG jobsworths should be considered offensive and taken down? And what happened to Dt Everinton’s incisive response? Strange and concerning times.

NEIL BANIK 27 February, 2021 6:54 pm

Update on the update to the enhanced service:
again said vaccination ‘will be permitted to patients outside of the announced cohort’ where ‘clinically appropriate’, there are ‘exceptional circumstances’ and vaccine ‘would otherwise have been wasted’.

Martin Coleman 1 March, 2021 12:30 am

Be a good boy/girl & chuck the sh*t in th bin & save yourselves the agro!

Stephen Robertson 3 March, 2021 8:45 pm

What a waste of space some people really are. I thought we were meant to use clinical discretion and I was always taught about beneficence and justice in ethics, I feel it ticks all the boxes. Good for them on not wasting what the majority of people around the world don’t have a hope in hell of having access to anytime this year. Shameful that someone thinks it’s better to waste it, they’re in the wrong job!