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GPs must individually approve patients for Covid vaccine before delivery

pre-pandemic appointments

GPs are required to ‘individually assess’ each patient before they receive a Covid jab under the initial delivery mechanism, NHS England has said.

And they will take full clinical responsibility for all vaccinations delivered by non-prescribers until a national protocol is agreed, it added.

Each vaccination will take three minutes longer than previously planned under this mechanism, according to new calculations.

It comes as GPs have this weekend been given the green light to start delivering Covid vaccinations in the week commencing 14 December.

A new NHS England document outlining the programme’s legal mechanisms said that neither a Patient Group Direction (PGD) nor the newly-approved National Protocol mechanism will be in place for the start of the vaccination programme tomorrow.

In the meantime, a Patient Specific Direction (PSD) must be used – meaning that prescribers must assess each patient on an individual basis before they can be vaccinated.

The document said: ‘A prescriber will need to give an authorised instruction to administer a medicine to a list of individually named patients where each patient on the list has been individually assessed by that prescriber. 

‘The prescriber must have adequate knowledge of the patient’s health and be satisfied that the medicine to be administered serves the individual needs of each patient on that list.’

Prescribers must be medical practitioners, independent nurses or pharmacist prescribers who are ‘suitably trained with experience in immunisation’ because the vaccine is not yet fully licensed – ‘limiting’ the number of staff who can take this role, it added.

While there is no legal restriction as to who can administer the vaccine under a PSD, the prescriber has a ‘duty of care and is professionally and legally accountable’ for care provided by them or delegated to others, NHS England said.

The document said: ‘A key issue to consider is that in the case of a PSD the prescriber takes full accountability and responsibility for the patient and the members of staff administering the vaccine; unlike in a PGD or National Protocol where staff would be taking responsibility for their own tasks. 

‘In practice, professions are only likely to take on responsibility for others when that person is known to them and they are aware of their skills and training. It is therefore essential that the prescriber is content with taking on this responsibility and that there is no suggestion of expectation for them to take on this role.’

It added that this will lead to a ‘decrease in productivity’ and that ‘an extra three minutes has been included in the modelling’ to take into account prescribing time.

Meanwhile, NHS England said that although ‘more prescribers are available’ in general practice, they will ‘have to be released from other commitments to support with the delivery of vaccinations’. 

It added: ‘There are business continuity risks if large numbers of doctors are required to support in large numbers of vaccination centres as they would be removed from normal work, whether this is on the wards or in primary care and the impact of this will need to be considered.’

The use of a PSD to support delivery of the Covid vaccine ‘is not a long-term viable solution’, it said. 

An NHS spokesman said: ‘As planned, the Patient Specific Direction will be the operational approach during the initial period of the roll-out beginning on Tuesday, as the POD delivery model is first put into practice.

‘This will then subsequently be expanded to PGDs as more vaccine becomes available and wider PCN vaccinating comes online, with further guidance on subsequent steps to be issued next week.’

Around 50 hospital hubs are set to begin administering Covid vaccinations to care home staff and the over-80s this week as part of a ‘phased’ rollout.


Alan Laurie 7 December, 2020 10:51 am

“…neither a Patient Group Direction (PGD) nor the newly-approved National Protocol mechanism will be in place for the start of the vaccination programme tomorrow.”

Michael Mullineux 7 December, 2020 11:19 am

Shifting sands of NHSE directive looking increasingly onerous if not impossible to deliver. Why would any GP sign up to this?

David Ruben 7 December, 2020 11:29 am

So after 8 months of planning, NHSE state this is “‘is not a long-term viable solution’… yet we are meant to be enticed to sign up to the enhanced service by midnight tonight (which if one accepts then becomes part of core primary care contract, and thus any failure to deliver the service is a breach of contract)

David jenkins 7 December, 2020 12:38 pm

why would any self respecting doctor want to sign up to this on these terms ?

a basic rule of mine – which has stood me in good stead for over 40 years – is that if you are at all worried about a course of action, you should not do it !

no thank you – i’d rather go for a lie down !

David Banner 7 December, 2020 1:43 pm

Alan Laurie sums it up in 2 words. A National Protocol mechanism, specifically designed for this catastrophic pandemic, and desperately needed to roll out a crucial and widely anticipated vaccination programme, is not ready in time the day before mass injecting starts. WHY NOT??? Disgraceful buck-passing at its worst.

john mccormack 7 December, 2020 2:25 pm

Completely risk averse bureaucrats once again creating a legal framework to shift the entire responsibility for any negative vaccine outcomes on GPs. Nothing new there.

Anonymous GP 7 December, 2020 2:33 pm

Covid-19 took down the global economy with a Demand & Supply shock, likely to lead to multiple recessions within prolonged depressed global econimic outlook.

The best healthcare systems like Germany had no choice but resort to National Lockdowns as their ICU beds over flowed.

Yet it was the Humble NHS GP, using nothing more than £12.58 shirt on thier back and the promise of the “Enhanced Service” that defeated the Covid-19 dragon, once and for all!

And they all live happily ever after….

Patrufini Duffy 7 December, 2020 2:57 pm

You – not Pfizer will be attending the court room.

Rogue 1 7 December, 2020 3:07 pm

They have been talking about a vaccine since the start of the Covid pandemic, why haven’t they got a national protocol in place. Yet another government fiasco, shame on them!

The Prime Minister 7 December, 2020 3:59 pm



Marie-Louise Irvine 7 December, 2020 7:09 pm

‘The prescriber must have adequate knowledge of the patient’s health and be satisfied that the medicine to be administered serves the individual needs of each patient on that list.’

What knowledge about the patient’s health is needed to be satisfied that the medicine to be administered serves their individual needs?

terry sullivan 7 December, 2020 8:23 pm

just say no

terry sullivan 7 December, 2020 8:24 pm

are the defence cos happy with this?

terry sullivan 7 December, 2020 8:25 pm

bma to comment??