GPs should visit care homes that have confirmed cases of Covid to deliver vaccinations, NHS England has said.
New NHS England guidance said that while vaccination can be ‘temporarily deferred’ for those who are ‘acutely unwell’ or within four weeks of starting symptoms, all other staff and residents should receive ‘prompt’ vaccination.
It comes as GPs have been told to vaccinate every care home resident in their local area by the end of January – with around a quarter of almost 250,000 so far given their first dose.
The document, published last month, said: ‘Covid vaccine should be offered to older adults in care homes and their carers, with the aim of achieving high uptake as rapidly as possible. This includes when other residents have been diagnosed as having Covid-19 infection.
‘Whilst vaccination against Covid may be temporarily deferred in some individuals e.g. acutely unwell or still within four weeks of onset of Covid symptoms, all other staff and care home residents should receive prompt Covid vaccination.’
It recommended that general risk assessments be carried out by the lead vaccinator and care home manager prior to each visit, including for ‘mop-up vaccinations’.
The document said: ‘Before sending vaccination teams to the care home, a risk assessment must be undertaken to ascertain if there are currently any cases or suspected cases of Covid infection in the home.
‘This should include for example the total number of cases/suspected cases, whether the outbreak is emerging or resolving [and] the ability of the home to adequately isolate cases or care for them in larger cohorts.’
If there is an ‘outbreak’ in the care home, GPs should ‘restrict visits’ but if there is a ‘low’ number of cases or they are ‘well-isolated’ from other residents, ‘prompt vaccination of unaffected or recovered staff and residents should be planned’, it added.
Individual staff should also be risk assessed as well as the PPE required for the visit and the care home’s ‘adaptability for Covid vaccination’, NHS England added .
It said: ‘Risk assess individual HCW risk from Covid and exclude those at highest risk if possible. If possible, mitigate risks to HCWs going into the home by vaccinating them beforehand.’
The document suggests vaccinators establish an ‘immunisation station’ or ‘confine their activity to a specific area’, or ‘minimise possible exposure to affected areas’ in their movement through the home.
Birmingham LMC chair Dr Gavin Ralston said GPs should be ‘very cautious’ about the new guidance amid ‘patchy’ access to vaccines.
While ‘quite a lot’ of Birmingham GPs have received their first dose of the vaccine, there is ‘no guarantee’ they will receive a second dose and there are concerns about their current level of protection, he added.
He told Pulse: ‘Obviously it’s important to vaccinate these vulnerable people [in care homes] as quickly as one can, so that’s definitely the right thing to do.
‘But you certainly wouldn’t want to put your workforce in unnecessary danger doing that because otherwise the wider general practice system could quickly fall down.’
Last week, the health secretary promised that all GPs and their staff will be vaccinated by 15 February – and hopefully ‘sooner’.
It comes as two further GPs have died with Covid-19, bringing the total number of GPs lost to the pandemic to 16.
Meanwhile, the health secretary announced this week that almost 25% of older care home residents have received their first dose of the vaccine.
NHS England revealed in a GP webinar last week that a total of 248,581 residents across almost 11,000 care homes in England must be vaccinated by the end of this month.
At the time, 53,285 care home staff had also received their first dose, according to slides presented at the webinar.
The slides added that PCNs should make care homes ‘a priority with both Pfizer and AZ vaccines’.
They reassured practices that there will be ‘sufficient dose in the system by [the] end of this week to meet all care home residents in [the] priority cohort’.
The BMA warned yesterday that the Government must prioritise GP hubs for limited Covid vaccine supplies, rather than having vulnerable elderly travel to mass vaccination centres.