Patients with asthma are to be prioritised for Covid vaccination if they repeatedly use systemic steroids or have been hospitalised due to asthma, prompting warnings about the confusion and extra work the new NHS guidance will cause GPs.
In a letter sent over the weekend to GPs about the next stage of the vaccine programme, NHS England stressed over the next two weeks primary care network sites ‘should focus their efforts on inviting JCVI cohort six which includes a wider group of people at higher clinical risk’.
NHS England said patients with asthma would fall under cohort six if they have ever had an emergency asthma admission. The other criteria is an asthma diagnosis while also having had three prescriptions for oral steroids over a three-month period.
GPs say confused patients will end up calling practices to find out if they are eligible – and it will be ‘yet another task’ for GPs to determine who meets the criteria.
Others warn it will not even be possible to search their practice IT systems to identify patients.
Charity Asthma UK added that the new NHS guidance is too restrictive and will be ‘frustrating’ and ‘upsetting’ for many patients.
Dr Phil Williams, a GP partner in Lincoln, told Pulse that there is no coding on his practice’s clinical system that pulls out a list of patients who have ever been admitted for an asthma exacerbation, meaning he would be unable to search for and invite those patients.
He added that while the clinical system does allow the practice to search for patients who have had oral steroids issued in each of the last three months, ‘you can’t do that for the last century’.
He said: ‘We need clarity on is it ‘ever’, so if somebody had a particularly bad year 50 years ago – does that still count?
‘People will be contacting their GP saying am I eligible, and I need to be able to give them an answer – and I can’t at the moment.
Northumberland LMC medical secretary Dr Jane Lothian also said the new guidance risks causing a set of fresh queries from patients trying to find out if they are eligible.
She said: ‘I think it could cause confusion. We need much clearer guidelines and a lot more time to put it into place.’
Dr Lothian said while the criteria was narrow enough not to cause a huge spike in work for practices, GPs would likely end up in any case taking a more risk-averse approach by including more patients: ‘What will happen, probably, is that practices will include rather than exclude patients, unless somebody has pretty mild asthma.’
Dr Dean Eggitt, Doncaster LMC chief executive, also said: ‘I would be totally unsurprised if patients are confused by this, because I think clinicians and patients alike are both confused.
‘Not only are we confused, as soon as we get our head around it, it changes.’
He noted the same pattern had occurred throughout the year – in which NHS guidelines change and GPs have to deal with patient queries with no notice.
He said that searching for eligible patients that meet the criteria ‘it is yet another task’ for primary care.
Sarah Woolnough, chief executive of Asthma UK and British Lung Foundation, said many patients with asthma were expecting to be prioritised as part of cohort six and will now be disappointed.
She said: ‘The Government have advised people with asthma that they are clinically vulnerable to Covid, throughout the pandemic, leaving many people with asthma to believe that they were going to be in priority group six for the Covid vaccine.
‘However, based on evidence that a lot of people with asthma are at no increased risk of dying from coronavirus, it has changed the eligibility for category six, which means many people with asthma no longer fall into this group.’
She added: ‘The Government must urgently communicate directly to people with asthma why it has made this decision and explain the reasoning behind it. The Government’s lack of attention, urgency and confused messaging around this issue from the start of the pandemic has caused needless anxiety for people and it needs to be put right.’
In its letter sent on 13 February, NHS England said: ‘An individual with a more severe case of asthma may have been included in the clinically extremely vulnerable group, in which case they will be vaccinated in group 4.
‘People with asthma which requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, will be vaccinated in priority group 6.’
It said this will include ‘anyone who has ever had an emergency asthma admission or; those who have an asthma diagnosis and have had 3 prescriptions for oral steroids over a 3-month period (each prescription must fall within separate individual month windows), as an indication of repeated or continuous oral steroids.’
Vaccines minister Nadhim Zahawi was today forced to apologise for adding to the confusion.
He had suggested on LBC Radio on Monday evening that category 6 referred to underlying health conditions ‘including asthma but within that obviously people on inhalers’, with GPs making the call on who had ‘serious’ asthma. However, speaking on ITV’s Good Morning Britain on Tuesday morning, Mr Zahawi said that patients are in the category ‘if they have oral steroids’.
He added: ‘I apologise if there is any confusion, I certainly don’t want to have any confusion at all.’
The Government’s target for 15 million people to be vaccinated against Covid-19 my mid-February was met a day earlier than planned over the weekend. GP-led vaccination teams are now expected to focus on at-risk patients aged 16-64, with GPs using their ‘clinical discretion’ to identify which patients with learning disability should be invited.