15m vaccine target hit as GPs told to use ‘clinical discretion’ with learning disability patients

GPs have helped the UK hit its target of 15 million Covid-19 vaccinations a day early, with the health secretary confirming all adults aged 50 and above should be offered the jab by the end of April.

It comes as NHS England has told GPs they should identify patients with severe learning disability, who are eligible for the jab, based on ‘clinical discretion’, as it laid out how GPs should start inviting at-risk patients aged 16-64.

GPs are also encouraged ‘to take a similar approach’ with identifying which patients with severe mental illness should be given the jab, by working with secondary care mental health services, said NHS England.

Children with severe neuro-disabilities who tend to get recurrent respiratory tract infections – and who ‘frequently’ spend time in specialised residential care settings – should only be offered the Pfizer jab, and if they are aged 12 years or over, it also said.

Meanwhile, NHS England has clarified the criteria for inviting patients with asthma as part of cohort six should be anyone who has ever had an emergency asthma admission, or those who have an asthma diagnosis and have had three prescriptions for oral steroids over a three-month period.

The latest NHS England advice came in a letter sent over the weekend, which also said GPs will be paid an additional £10 supplement for each jab given in a residential setting – such as care homes for people with learning disabilities or mental health problems, or hostels for homeless people – on top of the £12.58 item-of-service fee.

Laying out how GPs should help to assess which patients with learning disability fall into the priority six cohort, it said: ‘JCVI determined that those with severe and profound learning disability are in cohort 6.

‘GPs can use GP Learning Disability Registers and SNOMED codes (which describe the impact of learning disability although there is variation in how these are applied) to help identify this group.

‘We recognise that there may still be people who are not on these registers and the NHS needs to make an extra effort to put this right. GPs should use clinical discretion to ensure the right people who meet the severe and profound learning disability definition are on the register.’

The letter added: ‘JCVI also determined that those with schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment are within cohort 6, and we would encourage GPs to take a similar approach for this group of people, to that being proposed for learning disability, working in partnership with secondary care mental health services and VCS partners to ensure appropriate outreach mechanisms are in place.’

NHS England said the majority of children should not be vaccinated
at this time.

However a small number – around 1,500-2,000 – with ‘severe neuro-disabilities, who tend to get recurrent respiratory tract infections and who frequently spend time in specialised residential care settings’ should be given the Pfizer jab at GP-led or hospital hub sites.

It reiterated that while the Oxford vaccine is only authorised for use in the over 18s, the Pfizer vaccine is licensed for over 16s.

GPs should prescribe the Pfizer vaccine off licence for children over the age of 12, following advice from the patient’s paediatrician, but those under 12 should not be called for vaccination, it reiterated.

NHS England added that Covid vaccines ‘should not be given to people outside of cohorts one to six’ – seemingly in contrast to previous advice in which it said GPs could offer Covid jabs outside the eligible priority cohorts if there is a ‘risk’ of vaccine wastage.

It reiterated that PCN sites are ‘encouraged’ to have reserve lists of patients for last-minute vaccination, but said these should only include those from eligible cohorts.

The Prime Minister set out the ambition to offer the vaccine to the first four cohorts – around 15 million patients – by mid-February when announcing the start of the current national lockdown in January.

Yesterday he announced that the UK has now vaccinated more than the target number of people – reaching its 15 February goal a day early.

Boris Johnson said: ‘In England, I can tell you we have now offered jabs to everyone in the first four priority groups – the people most likely to be seriously ill from coronavirus, hitting the first target that we set ourselves.’

Health secretary Matt Hancock added: ‘I’m so proud of the team – we’ve hit this fantastic milestone in our battle against Covid-19. 

‘In less than 10 weeks we’ve jabbed over 15 million people across the UK. That’s one in every four adults now starting to receive protection from this dreadful disease.’

He thanked the ‘incredible efforts of frontline NHS workers’ and reiterated that the vaccine ‘is our route to freedom’.

Speaking on ITV’s Good Morning Britain today, Mr Hancock confirmed the ‘next phase’ of the vaccine rollout aims to offer a first dose to the remaining priority cohorts – all those aged 50 and above – by the end of April.

He said: ‘The next phase is that we want to offer the jab to everybody in groups one to nine by the end of April. 

‘We’ve got the supplies, we think, to be able to do that and to start the second jabs that will start in earnest next month.’

Last month, NHS England chief Sir Simon Stevens pledged that patients due their second Covid vaccine dose will be prioritised for existing supply within the 12-week window.