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LMCs: ‘Impossible’ Covid vaccine DES requirements will put GPs at ‘contractual risk’


The ‘impossible’ requirements of the proposed Covid vaccination DES risk putting GP practices ‘contractually at risk’, LMCs have warned in a strongly worded document.

Berkshire, Buckinghamshire and Oxfordshire local medical committees told practices they have ‘deep concerns’ over impact of the plans on the ‘stability and capacity’ to care for patients.

They said the way the DES had been put to to the profession was ‘unprofessional, overly prescriptive, lacking in proper planning, devoid of realistic expectations, opaque, vague and with imposition of grossly unreasonable deadlines’.

It comes as Surrey and Sussex LMCs developed their own ‘Covculator’ to help practices weigh up the plans which suggested practices could be left out of pocket.

The LMCs said they would very much like general practice to play a major role in the roll-out of the vaccine but they wanted to help practices make a ‘rational decision’ based on the funding available and their capacity.

Various scenarios tested by the team on costs of practice staff required to run a Covid vaccination programme suggest the £12.58 per vaccine may not come close to the funding required.

Dr Darren Tymans, medical director for Surrey and Sussex LMCs, said: ‘I think it would have been very helpful for NHSE and GPC to publish any financial due diligence that took place, including costings and the assumptions they were both working on. Practices need this information to make rational decisions.

‘What seems clear to me is that practices attempting to run this using practice-based models which utilise a lot of doctor and nurse time run a risk of making a very significant loss. 

‘Delivering at a larger scale, using lots of HCAs or less expensive staff who have been trained to deliver vaccines, it might be possible to deliver with enough surplus to also pay for at least some of the other costs of the programme.

‘But this is not guaranteed, and there are a lot of ‘ifs’ that will remain beyond practices’ control.’

In a briefing letter, Berkshire, Buckinghamshire and Oxfordshire LMCs said it was not a question of whether GPs who were ‘ready and willing’ should be involved but how.

‘The overwhelming consensus amongst reps of this LMC is that this proposed DES poses deep concerns regarding deliverability, practicality, logistics and patient safety due to the instability and compromise of other primary care service provision,’ their letter warns.

They also criticised the way the news of the ‘imminent’ DES was broken in the media despite no information being shared with GPs.

Pulse exclusively revealed that the DES would be imminently announced, followed NHS England chief executive Simon Stevens stating on BBC’s Today programme that they had ‘reached agreement with the GPs’.

There has been no opportunity to provide GPs with analysis of the implications of the DES because of ‘the extremely short timelines imposed by NHSE and the lack of detail available’, BBOLMCs said. 

But they added it would be up to individual practices to decide if they would be able to sign up to the DES and the LMC would support them either way.

‘The question as to whether any practice should sign up to this DES is an individual one and unprecedented given these uncertain times.

‘If a practice chooses to sign up to this DES, the LMC believes they should neither be penalised nor held in breach if they fail to meet the onerous and arguably impossible requirements of the specification.

‘We feel practices should be allowed to do as much as they can and be paid for all work done.

‘However, we are yet to receive written assurances from NHSE that this would be the case, therefore our current advice is you place yourself contractually at risk if you fail to meet the requirements.’ 

They stressed that no patient would miss out if a practice chose not to sign up to the DES as their patients would still be given the vaccine elsewhere by other providers and said practices should not feel forced into a decision.

‘The LMC feels no practice should feel coerced or otherwise under pressure to sign up to this service if they do not have the capacity to deliver it, and the LMC would strongly oppose any coercion of practices who choose not to sign up, by any party.’ 


Grant Jonathan Ingrams 13 November, 2020 12:00 pm

Catch up Pulse. Was never going to be a DES – the GPC even got that wrong …

Reply moderated
Darren Tymens 13 November, 2020 12:04 pm

Grant, it appears GPC were repeatedly told it was going to be a DES, right up until yesterday afternoon, when the goalposts were suddenly changed.

Tim Coker 13 November, 2020 1:18 pm

If it is no longer a DES, what is it?

Reply moderated
John Glasspool 13 November, 2020 2:21 pm

NES and it’s £12+ per shot, whether the punter turns up again on not, so a lot better than originally trailed. advantage of a NES is that your friendly CCG CANNOT take the money and use it for something else. That will annoy them! Probably no longer the “pig in a poke” it first seemed. Indemnity sorted too.
Source- Wessex LMCs. Thanks to them for this.
Aren’t there masses of poor and unemployed locums who might be glad to do this for practices? And no, you won’t HAVE to do it on Christmas Day!

Reply moderated
Patrufini Duffy 13 November, 2020 2:28 pm

The NHS is expert at writing 100 page contracts, knowing you can’t be ar**d or are too demoralised and weary to read them. An age old tradition of blind signing. It’s simple. Opt out of your PCN-DES, don’t breach your core duties and make CCGs figure out how they deliver services. Watch what happens to you and care homes in future years.