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Fine for GPs to get ‘creative’ to carry on ‘vital’ immunisations, says NHS England



NHS England has encouraged GPs who have come up with ‘creative’ solutions to keeping up with ‘vital’ immunisations during the Covid-19 pandemic.

Primary care medical director Dr Nikita Kanani praised practices which have come up with ‘drive-through’ solutions, saying the commissoner will not be putting in any restrictions on how practices carry out immunisations as long as they continue.

NHS England said practices should especially prioritise childhood vaccinations, to avoid any future outbreaks as a consequence of the pandemic.

Meanwhile, GP leaders have suggested practices are ‘smarter’ with the time they have with patients, for example combining the postnatal and newborn checks with babies’ eight-week immunisations.

In its latest email bulletin to GP practices, NHS England said this comes as immunisation services ‘have not been identified as activities that can be suspended within the GP contract’ and it is important to ‘ensure the continued delivery’ of the ‘vital’ service.

In a webinar for GPs on Thursday evening, NHS England said that practices should prioritise ‘all routine childhood immunisations offered to babies, infants and pre-school children’, including the first and second doses of the measles mumps and rubella (MMR) vaccine.

Practices should also offer ‘all doses’ of targeted hepatitis B vaccine for at-risk infants ‘in a timely manner’, it added.

Other immunisations that should be prioritised include the pertussis vaccination in pregnancy and the pneumococcal vaccination for patients in at risk-groups aged between two and 64 and all those over 65 years old – ‘subject to supplies’ and ‘clinical prioritisation’.

But it said that ‘due to the public health advice on social distancing and shielding’ practices are not expected to offer the opportunistic shingles vaccine for those aged 70 years ‘unless the patient is already in the GP practice for another reason’.

Speaking in the webinar, Dr Kanani said: ‘It’s still really important to us that we keep up with our immunisations.

‘We’ve published the DES for 2020/21 to ensure you’re supported to do this and what we would like to prioritise is set out there because what we don’t want is an outbreak coming later from one of these other diseases.’

She added that practices should ‘think about’ how they can continue to provide immunisations during the coronavirus pandemic.

She said: ‘I know some people have had quite creative drive-through nurse-led immunisation clinics. I don’t think we’re putting any restrictions on how you do it – do it safely – but please keep up with your immunisations.’

Dr Peter Swinyard, GP and former chair of the Family Doctor Association, told Pulse that practices must be ‘a bit smarter’ about maximising the time that patients are already in the surgery.

He said: ‘I agree we need to keep up with immunisations, but be a bit smarter about the amalgamation of postnatal checks and immunisations to minimise face-to-face [contact].’

Kent LMC has already advised practices to consider delivering the newborn baby check at the same time as the first immunisations.

Medical secretary Dr John Allingham said: ‘Some practices had stopped doing [the newborn check]. We’re suggesting to the practices that if the baby has to come in for the immunisations, they might as well do the baby check as well.’

The LMC has advised practices that childhood immunisations should remain ‘at the top of the list’ of routine activities to continue despite Covid-19.

He said: ‘The baby immunisations are a number one priority. We really have got to keep immunising babies.

‘The last thing we want is for the reemergence of a whooping cough epidemic or something because the newborn babies weren’t immunised. That would be awful.’

The Medicines and Healthcare products Regulatory Agency (MHRA) is also prioritising immunisations by lifting bans on sharing vaccine stocks between practices, as long as the proper temperature is maintained during storage and transportation.

In the GP bulletin, NHS England said: ‘While there are no central supply issues of vaccine stock, it may be necessary for CCGs and/or primary care networks to facilitate the transfer of locally held vaccine stock from one provider to another to ensure the continued delivery of immunisation programmes. 

‘To support this, the MHRA has now confirmed that it would not prevent the transfer of locally held vaccine stock from the NHS routine immunisation services during Covid-19.’

Dr Allingham told Pulse that he is ‘not aware’ of any Kent practices having problems with vaccine stock or needing to share it ‘yet’ but that he can ‘understand how supply chains may struggle’ in the circumstances.

However, he added that one or two small surgeries in Kent have had to ‘buddy up’, for example because the only nurse employed by a practice is in an at-risk group and unable to work, with one surgery providing immunisations on the other’s behalf.

In November, practices and pharmacies were told they could share supplies without a wholesaler licence amid flu vaccine shortages.

Meanwhile, Pulse revealed today that NHS England is reviewing whether to suspend national screening programmes during the coronavirus pandemic.

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