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Is the Covid DES worth practices’ while?


practices


GP partner Dr Gavin Jamie analyses what the Covid-19 vaccination entails, and whether it is in practices’ best interests to take it on

Some details of the Covid-19 vaccination enhanced service are still to be finalised, but based on what we know there are several figures that give some insight into how the logistics, workload and payment will play out.

The approach favours urban populations

The suggestion is that there should be a single vaccination centre in each PCN, with the exception of the couple of dozen PCNs which have a list size of over 100,000. Practices without a PCN can take part in the vaccination programme as well.

There are expected to be between 1,000 and 1,500 centres, which suggests that each will cover around 50,000 patients. In central London that could mean covering less than 5 km2but in around half the country they will cover at least 100 km2 and often much more. Patients may therefore have to travel a long way to their nearest centre, so this would appear to be a service much more suitable for urban areas – although these are also the areas that currently have the highest prevalence of Covid-19 infection.

Vaccination sites hugely resource intensive

Each vaccination centre will be expected to be open up to 12 hours a day seven days a week (84 hours) in order to administer vaccinations. The plans indicate the first vaccine to be available has only a short shelf life at fridge temperature, with practices having a week to use a batch of 975 doses, which comes in vials of 5 doses.

That could mean that the centre will have to be able to give at least one vaccine every 5 minutes, on average, throughout those 84 hours.

In addition, it is expected that each patient will need to be observed for at least 15 minutes after the vaccination if they are driving – requiring at least three socially distanced seats in an observation area. In practice, however, this will need to be more like five seats, to keep things working.

These hours will need roughly three whole-time equivalent (WTE) vaccinators and another three WTE staff to guide patients and keep an eye on the observation area. It will also need a GP on site at all hours to deal with complications.

In summary each site will need:

  • Premises accessible 84 hours a week
  • Socially distanced space to observe five patients
  • 84 hours of vaccinator time
  • 84 hours of reception time
  • GP time OOH as required
  • Management and administration of the system – including meetings to set it up, appointment booking etc.

It is expected that this will take place in GP surgeries. At the moment it is not clear when the service will start and for how long it will go on, so committing to facilities outside the surgery is likely to be difficult – and will also be considerably more expensive, as they would not usually have a GP on site during the week.

Payment depends entirely on vaccination uptake 

Payment is £25.16 for a course of two vaccinations – it is listed as £12.58 per dose, but is to be paid upon completion of the course. Although there will be a number of vaccination providers, patients will be usually expected to have both doses with the same provider.

For patients who have only a single vaccination dose, there is a system of exception reporting, similar to the personalised care adjustment in QOF. The details of the rules for this are yet to be announced but patients who cannot have a second dose for clinical or social reasons, along with patients who decline a second vaccination or simply do not respond to reminders, can be exception reported.

Of relevance here is that one of the vaccines supposed to be close to delivery – The Oxford Astrazeneca one – has shown a relatively high rate of pain, fatigue and chills in the four or five days after administration in early trials.

We will not know how many patients will consent to complete the course until the programme begins. Distance to the vaccination centre and recall arrangements are also likely to have an effect. We also don’t yet know how much variation from the three or four-week booster interval would be allowed.

A reasonable rough estimate of income would be around £150 per hour when operating at capacity.

Of course, money is not the whole story. General practice is constrained by staff and premises availability, at least as much as finance. Money cannot create these things overnight. Much else is uncertain. There is no confirmed start date. If vaccine supply is limited then centres may not open every week, making staffing arrangements more complicated. There is an intention to vaccinate the housebound and care home residents but the practicalities of delivering the vaccine and observing the patients afterwards are not detailed. Equally there is no indication that a mobile unit travelling between practices would be acceptable.

NHS England has announced an additional £150m funding to support general practice, but has made it clear this is separate to the vaccination programme, and comes with several strings attached.

In summary:

  • £25.16 per completed course – two jabs at £12.58
  • Exception reporting should help limit losses due to drop-out
  • No start date, or indeed end date
  • Vaccinations may be intermittent at least at first – week by week
  • Domiciliary and care home service not yet specified.

Choice of appointment system will also impact resources

Practices can make their own appointments or use a national service. There are advantages in both systems. Making your own appointments will give greater control to the vaccination centre, but will incur extra cost. Appointments for second doses can be made whilst the patient attends the centre for the first.

The timeline is incredibly tight

After months of vaccine development and weeks of negotiation practices have been given a week – until 17 November – to submit complicated proposals.

In other words, we still do not have the final details on many aspects of the service from NHS England or the GPC, but have a deadline of next Tuesday. That is simply unrealistic.


The programme requires more flexibility

Finally, some stats to consider for when this is rolled out more widely:

  • A thousand vaccinations centres with a capacity of a thousand vaccinations weekly suggests a national capacity of a million vaccinations a week.
  • With a population of 60 million and two doses needed it would take 120 weeks, or two years and four months, to vaccinate everyone.
  • This year practices vaccinated over three million patients against the flu in September alone, although the vaccine was not delivered until well into the month. The total Covid-19 capacity is likely to be less than flu under the current plans.

Personally, I agree that general practice is ideally placed to lead on the delivery of a Covid-19 vaccination programme.

But with current personnel this will be a challenge and I can entirely understand why some feel it will be too much for us in our current circumstances.

The strength of practices has always been about finding innovative and adaptable ways of delivering the required services. These proposals reduce the potential to do that, specifying the number of sites, the opening hours etc. Couldn’t the service travel around to get closer to patients? 

Lastly, the whole approach seems to be loaded with other agendas. We can see ‘working at scale’ and ‘8-8 7/7’ clearly running through the outline of the scheme. I am concerned that dogma may inhibit the delivery of this vital vaccination to patients.

Dr Gavin Jamie is a GP partner in Swindon and runs the QOF Database website

READERS' COMMENTS [9]

David jenkins 13 November, 2020 12:30 pm

divide the £150m between all the practices included (does it include wales, for example ? we have different idiots running the show here !). then divide each practice’s share between all the partners/locums/salaried staff/ nurses etc etc, and you’ll realise that what you are likely to get at the end is close to bugger all.

then take off the 40% tax you will have to pay (assuming they haven’t put high earners taxes up to pay for all sunak’s freebies), and you will be paid way less than someone stacking shelves in the supermarket.

add in the risk to you and your family for this beneficial act, face the east, and ask yourself whether this is a wise course of action !

Reply moderated
Patrufini Duffy 13 November, 2020 2:38 pm

Nice breakdown. Sanity, GMC-preservation and self-worth are priceless, particularly when NHSE and the public couldn’t care less about a clap or your scapegoating.

Reply moderated
Hello My name is 13 November, 2020 2:49 pm

Agree. GPs try to provide patient centred services, which are efficient and effective. NHSE desperate for an 8-8 all you can eat buffet, and for some reason have become obsessed with the efficiencies that ‘at scale’ general practice may offer. It is nonsense, they are inept, and we will be left picking up the pieces.

Reply moderated
ronnie Ip 13 November, 2020 7:52 pm

What happens if you set it all up, full clinics for week and then at last minute one or two vaccinators need to self isolate. It will be an absolute headache then.

Reply moderated
Shazia Ovaisi 17 November, 2020 6:30 am

Really interesting article; succinct, to the point and raises some very helpful points that have been overlooked elsewhere. I am worried about the rush to sign up to this in its current format and more debate and discussion would be welcome. Thank you.

Qasim Bhatti 18 November, 2020 8:57 am

150million?
they just spent 130million on ‘marketing’
they keep giving dildo harding money.

this is a complete and utter insult.

fuck you NHSE, and fuck you GPC for agreeing to this.
the public think we arent working anyway, they cant really think less of us, and i dont see why our own mental health’s have to suffer to fulfil someone’s political ambition.

Neil Paul 18 November, 2020 2:22 pm

locally pcns are looking at sies such at town halls to do this from. the coucil are apparently charging £3800 a week for one site — one site.. in one pcn.. id let them use my surgery if i could charge £3800 a week

Mr Marvellous 19 November, 2020 9:00 am

Everyone apart from GPs can make a profit from this.

Whereas GPs will have to pay to deliver this. Bonkers!

John Glasspool 20 November, 2020 3:54 pm

Walk away and deal with the day job.