The BMA GP committee England and NHSEI have agreed a DES (direct enhanced service) for general practice to lead the delivery of the CVP (COVID-19 vaccination programme).
As a DES, it will be optional for practices to sign up to the service.
The intention is to prepare for a service to be delivered from 1 December, however the actual start date will depend on the availability of vaccines.
Similarly, we expect vaccine availability to be limited to begin with, meaning only small numbers of vaccine may be given in December and most vaccinations taking place in early 2021, giving practices more time to prepare.
What the service involves
At present, based on the information currently known to us, the vaccines being developed require two doses per patient, with a 21-28 day gap between doses.
Eligible patients will be confirmed soon, but are expected to be in line with the latest JCVI (joint committee on vaccination and immunisation) recommendations.
Similar to the flu groups, they include:
- all over the age of 50
- those at high risk
- care home residents and staff
- all health and care workers (although it is unlikely that general practice will be required to deliver to all health and care staff who may get it from their employer).
The high priority groups will be vaccinated first, and as the vaccine becomes more available, practices will be able to provide this to increasing numbers.
The DES includes provision of vaccinations to housebound patients via home visits, as well as staff and residents of care homes. Community service providers will be expected to play a role in this service, particularly with housebound patients, as many do with flu immunisations using practice stocks.
Practices will be able to vaccinate their own staff and be paid for doing so.
Alongside the general practice-led service, other providers (likely to be NHS trusts) will be commissioned to provide the programme through other means, probably via regional vaccination centres in a similar way to the testing centres.
Local pharmacies may be commissioned where general practice coverage is not enough.
National and local public campaigns will advertise the services on offer, and which patients are eligible.
How the service will operate
Due to the logistics of delivery and characteristics of the vaccines, the service needs to be delivered at scale. The current assumption is that it will need to be done through groups of practices working together (likely along PCN (primary care network) geographies), with one designated vaccination site (ideally to be a GP practice). That would be determined by the practices involved.
As vaccines become more widely available it is possible that more than one site could be possible within each grouping.
Working together, practices will need to be prepared to offer vaccinations seven days a week so that the vaccine is delivered within its short shelf-life and so patients receive it as soon as possible. Specifics around delivery of the service will depend on matching patient demand and vaccine availability.
Call and recall system
A national call and recall system will be used, in addition to practices operating their own call and recall systems if they wish to do so.
Patients can choose to attend either their local general practice-led designated site, or a regional immunisation service. If patients choose the local site, practices will need to contact patients to book an appropriate time. Practices will be able to use the national booking system instead of their local booking system if they choose.
Administering the vaccine
A registered healthcare professional will need to carry out the clinical assessment and consent. A suitably trained non-registered member of staff will be able to administer the vaccine itself under clinical supervision.
This could include staff from the relevant practices, from the PCN, as well as volunteers and other NHS staff – as decided by the relevant practices. There is an expectation that staff will be required to undertake appropriate training in advance. Other staff assisting in an administrative capacity would not be required to undertake the training, but an information pack will be provided.
It will be for practices to determine how they work together to deliver the programme. For instance, practices could operate a rota using their teams to immunise their own registered patients in different sessions during the week. Or, they may wish to employ a dedicated team to do this on behalf of all practices, or for some practices to act on behalf of others.
Once the vaccine has been administered, patients must remain under clinical observation for 15 minutes.
Patients would need to be contacted again to book in their second appointment (or this could be done at the time of administering the first) allowing for the appropriate gap. Patients will need to receive the second dose from the same provider.
Safety and risk
The vaccines will be going through testing procedures and MHRA (medicines and healthcare products regulatory agency) licencing process.
The JCVI and others will provide independent input and decisions will be made in the normal way. If the vaccine is not approved through the rigorous approvals process, then there will not be a programme. The NHS and practices must be prepared for rapid delivery in the event that the vaccine is approved.
The Government previously released the outcome of the human medicines regulations consultation. This outlines that the Government will be liable for any adverse implications from a vaccine being put into supply (both immediately and into the future).
Commissioning as an enhanced service ensures that all individuals delivering the services will have indemnity under the clinical negligence scheme for general practice.
Funding and workload
- Practices will be provided with the vaccines, needles, syringes, diluents and PPE.
- A £12.58 IOS (item of service) fee will be provided per dose.
- This will be provided through a single payment of £25.16 upon completion of the second dose.
- Should it not be possible to administer the second dose, one IOS can be claimed.
- Additional local funding will be provided, in line with the additional funding for the flu programme arrangements (for example for hire of venues, additional storage, text message credits etc). This will need to be agreed locally.
- There will be £150m of further support from NHSEI for additional capacity, ringfenced for general practice until the end of March 2021. This funding is not part of the CVP (COVID-19 vaccination programme) service, but will sit alongside it and should ease other pressures in general practice to allow prioritisation of the CVP.
We expect the majority of patients will want to be vaccinated in general practice due to existing, trusted relationships.
Practices participating in the CVP will need to accordingly prioritise their workload to ensure appropriate patients can access COVID-19 vaccinations, flu vaccinations, and other urgent clinical needs (see practical considerations section below).
Other work and services can be deprioritised. GPCE and RCGP have revised our joint workload prioritisation guidance to assist practices in this.
This will be assisted by the QOF (quality and outcomes framework) income protection previously agreed, the streamlined and now optional appraisal system and other bureaucracy-reducing measures implemented early in the year remaining in place. We have written to CQC (Care Quality Commission) to request the further suspension of inspections over this period.
GPCE will closely monitor the situation and work with NHSEI to ease further workload pressures where possible. With the prioritisation process in place, NHSEI and commissioners will be assured that practices are continuing to deliver what patients need.
Arrangements for home visits currently in place in many areas for flu vaccines, with providers working together to ensure coverage (for example community providers and district nurses) will be expected to be maintained, and if not in place to be put in place. NHSEI strongly encourages CCGs to work with community providers to assist general practice to deliver the service. We encourage LMCs to discuss this with their CCG and local community provider.
The funding and staff providing the improving access schemes can be utilised to deliver the service with local agreement, particularly in the evenings and at weekends. LMCs should discuss this with the local service providers to facilitate good collaboration.
Utilising the funding for additional capacity, the IoS fee and the clinical prioritisation of services, practices and community teams will be able to work together to successfully deliver the service.
|Practices, in groups, to decide whether to deliver the service, and discuss practicalities (see below)||Friday 6 to Friday 13 November|
|Practices to notify commissioners if you wish to participate in this ES and respond to the designation process||Friday 13 November|
|Commissioners provisionally confirm designated sites||Monday 16 November|
|Final enhanced service specification published to come into effect on specified date||Provisionally Friday 23 November but dependent on vaccine supply|
|Administration of the vaccinations commences||Start date to be confirmed, earliest will be 1 December|
Practical considerations for practices and PCNs
With the timeline being extremely tight, practices will have a short amount of time to make some key decisions, not least whether to take part in the service.
Considerations when deciding whether to provide the programme
Practices will need to work together to decide:
- which one practice (or another appropriate site) is used for the vaccination site, remembering the need for provision to be potentially available 8am – 8pm, seven days a week to all patients of the participating practices and considering storage facilities
- how that designated vaccination site is staffed (remembering implications for practice staff, PCN staff and other community providers can be utilised)
- implications for services at practices where their staff may be deployed instead to the designated vaccination site
- implications for what happens at the designated site if it is a GP practice (for example is it just providing the CVP, or is it also providing other routine GP services too)
- how to coordinate the appointment bookings for all patients (will all bookings be made through the designated vaccination site, or separately via individual practices, whether to use the national booking system etc)
- how patients will access other services while the programme is ongoing – and ensuring all patients are aware of any changes to services
- how housebound patients will receive their vaccinations (bearing in mind the characteristics of the vaccines might have practical implications which may not be known until delivery)
- how care home residents and staff receive their vaccinations
- how additional staff will be paid, and how funding will flow to ensure fair distribution depending on staffing and delivery decisions.
Considerations when preparing to provide the programme
Once practices have agreed and signed up to the service, you will need to think about:
- practicalities for the designated vaccination site, for example patient flows and signage
- information to patients about the service, including eligibility and venue timings
- matching vaccine supply with patient demand
- timetabling for staff and patients for the designated vaccination site
- practicalities of delivering to housebound and care home residents
- any approvals required for, and costs of, additional opening of the designated site premises
- how to vaccinate your own staff.