In full: NHS England letter on Covid vaccination in care homes

The next stage on Covid vaccination in older adult care homes

To: CCGs, PCN local vaccination sites, NHSE/I regional teams and community health provider chief executives

Dear colleagues,

Thank you for the progress you have already made vaccinating care home residents and staff. With the increased rate and spread of infections, the need to ensure that these cohorts are vaccinated as the top priority is higher than ever. For every 20 vaccinations in the care homes resident cohort, one death is potentially preventable. This letter is an update on the next stages in COVID-19 vaccination for this cohort.

The approval of the Oxford/AstraZeneca vaccine, and its addition to the vaccine delivery schedule from w/c 4th January, means that smaller care homes can be vaccinated immediately. Oxford/AstraZeneca vaccine must be used first for care home visits given its more flexible handling properties, as outlined in our letter to general practice and pharmacists. Only then should it be used for wider cohorts.

In line with JCVI guidance and the statement from the Chief Medical Officers on second doses published on 30 December, vaccine supplied should only be used to deliver first doses of vaccines. It is supplied on the basis that it will be used immediately for vaccination of patients and not stored, since weekly deliveries are now being made.

We are therefore expecting all PCN local vaccination services to administer the first dose of the COVID-19 vaccine to care home residents and staff in the older adult care homes for which the PCN is responsible by the end of this week wherever possible and, at the latest, by the end of next week (Sunday 24th January).

In order to meet this timeline, this letter is formal notification that you may need to operate in line with the maximum hours stipulated in the Enhanced Services specification, 8am to 8pm, 7 days per week and you should approach your CCG for any support required.

When the Pfizer/BioNTech vaccine was approved for use, a supervised walk through of seven PCN sites delivery and administering vaccines in care homes took place. This demonstrated how with effective working across health and social care that professionals can rise to the challenge of delivering a novel vaccine with unique characteristics in a short but safe timescale. The evaluation report of the walk through can be found on the FutureNHS workspace.

As a result of this key work a number of supporting resources have been produced and shared to support the mobilisation of delivering vaccines in Care Homes, and these are brought together on the FutureNHS workspace. For ease of reference, the Care Homes Vaccination Mobilisation Support Pack is attached.

All Wave 1-5 sites have received one roving Supply Inventory List (SIL) comprising equipment, consumables and PPE and a freezer to support care home vaccinations (allowing sites to visit one care home at a time). Wave 6 sites will receive their roving SIL and freezer in time for their individual mobilisation dates in w/c 11 January.

Care Homes supplement and vaccination recording

In recognition of the time and resource needed to deliver COVID vaccination to care home residents and staff in the care home setting, we announced that local vaccination services can claim an additional £10 per dose on top of the £12.58 Item of Service fee for COVID vaccinations delivered in a care home setting. We can now announce that to ensure the fastest possible coverage of care homes, first doses delivered in a care home setting from 14 December 2020 to close Sunday 17 January will now carry an enhanced additional payment of £30 instead, and doses delivered in the week beginning 18 January a payment of £20.

The £10 can continue to apply for all COVID vaccinations in a care home setting between the 25 and 31 January 2021 as well as for the second dose for all patients and staff who received their first dose on or before 31 January 2021. It does not apply where a patient was administered the vaccination in any other setting i.e. while the care home resident was in hospital or if the care home staff member visited a PCN site for their vaccination.

To summarise, the care homes supplement is structured as follows:
• £30 for first doses administered Monday 14 December – Sunday 17 January;
• £20 for first doses administered Monday 18 – Sunday 24 January;
• £10 for first doses administered Monday 25 – Sunday 31 January;
• £10 for all second doses administered.

The Pinnacle/Outcomes for Health Point of Care system was updated on 2 January 2021 to include additional fields relating to the collection of care home data to support the payment of the £10-30 care home supplement. Further information on the payment process– including how retrospective data for care home vaccinations administered between 14 December 2020 to 1 January 2021 (before the changes to Pinnacle were made) – will be made available shortly. Please note that Pinnacle’s advice at the current time is for PCN sites not to retrospectively adjust records.

Vaccination must be recorded immediately in Pinnacle in order to ensure the clinical record is updated and to be sure that PCNs are paid for the work that they are undertaking. PCNs bringing in additional workforce between now and the end of January to ensure that all records for vaccination of priority cohorts are up to date and recorded properly in Pinnacle will be eligible to claim up to £950 per week (a maximum of £2500 per PCN grouping) of funding support. Further details will be provided shortly.

Mutual aid provision

There are a small number of PCNs with lead responsibility for care homes which have chosen not to sign up to the Enhanced Service, as well as some PCN sites that are not due to come on stream until the week commencing 18 January. Regions, ICSs and CCGs will need to coordinate mutual aid provision to ensure that all Older Adults Care Homes under these PCNs have been visited and vaccinated by the end of w/c 18 January.

CCGs will urgently need to contact and work with PCN Groupings that have already mobilised to ensure the vaccination of care home residents and staff in areas where PCNs are not yet mobilised in full. PCN groupings should also let their CCG and local system know if they have capacity to vaccinate additional care homes on behalf of other PCN Groupings.

We have issued guidance and a template commissioner letter to NHSE/I regional teams, which describes the local agreements and contractual arrangements that can be put in place to support this, and which have been discussed with the BMA. An updated version of this guidance and template letter will be available on the FutureNHS workspace soon. If you require further information on these arrangements please contact england.pccovidvaccine@nhs.net.

We would also ask that providers of Community Health Services to do all they can to release staff to support local vaccination services with the vaccination of care home residents and staff during the next fortnight. Lead providers of vaccination centres are able to make staff temporarily available in a flexible manner to support PCN Groupings in this important work and community nursing teams, who provide care daily into care homes, are well placed to support this work. Any financial costs in having to back fill staff can be found in our letter to Regional Directors of Workforce of 20 December 2020.

For those areas with significant gaps in their projected care home vaccination coverage, and where additional support is required, there is also the option to make use of military clinical teams, which are coordinated at a national level. We will work with regions to put in place additional support where needed.

Vaccination in care homes that have COVID-19 cases and outbreaks

We are aware of there being some uncertainty around vaccination in care homes where there are COVID-19 cases or an outbreak. However vaccination should still take place in care homes with outbreaks. Whilst vaccination against COVID may be temporarily deferred in some individuals e.g. acutely unwell or still within four weeks of onset of COVID symptoms, all other staff and care home residents in a care home where an outbreak is occurring must receive prompt COVID vaccination. There is no evidence of any safety concerns from vaccinating individuals with a past history of COVID-19 infection, or with detectable COVID-19 antibody.

Guidance for COVID-19 vaccination in care homes that have cases and outbreaks was published on 31 December 2020: https://www.england.nhs.uk/coronavirus/publication/guidance-for-covid-19-vaccination-in-care-homes-that-have-cases-and-outbreaks/

Before sending vaccination teams to the care home, a risk assessment to enable safe vaccination to go ahead must be carried out by the lead vaccinator and this should be performed in conjunction with the care home manager. If needed, advice should be sought from others such as the local health protection team, CCG infection prevention and control lead and local Director of Public Health. If more than one visit is required to the home, e.g. to undertake mop up vaccinations, the risk assessment should be repeated.

Your continued support and co-operation is very much appreciated as you continue to work at pace to mobilise additional capacity to ensure we deliver the vaccines to our most vulnerable groups.

Many thanks,

Dr Nikita Kanani, Medical Director for Primary Care

Ed Waller, Director of Primary Care