There has never been a health crisis like that caused by Covid – it’s not only brought the NHS to its knees, but has paralysed the country as a whole, affecting every sector and threatening the livelihoods and the mental and physical health of many. We may not be at war, but we are very much on a war footing.
In the midst of Tier 4 lockdown and NHS England emergency measures for appointments, the appointment screens for my surgery show the wait times for telephone appointments are a matter of a few days at most, whilst the building is empty. The contrast between this situation and the horrific headlines on the nightly news could not be starker.
As members of primary care networks, we either signed up to the Enhanced Service contract, or delegated responsibility elsewhere. The latter group cannot say who has picked up the responsibility, and social media is awash with complaints from their patients about whether these practices know ‘whether there is a pandemic on’.
What seemed like an arcane contractual decision now has real ramifications for the credibility of these practices.
Those of us who subscribed to the PCN model did so when the Pfizer/Biotech vaccine necessitated a special site with ‘premises approval’ due to its requirement for storage at -70 degrees. But on 31 December, the MHRA gave emergency authorisation to the new AstraZeneca/Oxford vaccine.
This AstraZenca/Oxford one is a game-changer. It did away with the requirements for cryogenic storage and its complicated drawing up and delivery regimes. It did away with the 15-minute observation period that entailed the need for large waiting areas for inoculated patients that limited the ability of GPs to deliver it in typically-sized practice buildings.
With all those complications swept aside, the new vaccine is much akin to that of the flu and other routine vaccines that we deliver in general practice. Our empty buildings and shortened waiting times now look hard to justify. It can be stored in our fridges, is room temperature stable for six hours, and has a shelf life of six months.
The clinical considerations around giving it to suitable patients are not complicated or differing from the other vaccinations that we give routinely. Staff must have some rudimentary training such as anaphylaxis, hold basic life support training and have a cold chain policy in place – which they will do for the childhood immunisations and flu and travel vaccinations that they already give.
In short, the business of giving vaccinations is the business of general practice. This is what we do
At a time when the country needs to vaccinate the greatest number of people in the shortest time, general practice has been sidelined by the dependence of NHS England on the apparatus of PCNs, and the rapid, almost daily changes in the fast-moving situation of vaccine deployment.
Many GP practices, like ours, are willing to step up and join the frontline. The ministerial ambition is to achieve vaccination of the top priority groups by 15 February – this could be about 30% of the population depending on demographics. Our local PCN has deployed 2,760 complete courses of vaccination in three weeks. From a standing start, this is a remarkable achievement and testament to the good will and community spirit of right minded people pulling together for the common good.
But it is not enough, and not sustainable.
Extrapolating this to the total numbers needed to vaccinate indicates that we will only reach the priority groups by 18 May. In the meantime, people will continue to contract the virus, and the longer it goes unabated, the more opportunity it has to mutate. Time is of the essence.
Local reports circulate of clinical directors refusing deliveries of vaccines because they do not have the logistical capability to deliver it through their PCN model. This is the wrong way around and should ring alarm bells. The logistics must be up to the job of delivering the vaccine. If there was ever a case of generals still fighting the last war, this is it. The AstraZenca/Oxford vaccine is a disruptive innovation, and no one seems to have noticed.
It seemed we received clear guidance from NHS England, reported in Pulse last week, that the new vaccine could be distributed to constituent Practices of PCN’s ‘where it is considered that this will improve patient access or increase vaccination capacity – which remains a prime consideration.’
Sadly, it seems they did not reckon on CCGs reverting to their bureaucratic instincts and insisting on ‘premises approval’ and a number of other stipulations, not having woken up to the opportunity that the new AstraZenca/Oxford vaccine represents, and seemingly unaware of its similarity with other vaccines that we are accredited to deliver.
CCGs don’t seem to realise that the UK already has a mass vaccination delivery vehicle – it’s called general practice. In a dire situation such as the one we’re facing, everything that can be done must be done. By crowd sourcing distribution from able GP practices, and any other provides who already do this work, such as pharmacists and dentists, there is an invaluable opportunity to tap into underused supply.
Billions have been spent upon building primary care in this country to world class standards. Many GP practices could deliver the new AstraZenca/Oxford vaccine in their daily clinics. There are approximately 4,700 GP practices in England, and if 80% allocated only three hours of clinic time to immunising patients with the new vaccine (at a rate of eight patients per hour) this would add an additional 450,000 vaccinations each week, or around two million in a month.
In reality, my practice estimates that it could devote up to half its daily clinics to this work – which, if replicated by 80% of practices nationally, would add around 1.8 million vaccinations a week, or around eight million in a month. By running clinics over weekends, we could achieve even more. The only constraint is the supply of vaccine – the capability is there, and the will is not lacking.
The AstraZenca/Oxford vaccine is a game-changer. Vaccine delivery is the business of general practice, and even though the lockdown conditions are time-limited, the NHS has not woken up to the incredible contribution that crowdsourcing unused capacity in general practice can make. Yes, some people will baulk at this and others will be constrained by staff absence from the virus itself, but if there was ever a time for general practice to step up, this is it.
Dr Rubin Minhas and Denise Payne are a partner and general manager at Oakfield Health Centre, in Gravesend, Kent, respectively. Dr Minhas is an expert advisory to an MHRA Committee. However, the views expressed here are entirely those of the authors.