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Vaccination on the cheap



By the time you’re reading this, it’s likely most practices will be scrambling around for staff to deliver the second batch of Covid vaccines.

But as I write, this is the second weekend I’ve spent training, planning or modelling in anticipation of our first delivery. And as that delivery will arrive at the end of the week, there is a distinct possibility I may spend a third weekend actually vaccinating if we can’t recruit enough nurses.

No one is denying this is an important cause. The development of multiple vaccines less than a year into a pandemic is a truly remarkable feat. And where better to deliver this triumph than in general practice? We have decades of experience administering vaccination programmes to our lists.

But continuity of care and practice-based attendance does not feature in this Covid vaccination programme. Elderly patients, many with sensory and mobility issues, are being expected to attend a designated site and be vaccinated by unfamiliar staff. This is related to the unique cold-chain storage requirements of the Pfizer vaccine, but it does beg the question, why are GPs even involved with the delivery of such a challenging programme?

It remains uncertain when a less challenging vaccine will be available, but we know it is around the corner. Why not use the Pfizer vaccine at the mass delivery sites and allow GPs to wait for a vaccine they can deliver in-house, as we do with the flu vaccination each year?

I think a comparison of the Covid vaccination programme with the national Test and Trace system offers a simple answer to this question. General practice, with its capitation-based payment, its loyalty to patients and its independent contractor commitment, is as cheap as chips. I wonder which other private organisation would sign up to an enhanced service before the details are even known, making any financial modelling nearly impossible.

In the case of my practice, a vaccine delivery so close to the weekend and the absence of a national protocol for non-registered healthcare professionals means we will be running our first cohort of vaccination clinics at a loss.

Alongside the financial losses, how many chief executives would spend hours of their own time in the evenings and at weekends, preparing their company, awaiting deliveries, and project managing such a colossal task?

The most disturbing question of all is, as GPs are swept away on the vaccination wave, who will be seeing our patients? Many people can be trained to dilute or administer a vaccine, but who can untangle the usual mass of physical and psychological symptoms? Who can juggle the long list of medications for multimorbidity?

Despite the battering the profession has taken in recent times, GPs will always be there for our patients, even if we have to give up our weekends.

The Government knows this and that’s why it chose us. Ministers knew they would get vaccination on the cheap.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs online at pulsetoday.co.uk/nabi

This piece originally appeared in the January print issue of Pulse

READERS' COMMENTS [9]

Not Arvind Madan 21 January, 2021 11:05 am

Dont blame the government. Blame the GPs who always fall for this

Andrew Jackson 21 January, 2021 11:11 am

We as Partners are well into vaccine delivery and have involved the staff with the following ethos.
1) The Partners will take no profit from the program
2) All vaccine delivery will happen outside of normal working patterns as paid overtime and everyone involved in the process including all admin staff will share in this.
3) As it is being done in ‘overtime’ there is no effect on daytime provision of services.
4) We work on the principle of an empty monday morning fridge so all staff have given us their availabilities so we can take as much vaccine as offered during the week and will use weekends if needed to jab.
5) Rates per hour (including on costs) are as follows; GPs £55, Nurses £30, admin staff rates above their ordinary rates. If there is a surplus following this of profit we will divvy out at the end.

We have had no problems filling shifts (SO FAR) and it has allowed all staff to feel they are contributing within the spare time they have available and hopefully everyone will have a bit extra in their pockets to spend on a summer holiday!

We have to get this done so might as well get it done ASAP.

Not Arvind Madan 21 January, 2021 3:51 pm

“The Partners will take no profit from the programme”

See what i mean? Im guessing that wasnt the starting point for Sercos negotiations for T+T!?

Patrufini Duffy 22 January, 2021 4:30 pm

Like I said. Cardiologists don’t meddle with doing an ECG. Respiratory consultants don’t do the spirometry. GPs have no place in this trivial injecting of this vaccine. NHSE just roped you in, because, despite all the offal, disrepsect and battering you get, they know without scapegoating and abusing the patient trust and blind altruism you show, then they can’t succeed, at anything. You are Consultants in Family medicine, not PHE vaccinators. Architects do not lay the bricks, that is just the reality, not ego, and not stubbornness. But respect for your expert role where others need you.

David Jarvis 25 January, 2021 12:49 pm

We are doing vaccines held back by supply rather than staff or our organisation. Staff are enjoying doing something they can see we will all benefit from. It is not stressful. I can’t do much with my free days currently anyway. Practice morale has been lifted by getting involved with a clear goal.
I am getting paid.

But whilst I hate the govt and it stuffing it’s mates mouths with cash in this you are complicit if you don’t partake. You leave a void that someone does have to fill. Perhaps you are happy to do that.

I suspect the best architects have got their hands dirty. The best cardiologist can do an ECG themselves if needs be. The ones to up themselves to get their hands dirty with something they see as beneath them are probably not as good at their jobs. So seeing senior GPs get in and mix vaccines and give jabs in my experience is very positive. I quite enjoy it. I feel it is something positive I can do to help get us out of this mess rather than sitting on the sidelines bored as I run out of box sets.
I work full time and still do some Out of Hours so perhaps I am a dinosaur from a past life but I do think we should be doing this not just for money or with green eyes of what others are making. Come and join us on the pitch and getting out of the crowd in the stands moaning. It is actually quite rewarding down and dirty in the mud scoring goals.

Patrufini Duffy 25 January, 2021 3:03 pm

To commend your football team and goal scoring. Team effort. The joy of patient contact, an outdoor church, a divine intervention and smeared pat on the back – ofcourse it’s fun and a sprightly day out. But, the game is certainly a long one, and will repeat itself into extra time, with plenty of opportunity – probably not with the same rules, and goalposts shifted. But, there are no true goals here. There is perspective and awareness. That lasts. The referee is ready to red card you. And there’s no stretcher, as you aren’t so important. You know, some of your team mates were only given one shoe, and others no kit and had their shoelaces tied. Others fell over in training, and they were terminated. Tell the groundsman that mud sticks and sitting on the sidelines bored is well, subjective. Any human can needle a deltoid, that is the point, it doesn’t need training or expertise. Just a hand and thumb and management. It is a skill, not above or below anyone. But, some of us need to see this river, so others can be in it, frolicking and playing. And some of us aren’t in the stands, we’re on the pitch giving you the ball to kick around. Team effort. And neutral observation.

David Jarvis 25 January, 2021 5:50 pm

Love it. Excellent riposte.
Doing it as a GP I feel it is my pitch my ball and I pay the refs wages. I am in control of what I can and hopefully if vaccinating works save as many lives doing that as I would in any other activity of a GP. What is more if it works and enough vaccinated I get back on with my life so I stand to gain personally.
I actually do feel angry in how much we have been offered when they are splashing obscene amounts of my tax cash elsewhere. But I have learnt that impotent rage only makes yourself ill with no impact on those you are angry at. Doing things constructively that genuinely may do some good in the community in which I live is a pleasure. It has boosted morale within all the surgeries and no shortage of volunteers and recently retired whom we have swiftly done the necessary on. No machiavellian complexity for those working for us. Again we have retained control. Not going to make me richer.
I am seeing a north south divide and I suspect that with property price differentials you are significantly richer as a GP in the north than the south. Perhaps that drives a need to chase every last penny and the playing field is not even.
The other thing about control is all my staff and partners are vaccinated. All our care home residents and LD homes were done a week ago and we are now moving on to the over 70’s and housebound. Slowed only by lack of vaccine.
I am also making sure my patients know who is organising their vaccines. The government are gaining little credit.

Patrufini Duffy 26 January, 2021 2:43 pm

I agree David. All good – stay safe and joyous.

David Jarvis 28 January, 2021 12:08 pm

Hi happy to disagree and aware we are in massively different places in the variety of GP’s. Perhaps a bit upset with those who feel money is everything although we are negotiating with people who are like that. But I may be lucky that I can afford this. I was angry about the ES but I live in a small town so many gains not just fiscally.
Keep safe.