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Covid vaccinations round table part 1: Tensions with mass vaccination centres

Tensions with mass vaccination centres

Eight PCN clinical directors joined Pulse editor Jaimie Kaffash on Microsoft Teams to discuss how the Covid vaccination scheme has progressed

Dr Tom Rustom Clinical director, Hawley PCN, East Surrey

Dr Robin Harlow Clinical director, Gosport Central PCN, Hampshire

Dr Partha Ganguli Clinical director, South Ribble PCN, Preston and Chorley, Lancashire

Dr Monica Alabi Clinical director, Titan PCN, Bedfordshire

Dr Reshma Syed Joint clinical director, Sittingbourne PCN, Kent

Dr Tom Holdsworth Clinical director, Townships PCN, Sheffield, South Yorkshire

Dr Helen McAndrew Clinical director, Abbey Health PCN, St Albans, Hertfordshire

Dr Sanjoy Kumar Clinical director, North East London PCN, Waltham Forest, London

Chair Jaimie Kaffash Editor, Pulse

Jaimie Let’s first discuss the problems with the vaccine rollout. How do you think things could’ve been done better?

Monica There could have been a lot more communication to start with. There could have been a lot more trust placed in the hands of the GPs…and more notice given. GPs have been doing [vaccines] for many years, we don’t have any problems [with it].

We should be allowed to request vaccines as we need them. For instance, for Titan PCN in Luton, we had a delivery of vaccines in January and a month later we’d had no more.

Reshma Vaccine delivery is a major problem. We don’t know when the vaccines are going to come to the various sites, deliveries are very erratic and there hasn’t been the opportunity for other sorts of practices to get involved. So, PCNs have been given this cool contract but obviously there are separate contracts for other providers and individual practices have not been given the ability to also provide vaccinations. Vaccination could have been ramped up a fair bit if practices had been allowed to do it individually.

Helen In terms of vaccine supply, I think it’s been split into too many different models of delivery. I suspect that primary care probably wasn’t supposed to be involved in this programme from the offset. My cynical side thinks that there is still a strong push for mass vaccination sites to be delivering this but general practice has proved it has the means, expertise and the access to patients and relationships to deliver it and has far exceeded what any government expected us to do. Now there’s a situation where there aren’t enough vaccines to spread around all these different models of delivery. But there’s a very successful service in primary care that can’t easily be stopped.

Robin There were concerns about resilience, longer term. Yes, we’ve done this, and it’s fantastic, but what services have we not delivered because we’ve been delivering vaccinations as a priority? Most of our staff have done [vaccinations] as additional hours – and yes, we’ve brought in volunteers to help support that – but still, that is additional work for our staff.

Jaimie When we talk about supply issues, is this simply a problem with lack of supply from Pfizer and AstraZeneca or is it a problem with logistics in NHS England?

Tom H My honest feeling is we don’t know. The transparency is really difficult. I’m not completely against mass vaccination centres. I think the issue is about the communication and the working together. At times, it feels the system’s working in silos rather than working together. Sometimes the level of communication is that we [first] hear [about] things in the press and that’s really bad.

Helen Our CCG on the surface seemed to be really supportive of the fact that we would have a mass vaccination site imposed [on us]. They openly admit that there are thousands of vaccines in the fridges of our local pharmacists and our local mass vaccination sites and that people aren’t currently going to them because of the cohorts they’ve [set up].

Yet we have more than 10,000 people in cohort six that I can’t vaccinate because I haven’t got any supply. We’ve tried the mutual aid route of asking for that vaccine to be moved to us, [which would] also let us go out and get some of the health inequality and vulnerable groups. Last night I vaccinated 20 homeless people. But I couldn’t vaccinate the other 50-60 because I didn’t have enough vaccine.

Jaimie Why do you think the mass vaccination centres are being pushed instead of the PCN groupings?

Helen Using this area – St Albans – as an example, GPs could successfully deliver 15,000 [doses] a week. We’ve proved this by doing 2,000 in a day – easily – on the odd occasion that we’ve had vaccines. But a mass vaccination site is still going to be put in the city, even though there is not the vaccine capacity. I think you’ve got to question why. We suspect it’s to do with the May elections and the headlines that [might result from] mass vaccination sites.

Partha We actually have written to our integrated care system (ICS) vaccine team [saying] that we don’t need the confusion created by mass vaccination and whatever workforce they are planning to use, asking them to give it to us to run the service much better. That was turned down. [The reply was]: ‘We want to preserve your working capacity’.
We are going beyond our capacity to do the job and at the end of the day I think our uptake is much better than uptake at a mass vaccination site.

Tom R I think that PCNs are really showing their worth with all of this because they’ve shown that they’re the right size of footprint to be able to deliver a vaccination programme like this. So it would be a real shame if [vaccinations] did move out of PCNs from local sites to mass sites. We’ve got clinical directors who have built relationships with their practices over the last two and a half years. I think in most places the clinical directors are taking a lead with the vaccination sites. And we’ve proved that it’s working.

Sanjoy The work streams to set up mass vaccination sites are completely separate [from PCNs]. We weren’t told about the mass sites originally and how they would affect our area or that they’d be within half a mile of a PCN centre that’s doing particularly well. We weren’t told about the fact that someone else would be given the easiest cohorts which are in and out in three seconds.

We weren’t told about the supply problems. We weren’t told about the fact that if you do particularly well, NHS England will take your vaccine supply and give it to somewhere else that is perhaps making more noise about not having the supply.

We’re all being treated like children here, but we all have a significant amount of experience in general practice. We give 20 vaccinations to every child in our practice from the time they are born to the time they go to school. We are the experts at giving vaccinations. It should be a ground-up [service]. This is actually a top-down service – the exact opposite of the way you should set up a service.

Jaimie Does anyone here think that mass vaccination sites have been a support at all in your task of vaccinating your populations?

Partha Before we divided up the cohorts 65 to 70 and cohort six, in our network we and our CCG got in touch with our local mass vaccination provider – which is the acute trust. They were quite supportive of us. We wanted to involve the pharmacists to divvy up the patient group because there is no point in fishing in the same pond. We decided we would aim for one cohort and they would aim for another. But we weren’t told at the time that we could go down to [cohort] six. And then, some of [the patients] shared the link with patients who are quite young…younger than 50. Nobody is checking at the mass vaccination site which group anyone is in. By contrast, we are being monitored so closely, with distrust.

Reshma We’re getting a lot of complaints from patients who have noticed other cohorts or lower cohorts have had their vaccinations done at these mass vaccination sites. We’ve heard this constant argument:
‘I should be getting my vaccination before that person’, and so on. [This inequality] between patients causes a bit of distrust and a contradiction between what’s put out in the press and what we’re doing.

Robin Letters were being sent out to the public that weren’t clear about their offer. We were part way through the campaign and patients were being offered an option [of where to get a vaccine], but it wasn’t clear it was an option. So [this] increased the workload that we had in practices. That goes back to problems with communications. I also don’t think there was clarity at the start about process – [or the] trust in GPs to undertake this.

Jaimie Do you feel the mass vaccination sites have been allowed to be more flexible with cohorts than PCNs have?

Monica The way it’s being carried out is not right and they definitely have more flexibility. NHS England is gentler with them.

Reshma The cynical side of me thinks that basically the mass vaccination sites had this plan all along to do the easy cohorts of patients and leave GPs to do all the difficult ones, like care homes and patients who were housebound.