Answering the call to do more shifts at his local Covid vaccine hub is something GP partner Vinesh Patel says provides ‘a bit of a morale boost’ – but there’s also no escaping the extra pressure the programme is placing on an already overstretched workforce.

Last week, his practice in Sutton had to release more staff time to double the number of sessions both their clinicians and administrative staff were undertaking at the vaccination hub – after the site was notified at short notice that it would be receiving double the vaccines.

Dr Patel – was who speaking to Healthcare Leader on behalf of the Doctor’s Association UK – says ‘people forget’ GPs are not being told they can reduce two or four clinical sessions at their surgery to do this – it is ‘on top of all the extra work we’ve been asked to do’.

The Covid vaccination programme is rolling out alongside a raft of existing pressures. Staff are dealing with normal routine work and the ‘emergency normal day-to-day stuff’ seen in winter, says Dr Patel, as well as managing patients who have had elective and routine work delayed in hospital – and continuing this season’s expanded flu programme.

The request to provide more staff and time to the vaccination effort has also coincided with an email callout asking GPs to volunteer at the Nightingale Hospital, he adds.

‘Within all of that we have staff who are isolating – either because members of their family have got symptoms or who have been told to isolate, or they themselves have.

‘We are down to the bare minimum at the moment.’

GP workload

NHS England has recently set out a range of measures in a bid to address GP workload – including the suspension of local enhanced services. The same letter also detailed the ‘biggest priorities’ – alongside the Covid vaccination programme – for general practice, which included that it remains ‘fully and safely open’ and maintains appointments.

The waiting time for routine appointments at Dr Patel’s practice is still less than a week, but he says they have made an ‘active decision’ to reduce the number offered.

‘I could have a full clinic booked because I expected to be in, and then suddenly be isolating and call in that morning – and that puts the pressure on the team,’ he says.

‘We’re trying to manage that by reducing the number of routines so that if those incidences do occur, the pressure on the team that is available isn’t so much.’

This pushes the waiting time up, Dr Patel says, but it’s the ‘only way’ they can fill the timetable at the vaccine clinic – recognising that staff ‘are already strained and mentally and physically drained’ and that those last-minute changes make it harder to cope.

It is, he adds, ‘probably a story that is being replicated across the country’.

‘More pressure and more complaints’

Another key – but not new – challenge is managing patient expectations. Practices have come under fire for being ‘closed’ during the pandemic, when this is not the case, and a recent study warned of an ‘urgent need’ to restore public trust in remote consultations.

Dr Patel describes it as ‘constant battle’ to explain that practices are not closed, but says that the public needs to understand ‘the complexities that we can’t carry on the way we are’.

It is made worse, he adds, by the fact ‘the central output from NHS England and again within CCGs’ has been that practices need ‘to carry on business as usual’ – and by a lack of public announcements that provide a clear message about the pressures in primary care.

‘It would be great if we had more public announcements saying that ‘we know some elective work is being delayed and passed over to primary care’ – but that’s not something the Government want to advertise because it doesn’t reflect well on them.

‘But that is the reality and without that understanding, what they fail to do is actually creating more work, more pressure and more complaints.’

When asked how it feels to face complaints and abuse from patients at an already pressurised time, Dr Patel says it is ‘painful’, demoralising’ and ‘does get you down’, adding that an upcoming DAUK survey is due to reveal a stark rise in incidents.

‘We know that the ones who complain or who are unreasonable aren’t every single patient but the abuse that we get…we’re human, we are under pressure, we are stretched and there is a breaking point that us as human beings will reach as well.’

‘Eroding trust’

The timing of Government communications has also sparked anger among the profession – with one of the most recent examples being the Government’s move to change the dosing schedule for the Pfizer vaccine on New Year’s Eve – an announcement that would result in the cancellation of thousands of appointments at very short notice.

‘When we talk about trust within the vaccine programme, people are already sceptical and this erodes that trust both from a clinician and a public point of view,’ Dr Patel says.

The chief medical officers acknowledged the change would be ‘operationally very difficult’ and distressing for patients – but it’s a move Dr Patel deems ‘utter madness’ and one that has created a ‘postcode lottery’ due to the way different areas chose to respond to it.

Some PCNs opted to honour existing second dose appointments before adopting the change, others sent out blanket texts to patients, and some took an approach similar to Dr Patel’s – which was to spend two hours on the phone to patients explaining all the information and giving them the option of whether or not to agree to a cancellation.

‘If the patient knows all of the information and then says doctor I will delay my appointment, I will feel more comfortable because they’ve been given all the right information – I’m not going to do it without that because it’s not ethically correct,’ he says.

Not one of Dr Patel’s patients agreed to a cancellation, but he’s ‘quite happy to stand by that’: ‘I might get told off by senior managers or the powers that be who aren’t clinically front-facing, but ethically and morally I have to take responsibility for my own decision.’

‘More flexibility’

The latest figures show more than four million people in the UK have now received their first dose of a Covid-19 vaccine and the vaccination programme continues to accelerate, with 10 new mass vaccination centres opening this week and more pharmacy-led sites.

But as the vaccination effort ramps up, Dr Patel says the Government needs to be more transparent about vaccine supply – he’s heard of vaccine hubs getting deliveries cancelled ‘at the last minute and therefore rushing to cancel patients’, others getting a delivery they weren’t expecting and rushing to book in patients, and one area that was ‘doing so well at vaccinating that they asked for more vaccines and have been declined’.

‘There isn’t this kind of coordinated approach that you would expect and again that would really take knowing what the number of vaccines are, where there are scheduled deliveries and what to do with it – we can’t have this postcode lottery,’ he says.

He’s also calling for more flexibility in the primary care contract for the programme – ‘as long as its resourced and is a choice’ – to allow for some of the Oxford vaccines to be given to individual GP surgeries, because they know their patients and can organise it.

‘If they really want the vaccination programme to work then back it – show that they back it by giving good flexibility in the contract, understanding the complexities on the ground and giving us the opportunity – we know our patients and we know our staff,’ he adds.

The reality, Dr Patel concludes, is that despite feeling stretched, ‘we don’t want to stop because this is our vocation, we want to help, we are considering volunteering for the Nightingale hospital, we are trying to do the best we can to fill these [vaccine hub] shifts.

‘But without the Government listening and being transparent on the problems we face – both with us and with the public – there is only so much goodwill that can continue.’

Read the article here: https://healthcareleadernews.com/views/interviews/there-is-a-breaking-point-that-us-as-human-beings-will-reach-as-well/

“I support my patients who have already been consented to have their vaccine at the three week mark.” said Dr Patel

Hear Dr Vinesh Patel’s interview with LBC, where he discussed the proposed vaccination programme and the primary care perspective.

The key things he highlights are: it is a really positive thing to be able to discuss a possible exit strategy from the pandemic. Primary care should be involved in the decision making given their expertise in giving vaccinations and immunisations, the appropriate resources and funding should be given to allow this programme to be a success, and that all GP practices should be supported in a way that will allow them to participate.

#PrimaryCareAlwaysThere

DAUK’s Dr Vinesh Patel on residency delays stopping migrant medics from working:

“Surely at a time of the pandemic, the question we should be asking is can we invest in speeding up this process, reduce the bureaucracy that these clinicians are facing, and find out why we can’t have them on the front line.”

For months the Government has been boasting of its close relationship with Oxford and AstraZeneca, and how, when the time came, this would ensure a smooth vaccine roll-out. 

Yet this week, asked why our current stocks are so unexpectedly low, Government sources were advising journalists they should ‘ask AstraZeneca’. There had been rumours of problems with glass phials, which were denied. There were some limited admissions from sources close to the company about batch control.

Compare us with India, where the Oxford jab is being made under licence. There are already at least 50million doses stockpiled at a giant factory in Pune, ready to go. Britain has less than 1 per cent of that to roll-out on Monday.

Last night one senior medical source, a viral vaccines expert who has been advising the Government, suggested the reason is the ‘messy data’ from Oxford’s clinical trials. 

These suggested that giving an initial half-dose, followed by a full one four weeks later, was more effective than two full doses – a finding that emerged when trial participants were given the low dose by mistake.

‘They didn’t go all-out to get in supplies for the start of the year because getting approval was taking longer than it did for Pfizer,’ the source said.

Another reason for the delay is that the Oxford vaccine needs to spend 20 days in sterilisation before it can be used, while each new batch has to be checked by regulators.

But Professor Adam Finn of Bristol University, a member of the Government’s official Joint Committee on Vaccines and Immunisation (JCVI), insisted the picture was less gloomy than it might seem.

There was, he said, ‘an overwhelming argument’ in favour of widening the dosage gap to protect more people sooner, even though this was a result of shortages.

He added: ‘The UK is actually doing alright compared to other places. There are difficulties in rolling the vaccines out – but something as complicated as this has never been done before.

‘I’m personally impressed we’ve already managed to vaccinate 900,000 people – and now the use of the Oxford vaccine is going to make it much easier to target the elderly.’

Some experts believe that lengthening the gap between first and second dose from three to 12 weeks may actually improve protection, at least in the case of the Oxford vaccine.

But Pfizer has signalled it is unhappy its vaccine will be used in Britain in a way never envisaged when it passed its clinical trials. 

Professor Whitty explained the controversial change in his letter to doctors: ‘For every 1,000 people boosted with a second dose of Covid-19 vaccine in January, 1,000 people can’t have substantial initial protection, which is in most cases likely to raise them from 0 per cent protected to at least 70 per cent protected.’

He continued: ‘These unvaccinated people are far more likely to end up severely ill, hospitalised and in some cases dying without the vaccine.’ In other words, in a cost-benefit analysis, opting for the new approach means more people are protected.

Professor Finn said with the Pfizer vaccine, people who got their first jab would soon have 91 per cent protection. That figure would rise only marginally to 95 per cent after their second.

‘Vaccines going into more arms will save more lives’, he said.

According to the official committee on which he sits, data shows that the American Moderna vaccine – approved for use in the US, but not yet in Britain – is very similar to the Pfizer jab. It seems to grant protection from a single dose for at least 15 weeks – and it is this that the JCVI have used in coming to the decision about the Pfizer jab.

Yet Deenan Pillay, professor of virology at University College London, and a leading member of the UK Virologists’ Network, said there was a ‘theoretical possibility’ that delays in giving a second dose might encourage new mutations. He said: ‘Of course, I see there the argument that if you maximise the numbers who get an initial dose, that will be beneficial. But there is a theoretical risk.’

Professor Finn dismissed this. ‘This kind of speculation is not helpful. But we need to be astute about the mutations that do occur and whether they mean we need to alter the vaccine.’

The British Medical Association says it believes that ‘existing commitments’ to give a second jab to patients who have already had their first ‘should be respected, and if GPs decide to honour these booked appointments in January, the BMA will support them’.

Richard Vautrey, head of the BMA’s GP committee, said not meeting this would be ‘grossly unfair to tens of thousands of our most at risk patients.’

Vinesh Patel, of the Doctors’ Association UK, urged the Government to think again: ‘A patient can’t consent for a treatment then have it changed without their permission, especially when the evidence for change is lacking.’

The full article can be accessed here: https://www.dailymail.co.uk/news/article-9105249/Vaccine-freedom-fiasco-making-asks-DAVID-ROSE.html

Batches of the Oxford/AstraZeneca coronavirus vaccine have started arriving at UK hospitals ahead of the jab’s nationwide roll-out.

Some 530,000 doses of the treatment will be available for roll-out across the UK from Monday, with vulnerable groups already identified as the priority for immunisation.

The vaccine has been developed in the UK by Oxford University and the pharmaceutical giant AstraZeneca.

The roll-out will begin after England’s chief medical officer Chris Whitty warned vaccine shortages are likely to cause problems for “several months”.Advertisement

He said the UK urgently needs to maximise the number of people who are vaccinated, but added a lack of global supplies will likely hamper efforts to protect the nation in the first part of 2021.

Public Health England (PHE) has said it does not recommend mixing coronavirus vaccines from different suppliers amid fears over the possible shortages.

Both the Oxford/AstraZeneca vaccine and the Pfizer/BioNTech vaccine, which has been rolled out from December, require two doses.

The UK government had issued guidance telling NHS medics that if a person who has received their first coronavirus jab goes back for their second but the same type is not available, or the first vaccine type is unknown, then it is “reasonable” to offer a dose of another vaccine.

Dr Mary Ramsay, head of immunisations at PHE, has since told Sky News that mixing is not recommended and should only happen on “rare occasions”.

The Princess Royal Hospital in Haywards Heath, which is part of Brighton and Sussex University Hospitals NHS Trust, was one of the first hospitals to take delivery of a batch of the Oxford/AstraZeneca vaccine on Saturday morning.

First doses of the vaccine will be administered next week after the UK recorded another 57,725 coronavirus cases on Saturday – its highest ever daily total. Another 445 deaths were reported.

Dr George Findlay, chief medical officer and deputy chief executive at the trust, said the vaccination programme gives NHS staff “more confidence” coming into work.

He added hundreds of people are expected to be vaccinated per day at the Princess Royal Hospital site, with efficiency expected to increase after the first few days of the programme.

Dr Findlay said the Oxford/AstraZeneca vaccine, which can be kept at normal fridge temperature, is “much easier” to administer when compared with the jab from Pfizer and BioNTech, which needs cold storage of around minus 70C.

More than a million people have already received the first of two jabs of the Pfizer/BioNTech vaccine.

Second doses of either vaccine will now take place within 12 weeks rather than the 21 days that was initially planned with the Pfizer/BioNTech jab, following a change in guidance which aims to accelerate immunisation.

Doctors’ Association UK (DAUK) has raised concerns over the spacing of the second dose of the Pfizer vaccine and what it calls “the lack of a coherent strategy for the current crisis”.

Dr Natalie Ashburner, vice-chair of DAUK, said: “Poor communication and lack of engagement with frontline clinicians who are implementing this vaccine programme and dealing with the NHS pressures has led us to this point.

“Moving forward we urge a rapid reassessment of the strategy as a whole with a clear plan that has had frontline clinician input, so that even if we are deviating from certain guidelines, we are doing so together and with the backing of the science.”

Dr Vinesh Patel, from the GP committee of DAUK, said: “There are a great many concerns that the change in vaccine strategy and dosing regimen has been communicated poorly and represents an attempt to stem public health failings.

“There appears to have been little to no involvement with frontline clinicians in making this decision, and subsequently chaos is ensuing…. (the change in strategy) is a huge gamble, and one made without the data to back this strategy.”

The full article can be accessed here: https://news.sky.com/story/covid-19-batches-of-oxford-astrazeneca-coronavirus-vaccine-arrive-at-uk-hospitals-ahead-of-roll-out-12177510

As frontline GPs working in primary care we, like the rest of the country, are both excited and relieved that a vaccination for COVID-19 is in sight. Over the last week we have received some news regarding what a COVID-19 vaccine program may look like, and some primary care networks (PCNs) and GP surgeries are poised to take on this role and sign up.

Whilst this is brilliant news, the current offering from NHSE in terms of the Direct Enhanced Scheme (DES) falls short of making it feasible for many more GP surgeries and PCNs to deliver, with a huge number being unable to take up the offer. This will have significant implications for us all, and could threaten the success of the vaccine program as a whole. It is imperative that we act now and remedy these issues, in order to give us the best chance of defeating this virus.

Background

We must understand the background and atmosphere in which we are rolling out this programme, in order to identify possible pitfalls and problems. Prior to the pandemic, the Health Foundation reported In March 2020 that workload pressures were growing across general practice. Despite a 2015 target for 5,000 additional GPs by 2020, the number of qualified permanent full-time equivalent GPs in the UK has fallen. There are now 1,700 fewer qualified permanent GPs than in 2015.

Recently, the DAUK ran a survey of almost 900 GPs in which 78% reported the pandemic has had a negative effect on their mental health. Additionally, only 1.8% of respondents felt well-supported by NHSE. Furthermore, the Medical Protection Society (MPS) found 1 in 3 GPs report being subjected to verbal abuse during the pandemic.

All of this is occurring against a background of rising health inequalities, and a stalling life expectancy. Currently, primary care is working at maximum capacity, dealing with issues as a result of the pandemic as well as ongoing routine work. This limited workforce, with a limited capacity, needs to be kept at the centre of any plans to roll out a vaccine whilst recognising the current issues we are facing.

Issues and recommendations

We welcome the introduction of a potential vaccine and believe primary care has an invaluable role to play in its delivery, having seen the innovation with which those working in general practice have managed to roll out this year’s biggest ever, seasonal flu vaccine. It is this expertise we need for the COVID-19 vaccine, but it is imperative that we set primary care up for success in the delivery of this.

Below we list the current limitations of the DES based on the information we have received so far, which means many practices are struggling to agree. We set out what the potential solutions are, which would ensure higher primary care take-up and thus a greater chance of success in our only way out of this pandemic.

Flexibility and further information

Without the full specifications of the program being released it is difficult to ask GPs to commit to delivering the vaccine. We need the full details of the DES to be released to GPs in a timely manner, in order to allow them to make a decision regarding whether or not they are able to take this on. If this is not possible, there must be flexibility to sign up at this preliminary stage, but if it proves difficult to safely deliver the vaccine alongside routine clinical care, there must be the option to step down from this responsibility.

Funding

On the current DES, all payments for the vaccine program will be made retrospectively. This is a huge undertaking and poses a significant financial risk to primary care, who will have to shoulder the financial burden. We cannot ask this of GPs when so much is at stake nationally. We need significant, upfront funding to allow surgeries to purchase equipment needed, pay for temporary staff, and make urgent renovations to their buildings in order to be able to deliver this vaccine safely. Additionally, primary care needs to fully cost this service. There needs to be a higher fee to acknowledge the huge ask and realistic costs of this programme.
Additional further funding is necessary to cover delivery of the vaccine to housebound and nursing home patients, as this will require higher time constraints.

Furthermore, we need clear guarantees that if a patient chooses not to attend for the second vaccine, payment will still be made. The time, logistics and practicalities of delivering this program will otherwise incur high costs that primary care cannot singlehandedly shoulder.

We have seen the significant funds that the government has pumped into other areas including the private sector, for services such as Track and Trace. The funding that has been allocated to this DES is hugely insufficient and significantly lower in comparison.

Working hours and logistics

The DES specifies practices must be open from 08:00 – 20:00, 7 days a week to deliver the vaccine. We believe more flexibility needs to be allowed. Each year, practices deliver successful flu vaccine programmes, dependent on the local needs of their respective communities. Some practices run late evening or Saturday clinics, whereas others provide it in hours; these decisions are influenced by local factors which GPs take into account in order to best serve specific communities. Practices need to have the flexibility to provide a service they feel confident they can provide, for a population they know well.

The information around the vaccine also states that we will need to reconstitute the vaccine, counsel the patient and have them be observed, socially distanced, for 15 minutes after having the vaccine. All of this has not been adequately taken into account within the PCN DES, setting unrealistic expectations of the numbers vaccinated each week. Workforce and time available within primary care need to be taken into account and funded accordingly.

Reduction in workload

In order to enable a maximum number of staff to be utilised for the vaccine program, we need to reduce workload by stopping CQC inspections, making appraisal voluntary and stopping other forms of bureaucracy. This vaccine programme represents a significant workload during a global pandemic, when GPs need to rightly be focussing on appropriate clinical care.

We need urgent clarification as to what other methods are to be employed in delivery. We recognise there are plans for additional support and mass vaccines centres, but this needs to be clear and set up alongside the PCN DES with primary care input, rather than separate to it.

Information around COVID Vaccine

We are already seeing appropriate questions from both the public and clinicians on the data behind these vaccines. To ensure good uptake, we need the research data to be available to clinicians in an appropriate timeline before full agreement to the PCN DES. Without this we, as clinicians who will be rightly asked questions around the vaccines by patients, cannot morally engage in this vaccination programme. We need time to absorb, discuss and question the data before fully signing up to the DES.

Recommendations

1) The research data needs to be released to clinicians with sufficient time to allow them to analyse the data and before signing up to the DES.
2) The PCN DES needs to be delivered in conjunction with, and not separate to, bigger strategies around mass vaccination centres and additional workforces.
3) Improved funding allocated for possible hiring of venues, hiring of more staff, improving current primary care estates, purchasing necessary equipment, transport for vaccinations and storage and that this funding is allocated upfront to allow proper planning for this programme.
4) Improved funding for the administration of this vaccine to take into account the complexity and time required.
5) No restriction of funding if the patient does not attend for the second vaccine
6) Funding to be increased for the administration of the vaccine to housebound and nursing home patients.
7) Flexibility over the time and days for these vaccine centres to be open under the PCN DES.
8) Flexibility over current workload and ask of primary care to recognise this huge task being allocated under this PCN DES.

Summary

In order to enable more GP practices to take up the DES we need to allow more flexibility and limit financial risks to individual GPs.
We hope that by making the above changes to the DES, aiming to reduce the risks in signing up to the program, this will lead to a significant improvement in the ability of primary care to take up vaccination delivery which will ultimately benefit the population. Primary care wants the vaccination programme to work and is rightly placed to deliver it. However, we need to ensure that the exit strategy is realistic and appropriately supported so that it is a success.
Signed,

Dr Vinesh Patel
GP Partner, Sutton

Dr Lizzie Toberty
Salaried GP, Sunderland

Dr Kaveri Jalundhwala
GP Trainee, Thames Valley

Dr Zainab Najim
GP Trainee, Norfolk

DAUK GP Committee

The UK’s chief medical officers have defended plans to delay giving the second dose of a Covid vaccine to more than 500,000 people who have received the first jab, saying they believed the public would “understand and thank us for this decisive action” despite an outcry among doctors.

Recipients of the Pfizer/BioNTech vaccine had previously been told there would be a three-week gap between doses, with many already booked in for their second jab.

But the government announced a change to its Covid vaccination strategy on Wednesday, saying second doses of the newly approved Oxford/AstraZeneca vaccine and the previously approved Pfizer/BioNTech jab would now be given up to 12 weeks after the first dose.

The move applies to people scheduled to have their second dose of the Pfizer jab after 4 January, as well as those yet to receive either jab. The government said it hoped the approach would free up more doses and mean as many people as possible would soon get their first jab and have some protection against the disease.

The new regime was backed by the chief medical officers of the four UK nations, with instructions given to health service leaders in England by NHS bosses on Wednesday to postpone many of the scheduled second Pfizer/BioNTech jabs.

The announcement caused controversy, however. Pfizer and BioNTech warned that two doses of their vaccine were required for maximum protection against Covid and that they did not have evidence that the first dose alone offered protection after three weeks.

Azeem Majeed, a professor of primary care and public health at Imperial College London and a practising GP, said he was shocked by the change of plan.

“We’ve got thousands or perhaps tens of thousands of people who have already booked their second jabs, and these are people who are all elderly, so they often have to make special arrangements for their care or have someone to bring them down. Someone is going to have to ring all these patients to cancel their appointments and rebook them, so it is going to create a lot of work for people as well,” he said.

“Clearly the people making these rules are not the ones having to enforce them. I understand the rationale that the government wants to increase the vaccine supply to make sure more people are immunised, but I think that could have been done for people starting from now, rather than cancelling the ones who have already been booked in, which is very disruptive.”

In a joint statement on Thursday night, Chris Whitty, the chief medical officer of England, and his counterparts in Wales, Scotland and Northern Ireland stood by their decision, although they acknowledged that it would “distress patients who were looking forward to being fully immunised”. They added: “However, we are all conscious that for every 1,000 people boosted with a second dose of Covid-19 vaccine in January (who will as a result gain marginally on protection from severe disease), 1,000 new people can’t have substantial initial protection which is in most cases likely to raise them from 0% protected to at least 70% protected.”

They added: “We have to follow public health principles and act at speed if we are to beat this pandemic which is running rampant in our communities, and we believe the public will understand and thank us for this decisive action.”

Earlier, one doctor who spoke to the Guardian on condition on anonymity said they hoped to continue with the original schedule for the second dose rather than cancelling appointments, saying that to do otherwise would put their most vulnerable patients at risk and break promises to patients.

Alison Bolam, a GP at Horfield health centre in Bristol, said her practice would take a similar approach. “If we try to ring and cancel 1,000 80-year-olds, and then ring 1,000 75-year-olds and ask them to come in instead, we risk wasting vaccine because we don’t have the staff capacity to do that with the bank holiday in the way,” she said. “If anyone gets the first vaccine now, the second one will be 10 to 12 weeks later, but for anybody who has already had it, they will get their second vaccine as originally scheduled.”

The British Medical Association said it was unreasonable and unfair to expect practices to cancel and rebook appointments for patients to have their second dose.

The chair of the BMA’s GP committee, Dr Richard Vautrey, said: “Local leaders are telling us that is unprofessional and impractical to amend the appointments for thousands of frail, elderly patients, particularly those booked and who have already made arrangements to have their second vaccination in the next two weeks.”

Vautrey called on the government to publish a scientifically validated justification for the new approach, adding that rebooking appointments would cause huge logistical problems. 

The Guardian understands a number of NHS clinical commissioning groups were holding meetings on Thursday on the issue, to decide how to proceed.

Dr Helen Salisbury, a GP and medical adviser to the health experience research group at the University of Oxford, tweeted that the health secretary Matt Hancock, should help to phone her elderly patients and explain why their second jab had been delayed. She said her primary care network needed to cancel and rebook 1,160 appointments.

“At 5 mins per phone call, that’s 193 hours’ work. Not to mention the grief & anger,” she tweeted. 

Her comments unleashed a flurry of responses from other GPs, with some questioning whether it was ethical to delay a second dose when patients had given consent for the first dose on the premise that they would receive the second three weeks later.

The Doctors’ Association UK said it had sent a letter to Hancock and others involved in the change of strategy regarding the Pfizer vaccine. “A patient can’t consent for a treatment then have the treatment changed without their permission, especially when the evidence for change is lacking,” it said. Dr Vinesh Patel, a GP partner and spokesman for the DAUK’s GP committee, said using the Pfizer jab outside the trialled vaccination regime was a huge gamble.

Full article available here: https://www.theguardian.com/society/2020/dec/31/covid-vaccine-uk-doctors-criticise-rescheduling-of-second-doses

The Covid vaccine rollout could turn into a PPE-style fiasco, MPs, doctors and care chiefs warned last night.

Hundreds of GP surgeries and scores of hospitals are still waiting for Pfizer jabs.

Vaccine appointments for the most vulnerable are being cancelled at the last minute because of the delay, doctors say. 

And 12,000 of the country’s 15,000 care homes are not even being considered for jabs right now – with only seven areas of England getting them so far.

Health leaders have also raised concerns many frontline NHS staff are still not being sent for jabs.

On Christmas Eve the Government said 616,933 people in the UK had been given a first dose – 512,594 in England. 

But it’s understood half of England’s 135 trusts are still waiting, along with hundreds of surgeries.

Yesterday MPs warned ministers not to repeat the PPE and testing “shambles”. 

Meanwhile, Doctors Association UK said surgeries have reported failed deliveries of the Pfizer jab. 

Dr Vinesh Patel told of “practices booking in patients, and then cancelling because of promised vaccines not turning up”.

GPs in Warwickshire have 3,500 over-80s to vaccinate at a country club in Leek Wootton. But they received only 975 vaccines last week – with no idea when more will come.

Read the full article here: https://www.mirror.co.uk/news/uk-news/coronavirus-vaccine-chaos-appointments-axed-23224793

The BMA has said it will support GPs who honour appointments already made to administer the second dose of the Covid vaccine within three weeks of the first dose.

The Government said that GPs should cancel appointments they had already made to administer the second dose of the Pfizer vaccine within three weeks because it wanted more people to receive the first dose sooner.

But doctors’ groups have warned of the problem of cancelling second appointments for patients over 80, with the Doctors’ Association UK (DAUK) warned there was ‘chaos ensuing’.

 It comes as NHS England has made an additional £1,000 available to the first wave primary care networks to support with administrative costs in rescheduling appointments.

Pfizer initially stated that its vaccine must be taken in two doses, three weeks apart.

However, the chief medical officers and Joint Committee on Vaccination and Immunisation announced last week that healthcare professionals should instead deliver second doses after 12 weeks, to get more people vaccinated with their first dose in a shorter timeframe.

This was in part driven by the new strain of the Covid virus, which has led to rapidly rising rates, particularly concentrated in London and the South. The past four consecutive days have seen more than 55,000 new cases of the virus, while the UK has now surpassed 75,000 deaths within 28 days of a positive result.

The BMA has said that it had heard of the ‘significant impact re-booking thousands of elderly patients’ and at-risk healthcare workers’ appointments will have’.

He added: ‘In conversations with NHSEI, I have made clear that expecting GPs to rebook appointments in a few days’ time is unreasonable and totally unfair, and we expect that those practices who honour existing appointments booked for the next few days should be supported to do so.’

 ‘The BMA believes it is only right that patients who have already been promised, by the NHS and local clinicians, that they will receive a second dose of Pfizer vaccination next week do so, and that these appointments for at-risk groups should proceed as planned. These patients have given their consent to receive their vaccination and, quite rightly, are expecting to have it. Therefore, if GPs decide to honour these booked appointments in January, the BMA will support them.’

However, the RCGP is disagreeing with the BMA. Taking the ‘unusual step’ of addressing GPs on New Year’s Day, chair Professor Martin Marshall said: ‘This might feel uncomfortable and it will be hard work, but it is the right thing to do for our patients and the health of the wider population.

‘So much of what we do in general practice is in the interests of our patients’ long-term health and lives but these are effective interventions with immediate impact.

‘The current infection surge – and its impact on the NHS and patients’ lives – makes it imperative to protect as many people as possible, as quickly as possible. People will still need to receive two doses but releasing the ‘reserved for second dose’ vaccine will release, we are told, close to a million more doses, which means we can give more first doses to higher numbers of our vulnerable patients and get healthcare workers vaccinated more quickly.’

But Professor Marshall did note that NHS England’s guidance allows for ‘some clinical discretion for practices to go ahead with second vaccinations where necessary’.

Dr Vinesh Patel, who sits on DAUK’s GP committee, singled out the ‘poor communication’ behind the new strategy and dosing regimen. Describing this as representing ‘an attempt to stem public health failings’, Dr Patel said: ‘There appears to have been little to no involvement with frontline clinicians in making this decision, and subsequently chaos is ensuing. We can see the principle behind the recent CMO and JCVI advice; the priority is to provide some degree of protection for as many as possible’.

DAUK’s concerns include that there is ‘no data regarding administration of dose 2 vaccine >23 days after the initial dose’. It points out that Pfizer stated that it has ‘not evaluated the safety or efficacy of Covid-19 mRNA Vaccine BNT 162b2 when administered outside of the intervals evaluated in the Phase 3 study’.

NHS England/Improvement’s primary care bulletin, issued on 31 December, stated: ‘As 2020 comes to an end we are at a critical point in the pandemic and it is therefore imperative that we prioritise the first doses of vaccine for as many people as possible on the priority list.

‘We recognise that the request to re-schedule second appointments is operationally very difficult, especially at short notice. We have written to CCGs to outline a package of support to help you do this. We have made an additional £1,000 available to the first wave PCNs to support with administrative costs in rescheduling appointments and free support is also available from a CSU, via your CCG who have stood up a call centre which can be used to contact patients to reschedule vaccinations.’

Read the article here: https://www.pulsetoday.co.uk/news/coronavirus/bma-will-support-gps-who-honour-existing-appointments-for-second-dose-of-covid-vaccine