With one vaccine against COVID-19 now officially approved for use in the UK and others likely to follow, GP practices are certain to play their part in administering the vaccines to the population.

However, ensuring how this process, described by NHS England chief executive Sir Simon Stevens as “the largest-scale vaccination campaign in our country’s history” can take place smoothly is less clear.

Vaccine approval

On 2 December, the government said it had accepted the recommendation from the independent Medicines and Healthcare products Regulatory Agency (MHRA) to approve Pfizer/BioNTech’s COVID-19 vaccine for use.

The MHRA has said the vaccine has met its strict standards of safety, quality and effectiveness and advice from the Joint Committee on Vaccinations and Immunisations (JCVI) issued later the same day detailed the priority groups to receive the vaccine, including care home residents, health and care staff, the elderly and the clinically extremely vulnerable.

It is expected that the first 800,000 doses of the vaccine will be made available across the UK from 7 December but it is likely that hospitals will be the main site for providing the vaccine given that it needs to be stored at around -70 degrees centigrade and can only be kept for up to five days in a fridge, once delivered.

The government has, however, said that the vaccine would also be available from some GPs and pharmacists if they had suitable cold storage facilities. Mass specialist vaccination centres are also to be set up.

One of the other vaccines awaiting approval from the MHRA is from Oxford University and AstraZeneca, which only requires storage at a regular fridge temperature, meaning it will be easier for GP practices to store and use on patients.

Plans for vaccination

Last month, in anticipation of the vaccine programme, NHS England/Improvement agreed with the BMA an enhanced service under which vaccination would be  done through groups of practices working together (likely along primary care network geographies), with one designated vaccination site (ideally a GP practice) determined by the practices involved.

An additional £150m of support has also been ringfenced for general practice until the end of March 2021 to go towards increasing workforce capacity to manage an expected rise in workload.

This all sounds promising in principle, but some practices are sceptical about the mechanics of the programme and their ability to provide what is being expected of them.

Peter, a practice manager in Bristol says: “The reality is that practices will cope with the vaccination programme but you then have to look at who are going to be the casualties.

“It’s not just GP land. The whole of the health service is really stretched at the moment. Just adding something extra is not helpful. Having said all that, it’s quite clear this is something that’s absolutely necessary to be done and it’s going to help everybody.

“It’s got to be a good thing for us to be involved and we want to be involved. It’s about allowing us to do it the way we know we can deliver vaccination programmes. We do it every year with the flu vaccine and we do all the other immunisations and it’s about making sure that we are allowed to do it in the way that we can do it best.”

Nicola, a practice manager from Cornwall, says: “At the moment, we are looking at deliveries of a vaccine to go to a designated practice, for example one practice that might be able to hold the vaccine and then act as a hub for patients to then go there.

“Wherever they land, they [Pfizer vaccine doses] have to then be used in four days because they have been frozen.

“Things have moved on and there are now a couple of other vaccines that we might get delivered. The AstraZeneca one doesn’t need the freezing temperatures that the Pfizer one does so you can’t really prepare for something until you know which one it is that is coming.

“If I’m going to get the Pfizer vaccine, I’m in deepest, darkest Cornwall and the next nearest practice to me is a 30-minute drive away. I have no central hub available for all of practices in our network. We have to look at traffic management, ‘Hands, Face, Space’ delivering it in a socially distanced way, and those vials that arrive have a four-day window.”

It could take a day for vaccine doses to be transported to a practice, she adds, saying: “You are then working on day two to five, which is effectively four working days to book appointments and get patients in, in a COVID-safe environment and that is a nightmare.”

Local control of vaccination

If the vaccination programme is going to be successful, it’s essential that local practices feel they have a say in how best to implement it – something that appears high on the list of priorities for managers.

The BMA’s GP committee England chair Dr Richard Vautrey said recently: “GPs and their teams know how vital a safe, effective vaccine will be in defeating COVID-19.

“With their proven track record of mass immunisation campaigns and strong relationships within their communities, GPs, practice nurses and other key staff are the right people to be leading this campaign once vaccines become available. Practices, working together in their areas, will stand ready.”

An unnamed manager speaking in a discussion thread on the issue on Practice Index, says: “In the last three days we’ve agreed to final plans for deliveries to PCN [primary care network] with surgery satellites; PCN hub; CCG hub; direct to surgery deliveries; back to hubs.

“Yup, five options in three days. It’s one of those where ‘Management by doing nothing’ is the best option. Let it play out and then make your plans once the dust has settled.”

Peter says: “I appreciate there’s got to some control from the centre and the top because otherwise there could be a free-for-all and you can’t guarantee that you’re going to get as many people as possible covered and not be able to guarantee that you don’t waste any of the vaccine.

“When the DES [Direct Enhanced Service] first came out, it was 8 till 8, seven days a week, but how is that going to help and how are we going to manage to do that in amongst everything else we’ve got to do?

“If they allow us to do it on the ground, we will work with them and work collectively but don’t do a London-centric approach and deliver it with hospitals because GP land was brought into this right at the last minute.”

Support needed

It will also be essential for practices to be supported properly with the vaccination campaign as it gets underway soon in terms of workforce, facilities and decisions on what work to prioritise.

Nicola says: “Originally we were looking at Monday to Sunday, 8am till 8pm but the problem with that is workforce. If we said we could share a hub and vaccinate all of our patients in the same place, I then might have to volunteer two of my nurses to provide some vaccination time, but if they work Saturday and Sunday, who’s going to do their Monday and Tuesday clinics? Who is going to pay for the backfill?

“If they say you have to deprioritise other workload, what do I deprioritise? There is still an awful lot of issues around who does what, how, when and why and we’re still waiting for guidance.”

Peter agrees, adding: “We are going to need to bring in some temporary administration staff because the sort of model we’ve got in our heads is that we have vaccinating pairs, one of whom is clinical and one of whom is an administrator entering the details on the records.

“That administrative job is not going to be a complicated job once they’ve been trained to do it. Then we’ll need a little bit of backfill if we have to use our clinical staff to do the clinical side of the jabbing.

“It’s difficult to imagine how much we’re going to be able to do before the end of the year. If a lorry turned up outside my practice right now with 1,000 doses of vaccine, I’m not going to use them in the next two days. I can’t organise the patients to come that quickly, so given that we haven’t even been told when we’re likely to receive our first dose of vaccine or indeed which vaccine it is, we don’t know what the logistical chain is or how much we’re going to have.

“My suspicion is that we will probably end up doing the care homes, care home staff and possibly the over 80s in December and then move on to the other stratification groups perhaps after that.”

The BMA is stoic about the work ahead and Vautrey says: “We don’t expect practices to be getting any vaccines for at least another two weeks and we believe the campaign will begin in full force in the New Year.

“In the coming months, GPs, practice nurses and support staff will play a pivotal role in vaccinating the public, protecting everyone’s health and eventually restoring life to normal.

“We know this will be a significantly challenging undertaking, particularly as staff are already struggling with ever-increasing workloads and staff burnout from the first wave of the pandemic. Therefore, practices will need support both nationally and locally, as well as patience and understanding from the public as they embark on this unprecedented campaign.”

The end of 2020 and the new year are unlikely to be a quiet time for general practice.