Guidance issued by NHS England can be found here

This information is based on national guidance, available at 9^th November, and as no official confirmation has been included of the official vaccine details, or the confirmed final DES, this guidance is to assist with planning only.

Deadlines

Tuesday 17^th November – Designate site(s) to be used by PCN for vaccination. Nomination to CCG.

Monday 23^rd November – PCN groupings will be informed of site designation approval.

Final detail for DES should be available in late November.

What you need to consider

You’ll be expected to deliver vaccinations for COVID-19 as a PCN group, initially at one site (unless exceptional circumstances apply, e.g. >100k patients in the PCN). If you’re submitting more than one site for consideration, you’ll need to mark them in order of priority. Any sites that are to be assessed for suitability which aren’t included in the first site prioritisation should be clearly marked: ‘FUTURE SITE NOMINATION’.

Payment will be at the rate of £12.58 per vaccination, and will be paid on completion of the second dose if two doses are required – i.e. a total of £25.16 per patient (for two doses). Payment after a single dose will be allowed in specific and limited circumstances. Some additional funding is available, but only for exceptional circumstances and after agreement from your CCG/STP.

In order to free up capacity, it’s possible that at a CCG level, some enhanced service activity may be paused. This might also include use of extended hours capacity.

It’s expected that PCN groups will offer vaccination seven days per week, 8am to 8pm, potentially including bank holidays.

You’ll need to consider practice premises and their suitability for delivering a vaccination programme at scale over seven days a week.

If you’re not currently part of a PCN, it’s likely that you’ll need to link with a local PCN for the purposes of this DES.

Vaccines will be delivered and will need to be stored between 2 and 8 degrees centigrade.

You’ll need to store and deliver a minimum of 975 vaccines per week, plus associated consumables. It appears, at first glance, that the consumables required will be provided for general practice. Consumables are likely to include gloves, aprons, syringes, needles, dilution syringes and diluent. Delivery should be achievable with an absolute maximum of 5% wastage. Ability to roll out further vaccination types once they become available should be considered.

Vaccinations will be delivered in multiples of 975, and it’s expected that each week you’ll be required to confirm your needs for the following week(s).

You’ll need the facility to draw up and dilute syringes with normal safeguards in place, using aseptic techniques.

PGD will be provided centrally.

There will be a national call and re-call programme, alongside a GP-led call and re-call programme. There will be a national appointment booking service and you can choose to participate in this. There will be specific requirements in order to participate in the national system and if you don’t participate, you’ll need to arrange your own clinics and appointments. At the moment, there’s no facility for the national programme to notify general practice that an appointment has been booked with another provider (these could be national provision or pharmacies, for example).

The national indemnity scheme will apply, and practices will need to have a local agreement to ensure that the national indemnity scheme will apply across the PCN when vaccination occurs. A template for this will be supplied by NHSE.

What to do now

Assess suitability of provision. Assessment will include, but will not be limited to:

[(covering vaccine storage, planning and coordination, site safety and security, vaccine wastage, space, workforce, patient experience, and handling, preparation, administration, aftercare, data collection and reporting) – extracted from NHSE documentation]

Site: 

As a PCN, agree which site you think is most likely to be suitable. You’ll need to consider transport links and car parking, plus probable disruption to practice neighbours, especially as this campaign is likely to last for some time. Consider the accessibility of the site, and ability to social distance, especially as it’s likely that patients will need to remain in the practice for 15 minutes after administration. You’ll also need to consider the complexities of administering vaccinations to patients from multiple practices and the need to record their information in clinical systems after administering the vaccine. You should give careful consideration to how each site is currently dealing with COVID-19 ‘hot patients/areas’ as this might impact the suitability for a vaccination site. As further sites are likely to be needed once the vaccination is more widely available, it might be wise to assess each site for suitability before agreeing the most suitable. If you don’t believe that any of the current sites your PCN operates will be suitable, speak to your CCG about what additional funding might be available to help you designate an alternative site.

Workforce:

As a PCN, you’ll need to be able to staff vaccination clinics between 8am and 8pm, seven days per week including bank holidays. This is to ensure minimum wastage of the vaccine. It isn’t yet clear from the DES whether seven-day, 8 till 8 working, each and every day, is a contractual part of the DES, or whether it’s suggested that this would help to ensure maximum uptake with minimum wastage. As a PCN, ask all your staff if they’d be prepared to work additional hours, and how much time commitment they could reasonably make. This programme is likely to continue for some time to come and ensuring that staff don’t burn out is important.

The DES allows for additional, non-registered (i.e. not GP or nurse) personnel to administer the vaccines, but at the time of publication this has not been confirmed, in terms of the types of roles this might include. It might be reasonable to think that HCAs, pharmacists and physicians’ associates might be included. There’s reference to voluntary roles and some access to additional support at CCG level, but for ease of planning purposes, assume that your own staff across the PCN is what is available to you.

You’ll need to allow around 1.5 hours of vaccination training per vaccination. Vaccination training will be online and provided by NHSE.

Other planning:

You’ll need to be able to store and transport the vaccines in temperature-controlled environments with time-specific requirements for maximum time at 2 to 8 degrees and maximum time at ambient temperature. At the moment this specific guidance isn’t available, but you should plan for very limited shelf-life. (Cold-chain transport needs to be considered in the context of the requirements for storage, transfer between sites and for vaccinations needed for nursing/residential homes and housebound patients.)

PCNs will be vaccinating their own staff, and this should be planned for and included in the weekly totals.

As a PCN, run reports for each individual practice, stratifying patients in the following ways:

Patients in nursing and residential homes for the elderly

Patients aged 85+

Patients aged 80-84

Patients aged 75-79

Patients aged 70-74

Patients aged 65-69

Patients aged 60-64

Patients aged 50-59

Patients aged 49 and below

Also, consider how many patients are at ‘high risk’ in each age group as the JCVI guidance to follow may prioritise risk over some age groups.

Look at what can realistically be achieved by age group and how you could break that down into groups of multiples of 975, allowing for physical site restrictions and social distancing. If you’re stratifying and vaccinating by age group, you’ll need to consider that the older age groups are likely to need additional time per patient.

You’ll need to think about vaccination of housebound patients and how to administer to them, and to nursing/residential home patients, taking into account the requirements for time and temperature of the vaccines. If you don’t currently have robust cold-chain procedures, this is something you need to think about urgently.

Consider, also, how many patients you have who are lacking capacity to make the decision about vaccination, and start making clinical decisions and planning immediately.

If you look at the numbers and assume seven-day working, 8 am to 8 pm, you’ll need to vaccinate (per 975 patients):

11.6 patients per hour, if shelf-life is 7 days

16.25 patients per hour, if shelf-life is 5 days

You also need to consider the implications of the second dose. Where vaccinations are administered, it’s likely under the current guidance that patients will need at least one week after a flu vaccination, and three weeks between doses of the COVID-19 vaccination. Consider increasing flu-vaccination activity in the nursing/residential home population and the over 80s if you haven’t already completed these vaccinations.

If patients are likely to need a second dose a minimum of three weeks after the first dose, you might consider your ability to increase your vaccinating capacity to double the initial capacity after the first three weeks.

You might consider splitting new and second-dose cohorts after the initial three-week period, but this would probably result in a backlog waiting for the second dose. This will have implications for cash flow as payment for the two doses will not be made until completion of the second dose.

Local areas are being provided with some additional, exceptional funding, and you can see the breakdown by STP here (page 4)

Patient call and re-call: Practice Index will release a call and re-call and comms plan shortly.