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Decoding the COVID-19 ES

We know that the COVID-19 ES is long and complicated! To help you get ahead of the deadlines, we’ve spent time reading and re-reading all the essential details to break it down into an easy to follow format.

The Enhanced Service specification can be found here

The ‘Next Steps’ letter, dated 1st December 2020, can be found here.

This guidance is based on the GP contract information for the COVID-19 vaccination that DES issued on 01.12.2020 (updated 07/12/2020)

Update 07/12/2020 

Amendments in version 2.0 of the DES
  • Practices will work together as a joint enterprise and will be considered patients of a temporary single medical practice for the purposes of the Human Medicines Regulations 2012
  • Section 9.2 now allows practices to vaccinate the patients of another practice where that practice has not signed up to the Enhanced Service.

Deadlines

Vaccination roll-out will not begin with fewer than 10 calendar days’ notice.

No later than the day before vaccination begins, practices must have in place a COVID-19 ES Collaboration agreement, signed by all practices in the PCN groups, that clearly sets out roles and responsibilities. (See further information in ‘What you need to Consider’.)

Friday 4th December 2020: Complete workforce survey (link available through Next Steps letter)

23:59 7th December 2020: Practices need to have signed up to participate in the DES by emailing their CCG. Sign-up should include the name of the designated site. The designated site must have suitable internet connection for access to point-of-care systems from 8am-8pm, 7 days a week.

8th December 2020: Vaccination DES begins

31st August 2021: End of the COVID-19 vaccination programme (unless subject to earlier termination)

Important points to note

Practices need to ensure that suitable internet connection is available for access to point-of-care systems at the designated site.

A signed collaboration agreement needs to be in place by the day before the vaccination programme begins.

COVID-19 vaccination online training is now available.

Further JCVI guidance will be issued about the at-risk groups. JCVI guidance on the groups may also change. NHSE will authorise each cohort to be vaccinated in order.

The physical security of vaccination supplies must be ensured, and the integrity of storage and cold chains of the same.

Payment will be made on the completion of the second dose. An appointment should be made for the second dose before the first is administered. (Exceptions only in very limited and specific circumstances.)

Cohorts of patients

Cohorts are to be called in order. NHSE will announce the authorisation of cohorts for vaccination (FROM THE DES):

  1. Older adults resident in a care home and care-home workers;
  2. All those 80 years of age (and over) and health and social care workers;

iii. All those 75 years of age and over;

  1. All those 70 years of age and over;
  2. All those 65 years of age and over;
  3. High-risk adults under 65 years of age;

vii. Moderate-risk adults under 65 years of age;

viii. All those 60 years of age and over;

  1. All those 55 years of age and over; and
  2. All those 50 years of age and over.

(Moderate and high-risk criteria will be provided by JCVI prior to immunisation of those groups.)

JCVI amended guidelines (02.12.2020) can be found here:

Residents in a care home for older adults and their carers

All those 80 years of age and over AND frontline health and social care workers

All those 75 years of age and over

All those 70 years of age and over AND clinically extremely vulnerable individuals*

All those 65 years of age and over

All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality

All those 60 years of age and over

All those 55 years of age and over

All those 50 years of age and over *

This advice on vaccination does not include pregnant women and those under the age of 16 years (see above).

JCVI advises that persons aged less than 70 years who are clinically extremely vulnerable should be offered vaccination alongside those aged 70-74 years of age. There are two key exceptions to this: pregnant women with heart disease and children (see below).

JCVI at risk criteria

  • Chronic respiratory disease, including chronic obstructive pulmonary disease (COPD), cystic fibrosis and severe asthma
  • Chronic heart disease (and vascular disease)
  • Chronic kidney disease
  • Chronic liver disease
  • Chronic neurological disease including epilepsy
  • Down’s syndrome
  • Severe and profound learning disability
  • Diabetes
  • Solid organ, bone marrow and stem cell transplant recipients
  • People with specific cancers
  • Immunosuppression due to disease or treatment
  • Asplenia and splenic dysfunction
  • Morbid obesity
  • Severe mental illness

Patients eligible to receive the vaccination in general practice are those patients who are on the GP practice’s registered patient list; are unregistered patients; or are care home workers or primary medical services workers who are registered on another primary medical services practice’s list of patients, but who have been advised by the Commissioner (NHSE) that they may elect to receive the vaccination from the GP practice for convenience; and fall under the cohorts listed. (Taken from the DES.) Vaccination will be considered outside these cohorts if given in exceptional circumstances, clinically necessary and where resources would otherwise have been wasted.

What you need to consider

The Enhanced Service Specification is subject to change, as the needs of the vaccination programme dictate.

NHSE will make allocation decisions about vaccinations. Decision-making will need to be supported by accurate and timely information from practices about their stock, usage and ordering. Practices will be considered to jointly and severally own the vaccines supplied to the PCN.

To be paid under the Enhanced Service, practices will need to participate in and comply with the Enhanced Service, including those conditions that may change. Practices will need to complete the vaccination programme doses.

 Practicalities

You will 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 are not currently part of a PCN, you will need to work collaboratively with local practices to deliver the service as a PCN grouping.

You will need to be prepared to deliver vaccination between the hours of 8am and 8pm, 7 days a week. NHSE will inform practices if this is required to ensure that vaccines are not wasted and to facilitate mass vaccination.

GP practices must agree to:

  • Co-operatively work with and openly, honestly and efficiently share such information as is necessary for the operation of the vaccination programme
  • Respond to any reasonable requests for information that NHSE makes
  • Comply with any clinical requirements including the timing of other vaccinations, e.g. flu
  • Communicate with patients including communication supplementary to that provided nationally
  • Have suitable arrangements for the lawful delivery of the vaccination programme and associated activities including data sharing

The COVID-19 ES Collaboration agreement must be signed by all practices in the PCN grouping and be in place by no later than the day before vaccination begins. A template will be provided on the .GP contract page here

The collaboration agreement needs to cover appropriate provision for:

  • How clinics are delivered and responsibility shared between the practices
  • Patient record sharing, taking account of data protection legislation
  • Reporting of activity, vaccine stock and available capacity
  • Arrangements for patient communications including but not limited to call and recall
  • Sharing and deployment of staff for efficient operation of the vaccination programme
  • Financial arrangements between practices including any with external providers
  • Arrangements in relation to use of the designated site
  • Any sub-contracting arrangements
  • A lead contact email address for onward dissemination of urgent communications
  • Appropriate indemnity arrangements

Service delivery will need to take account of:

  • Planning clinics according to expected vaccine supply
  • Coordinating required trained staff
  • Ordering required vaccine and consumables supply within required time frames
  • Receiving and safely storing supply
  • Amending clinic schedules if there is a disruption to supply and undertaking timely communication of any changes to patients

PCN groupings must agree one site that is suitable as a designated site. This process should already have been completed using guidance previously issued. The designation process must be completed so that practices can include the name of the designated site in their sign-up confirmation.

GP practices must ensure that there is sufficient and appropriate internet connection at the designated site to allow for access to point-of-care systems from 8am to 8pm, 7 days per week.

If NHSE requests practices to put into effect security arrangements for the vaccine, the practice will make reasonable efforts to ensure that they are put into place as soon as possible. With this in mind, you might want to consider the physical security of the vaccine storage. You might also need to consider what arrangements you have in place for the servicing and monitoring of vaccine fridges, to ensure minimal chance of wasted vaccines.

NHSE may be able to help with the loan of equipment, which will be returned to NHSE at the end of the programme for delivery.

NHSE recognises that some PCN groupings will need to use a sub-contracting arrangement to deliver the Enhanced Service. NHSE will not object to a sub-contracting arrangement where it is necessary to deliver the service, is compliant with the primary medical services contract, and the GP practice agrees to provide all relevant information to NSE when requested.

Communications

Practices will need to contact patients, ensuring that:

  • In addition to any national call/recall service, they write, text or call patients (as appropriate) using standard nationally determined text;
  • They actively cooperate with any national call/recall service requirements; and
  • They maintain clear records of how they have contacted (including ‘called’ and ‘recalled’) patients;
  • To support high uptake of vaccinations and minimise vaccine wastage, that they proactively contact patients for vaccinations. This may include additional contacts over and above the call/recall requirements set out in paragraph 9.5.1(a) of the ES, where appropriate to do so. GP practices are not required under this ES to offer call/recall to care home residents, and health and social care workers. Where these patients are easily identifiable, GP practices may wish to offer call/recall.

Clinical

Practices must ensure that:

  • Vaccines are not administered if contraindicated
  • The clinically suitable, correct dose of vaccine is administered
  • They are administered only within the period of the Enhanced Service
  • Informed consent is obtained and appropriately recorded (including where consent is given by an appropriate representative, and their relationship to the patient)
  • They comply with any relevant Standard Operating Procedures
  • Patients complete the course of the same vaccination except in exceptional and limited circumstances
  • They comply with JCVI guidance on the suitability, timing and dose schedule of vaccinations for each cohort
  • They provide printed information for each patient which may include the manufacturer’s leaflet or guidance provided by NHSE
  • The patient is aware that not completing the course might result in ineffective protection
  • That a follow-up appointment for administration of the second dose is booked before administering the first dose
  • Vaccination is accessible, appropriate and sensitive to the needs of the patient

The Government has provided information about administering the vaccination where the timing of other vaccinations is a factor

Staff and people

Information on immunisation training is available here

Immunisation training is now available here.

GP practices will be expected to oversee and keep a record to confirm that all staff and other people trained to vaccinate for COVID-19 have undertaken the necessary training prior to participating in vaccinations.

All healthcare professionals administering the vaccine must have:

  • Read and understood the clinical guidance available and to be published on: https://www.england.nhs.uk/coronavirus/covid19-vaccination-programme/;
  • Completed the additional online COVID-19-specific training modules available on the ‘e-Learning for Health’ website when available
  • The necessary experience, skills and training to:
    • Administer vaccines in general, including completion of the general immunisation training available on the ‘e-Learning for Health’ website and face-to-face administration training, where relevant;
    • Have undertaken training with regard to the recognition and initial treatment of anaphylaxis;
  • Understood and be familiar with the Patient Group Direction for the COVID-19 vaccines
  • Ensured that registered healthcare professionals were involved in the preparation (in accordance with the 16 manufacturers’ instructions) of the vaccine(s) unless unregistered staff have been trained to do this

All other persons administering the vaccine must:

  • Be authorised, listed, referred to or otherwise identified by reference to The Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2020
  • While preparing and/or administering vaccinations, be supervised by a healthcare professional fulfilling the requirements of the ES
  • Have completed the additional online COVID-19-specific training modules available on the ‘e-Learning for Health’ website when available
  • Have the necessary experience, skills and training to:
    • Administer vaccines in general, including completion of the general immunisation training available on the ‘e-Learning for Health’ website and face-to-face administration training, where relevant
    • Have undertaken training with regard to the recognition and initial treatment of anaphylaxis
  • Be familiar with, understand and act within the scope of the national protocol for the COVID-19 vaccines, made available by Public Health England and approved by the Secretary of State for Health and Social Care

Vaccine storage

GP practices should ensure that:

  • All vaccines are received, stored, prepared and subsequently transported (where appropriate) in accordance with the relevant manufacturer’s, Public Health England’s and NHS England’s instructions and all associated Standard Operating Procedures
  • All refrigerators in which vaccines are stored have a maximum/minimum thermometer
  • Readings are taken and recorded from that thermometer on all working days and that appropriate action is taken when readings are outside the recommended temperature
  • Where vaccinations are administered away from a designated site (for example, at a care home), the GP practice must ensure that appropriate measures are taken to ensure the integrity of the cold chain, following any guidance issued by JCVI or Public Health England
  • Appropriate procedures must be in place to ensure stock rotation, monitoring of expiry dates and appropriate use of multi-dose vials to ensure that wastage is minimised and certainly does not exceed 5% of the total number of vaccines supplied. Wastage levels will be reviewed by the Commissioner (NHSE) on an ongoing basis. Where wastage exceeds 5% of the vaccines supplied, and that wastage is as a result of supply chain or Commissioner (NHSE) fault, those vaccines shall be removed from any wastage calculations when reviewed by the Commissioner (NHSE) on an ongoing basis.

Monitoring

GP practices and PCN groupings delivering this ES must:

  • Sign up to receive the Primary Care Bulletin published by the Commissioner (NHSE)
  • Monitor and report all activity information in accordance with the monitoring and reporting standards as published by the Commissioner (NHSE)
  • Be responsible for recording adverse events and providing the patient with information on the process to follow if they experience an adverse event in the future after leaving the vaccination site, including signposting the Yellow Card service. GP practices will be expected to follow MHRA incident management processes in the case of a severe reaction.

Payment and validation

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 – a total of £25.16 per patient (two doses). NHSE does not intend to pay for a single dose administration unless in very specific and limited circumstances. This is to encourage practices to ensure that patients are called and recalled.

For payment criteria, see sections 11.2 to 11.10 of the COVID-19 Vaccination DES. As is usual for an Enhanced Service, NHSE may audit claims to ensure that the practice was eligible to receive payment.

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5 Responses to “Decoding the COVID-19 ES”
  1. Tina Byrne Says:

    Brilliant piece of work, as always! Thank you.

    One question: has anyone seen a PGD, yet?

    Reply

  2. Henny Byrne Says:

    Good Stuff

    Think there is an incorrect date on “end of Covid-19 vaccination programme – currently says August 2020 – should it be 2021?

    Reply

  3. Imran Mir Says:

    Heard on the news that there will be Covid vaccination hospital hubs. Why can’t the patients from GP practices be asked to go there?

    Reply

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