Rolling out such a vast vaccination programme is a quite remarkable achievement. While there are three routes of Covid-19 vaccine delivery at the moment – in hospitals; local vaccination delivery through GP-led sites and most recently mass vaccination hubs – in this blog I want to focus on the GP-led vaccine programme.
It’s no surprise to me that the two countries in the world with the most rapid and comprehensive vaccination programmes, Israel and the UK , are the two countries with probably the strongest universal primary health care systems in the world. General practice in England is perfectly placed to roll out this challenging programme – practices run mass vaccination programmes every year for flu, they know their local population and the vast majority of the population is registered with a local GP.
For this programme, primary care networks (groups of general practices) and in some cases groups of PCNs, have come together to create vaccine sites to serve their local community. The choice of sites is partly to do with the complex storage and handling needed for the Pfizer vaccine in particular, partly to do with the logistics of delivery and partly to allow efficient use of estates and workforce.
My Twitter feed is absolutely full of pictures of proud nurses, doctors, pharmacists, paramedics, health care assistants, administrators, volunteers and managers running their first vaccination clinics or delivering vaccines to care homes. Some of the sites are on NHS premises, but because of the scale needed places such as leisure centres, cathedrals, parish halls, football grounds (and even in my home town of St Albans, a former local nightclub ) have been turned into vaccination sites.
And, not least because of this, general practice is not doing this on its own. Local authorities, from county councils to parish councils, have sourced venues, cleared roads and car parks of snow, managed traffic. Other parts of the local NHS system such as clinical commissioning groups and commissioning support units have provided back office support and staff. Equally important has been the enormous volunteer operation put in place to support vaccination roll out – not just retired health care professionals coming back to work as vaccinators, but also car park marshals, meeters and greeters, drivers and clinic administrators. This has been driven in the main by local community groups who, despite the huge pressures they are under as a result of the pandemic, have mobilised enormous numbers of volunteers to support general practice.
Being able to provide vaccines in local communities feels particularly important at the beginning of the programme when the most vulnerable people are being targeted. Those living in care homes, those over the age of 80 and those who are extremely clinically vulnerable may not be able to drive or safely travel long distances and many need lots of support to access their vaccine .
Even when the programme expands, this local community effort will continue to be absolutely key. While vaccine uptake in the older age groups seems high, confidence in having the vaccines is much lower in some areas of the country, among particular ethnic groups and among younger people. And some people, such as those who are homeless or those who are not registered with general practices, will just find it harder to access the vaccine. While general practices can help, the only way to make sure vaccination reaches deeply into these groups will be to work in partnership with local communities, through voluntary groups, faith leaders and councils to make sure that barriers are removed and misinformation is challenged. If we’re going to avoid worsening existing inequalities there’ll need to be lots of support for work with local communities to make sure the vaccination reaches all who need it.
For me, one of the most positive things to have come out of this remarkable programme has been the forging of stronger links between general practice and their communities. This approach to providing care and support in the neighbourhoods where people live is likely to be increasingly important for the future, and the progress we’ve seen is a really good foundation on which to build.
I agree all you say, Beccy, and well done to all concerned. But there's one area that still needs improving in my view - comms. I quite understand the reason for the "don't call us we'll call you" message. But it doesn't provide enough reassurance to the local community when people hear of others their age getting a jab and they aren't; or receive broad upbeat messages about the roll-out - 3.5m people but not me! - and (again) they hear nothing about their jab; or there's all sorts of confusing stuff about mass vaccination centres, local mass vaccination centres, local centres, pharmacies, and about hearing when/where you will get a jab by letter, by phone, by text, and from your surgery or from "the NHS". In my experience, this then creates uncertainty and worry, resulting in a failure to damp down on calls to surgeries plus use of local social media to ask questions which can get misleading answers from others equally ill-informed. I think comms at local and national level tends to be focused on passing on the news that the communicators want to share, rather than asking what people want to know. In my view the latter is simple, straightforward info given locally by CCGs/PCNs/practices telling me that if I am 80+, or 70+ or whatever, and I live in x area or go to x practice, what/when/how I will hear about getting my first and my second jab, including any uncertainties and unknowns and including regular updates to maintain confidence that this is the latest sitrep. Eg 80+? We still haven't finished vaccinating this group, you should be contacted by your surgery by phone or text for jab in next x weeks, but depends on vaccine supply, and could be longer if housebound - NB will update as soon as new information; you could also get letter for a mass vaccination centre + can choose whether to go or wait for local jab (this applies also to 70+) ....
Could not agree more with comment posted by Mike Etkind. Situation in my CCG/local area is as follows:
# 70+ person receives NHS letter
# login on NHS vaccination booking website returns list of vaccination centres miles away from person and FAILS to list easy to reach operational centre
# and worse: pop up message indicates person has failed to attend first vaccination appointment
No wonder NW London STP is reported with the lowest take up rate (45%): People do want to comply with vaccination guidance but THEY CANNOT!
Whilst I agree with the commendable effort and delivery of the COVID vaccine, I still get a sense that PCNs are not the structure to deliver population health whilst integrating other health professionals especially community pharmacists.
NHSE&I has provided incredible infrastructure support to set up CCGs, GP federations and PCNs whilst almost ignoring the rest of primary care health professionals.
The roll out of designated community pharmacy COVID sites is an example, why have the PCNs not recognised the estate of community pharmacy which is readily accessible and operated an open door policy during COVID, no appointments, no online forms to fill before a consultation or telephone triage service before a consultation.
My personal opinion is that PCNs do not look for solutions beyond general practice, perhaps that is poor commissioning by NHSE&I. With the AZ vaccine we have an opportunity to replicate the "flu model" of delivery for the COVID vaccine which increases choice and access for care to be provided for patients/individuals closer to their homes by utilising community pharmacy.
The majority of London community pharmacies are located in areas of deprivation and are ideally placed to address the challenges of inequality that will emerge post COVID. Will PCNs be able to address this challenge alone?