As I type this blog, more than 3.5 million people in England have had their first dose of a Covid-19 vaccine. I took my parents-in-law for their vaccinations last week, my parents have theirs this week and I feel a glimmer of hope at a really difficult time.
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.
'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'
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 .
'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'
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.