19 January 2021

Dear colleagues,

Yesterday, the Government announced that people aged 70 and over and the Clinically Extremely Vulnerable (CEV) will begin receiving invitations for vaccinations.

The current deployment approach taken by the NHS is to offer COVID-19 vaccination as set out by the JCVI recommendations, and in sequential order by cohort. In order to support achievement of a vaccination offer to all individuals within JCVI cohorts 1-4 by 15 February 2021, and guided by the principles of minimising wastage, reducing inequality of access, and maximising pace, we are now moving to a more flexible approach across cohorts 1-4.

You should continue to prioritise vaccinating people from JCVI priority cohorts 1 and 2. We continue to expect all local vaccination services to administer the first dose of the COVID-19 vaccine to care home residents and staff in the older adult care homes for which the PCN is responsible by the end of this week (Sunday 24 January) at the latest, and to continue to prioritise over 80s including those who are truly housebound.

It is then permissible to offer vaccination to cohort 3 (75-79 year olds) and cohort 4 (70-74 year olds and the Clinically Extremely Vulnerable under 70). Advice to support vaccination of the Clinically Extremely Vulnerable will follow shortly. It is absolutely permissible, and indeed encouraged, to have reserve lists of recipients for every clinic, who can come in at short notice if vaccine is still available. It will make sense to have these reserve lists drawn from the ‘next cohort’ on the list – at the moment either cohort 3 or cohort 4.

In line with JCVI guidance and the statement from the Chief Medical Officers on second doses published on 30 December, vaccine supplied should only be used to deliver first doses of vaccine, with second doses being scheduled for the 12th week. It is supplied on the basis that it will be used immediately for vaccination of patients and not stored, since weekly deliveries are now being made.

What does this look like in practice?

• Minimising wastage

Vaccine should not be wasted. If there is vaccine supply and deployment capacity, but a degree of uncertainty on whether clinics will be full, further invitations can be made to individuals from the next eligible cohort (across cohorts 1-4) in order to utilise available supply. Vaccination beyond the current cohorts (1-4) can be offered if there is a risk that current vaccine stock will become unviable if not used.

• Reducing inequality

Working closely with local partners, deployment should continue to minimise inequalities between different communities. Please do as much as you can to get vaccination to your highest risk populations, mindful of deprivation, ethnicity and all factors impacting COVID risk. This increased flexibility offers an opportunity to tackle inequity and begin reaching health inclusion groups. Communities with greater levels of vaccine hesitancy or other challenges around engagement and uptake will take longer to reach, so all local areas should ensure engagement is either underway or begins now.

Every effort must be made to reach these groups using targeted local outreach and community champions as informed by local Equalities and Health Inequalities Assessments (EHIAs). Please ensure you work with your system partners, especially Local Authorities and Voluntary and Community Sectors in your area to ensure health inclusion. Please help us make sure no one gets left behind, and feed back on how the central team can help support excellent local work to ensure equity in vaccination rates.

• Maximising pace

Where there is vaccine supply and deployment capacity, this flexibility allows a pragmatic operational approach that enables opportunistic vaccination within cohorts 1-4, such as vaccinating partners of similar age from cohorts 3 & 4 who attend together, or those living in multigenerational households.

As before, GPs and other primary care providers may receive queries from patients who belong in the new cohorts asking about getting the vaccine. The messaging remains the same for the public – that the NHS will be in touch when it is time for your vaccine. Please continue to reiterate these messages.

We are holding a webinar tomorrow at 3pm for Local Vaccination Services. Please register before 1pm on 20 January 2021.

Kiren and Ali

COVID-19 updates and guidance

Position statement around use of the COVID-19 vaccine AstraZeneca (AZ) to vaccinate housebound patients (13 Jan 2021)

There have been queries around the movement of the AZ Vaccine once the vial has been punctured; we have worked with the National Infection Prevention and Control team to agree a way forward that reduces the risk of microbiological contamination of the unpreserved AZ vaccine and therefore the risk of infection to patients. The following statement is our recommendation.

Vaccinating frontline social care workers

This letter on 14 January is further to the Operational Guidance: Vaccination of Frontline Health & Social Care Workers of 7 January 2021, which signalled the immediate requirement to vaccinate frontline social care workers.

In addition, the Standard Operating Procedure (SOP) for frontline community-based social care workers provides a framework for local systems to identify the eligible cohort of care workers in JCVI priority group 2, and the arrangements that should be put in place to enable them to access their COVID-19 vaccination.

Arrangements for returning GPs to support vaccine rollout

We are writing to our register of potential returning GP candidates, inviting them to express an interest to support PCNs in their vaccination efforts. We provide the potential candidate with a named CCG or PCN contact in their local area to discuss if they can support vaccination within Primary Care. If a PCN decides to engage the returning GP, they should be contracted and onboarded in line with local employment processes.

Guidance on return to work for people with long COVID

The Faculty of Occupational Medicine has published guidance for healthcare professionals to assist them in facilitating the return to work of people who are unable to work due to long COVID.

COVID-19 Vaccination Programme – workspace

General practice

Suspected or diagnosed cancers and cervical screening

While recognising the significant pressures on primary care, GPs should continue to refer patients who fulfil NG12 criteria. Where referrals depart from normal practice, robust safety-netting must be in place.

It is important to be alert to overlapping symptoms between lung cancer and COVID-19. Urgent referrals for suspected lung cancer are much reduced. The Clinical Expert Group has issued guidance on differentiating between symptoms of lung cancer and COVID-19.

Where possible Faecal Immunochemical Testing (FIT) should be completed alongside lower GI referrals to support effective triage. Guidance on how to embed clinical prioritisation by FIT can be found here.

Cervical screening in primary care should continue and people on the Shielded Patient List should be invited to attend screening appointments as normal.

General Practice Awards 2020 – winners announced

The winners of the General Practice Awards 2020 can be found here. Congratulations to the winners and for everyone who was shortlisted – you’ve all done amazing work this year and continue to do so.

General practice – latest updates

Community pharmacy

Community pharmacy urged to continue flu vaccination programme

With community pharmacy vaccinating more people than ever before against the flu, contractors are urged to continue their efforts by encouraging as many as possible to get the flu jab to protect vulnerable people against co-infection of flu and COVID-19 and to reduce vaccine wastage.

Tips to help encourage uptake include:

• proactively targeting people coming into the pharmacy to encourage them to get the flu jab if they haven’t already had it;
• targeting people who collect prescriptions or call the pharmacy for advice, to ask if they have had the jab; and
• briefing team members about what the flu vaccine involves and why it is important, ensuring they are confident about booking appointments.

Dental

Reminder: Dentists to remain open during lockdown

Following the announcement from Government earlier this month, we published a NHS dentistry and oral health update on 4 January providing clarification that dentists will remain open during this current lockdown period.

Dental professionals and their teams are also defined by the Government as critical workers. If you need to prove this, email your NHS commissioner who can provide a letter from NHS England explaining that you are a critical worker.

Primary care

Lateral flow testing in primary care

Orders of lateral flow tests for those organisations ordering after the initial deadline of 30 December but before 17 January will be delivered from this week. Primary care contractors should still place orders on the PCSE portal if they have not done so to date. As the maximum amount of boxes of tests that can be ordered on the PCSE portal is now 27 (one box is for one member of staff), contractors who need to place an order for more than 27 members of staff should email pcse.urgentsupplies@nhs.net. Orders placed from today will be delivered as part of contractors’ BAU orders on their usual scheduled delivery day with PCSE. Contractors should ensure that they do not place duplicate orders on the portal, as these will be automatically removed

Primary care staff who are testing twice weekly with lateral flow devices are reminded that reporting of results (positive, negative or void) is a statutory requirement. Staff should report their results as soon as possible on the NHS Digital platform

A reminder that primary care contractors who are part of a PCN grouping for a vaccination site should ensure that they order tests for their staff working at the site as part of their order of LFD.

NHS Discharge Medicines Service cross sector toolkit published

The NHS Discharge Medicines Service (DMS) is a new essential service for community pharmacy contractors, commencing on 15 February 2021.

The service has been established to ensure better communication of changes to a patient’s medication when they leave hospital. Referring patients to community pharmacy on discharge for a check of their medicines will improve outcomes, prevent harm and reduce readmissions.

In addition to the guidance available for pharmacy contractors, a cross sector toolkit has been published to ensure a cross-sector approach to service implementation. The toolkit has been developed to support clinical teams across hospitals, PCNs and community pharmacies in delivering the NHS DMS.

Relevant teams in the respective organisations should ensure that they read the toolkit and understand their role and responsibilities.

Social care sector to receive £269 million to boost staffing levels and testing

The impact of the new variant is being felt across the country, with staff absence rates rising sharply both in care homes and among home care staff, due to testing positive or having to self-isolate. The funding announced on Sunday will protect and support the social care sector, including care homes and domiciliary care providers, by increasing workforce capacity and increasing testing.

Faecal Immunochemical Test eligibility

From April 2021, we will widen the population eligible to receive a Faecal Immunochemical Test (FIT). This self-test is easy for people to use at home. Since this test was introduced into the NHS Bowel Cancer Screening Programme in 2018, uptake has increased and expected to be in line with trials which suggested increased uptake among groups with low participation rates, such as men, people from ethnic minority backgrounds and people in more deprived areas.

To allow a focus on the expansion of the home testing programme, following expert clinical advice, the UK National Screening Committee has recommended, with the support of the Secretary of State, that bowel scope screening services are decommissioned.

Home testing will be extended from April 2021 and anyone who was invited for a bowel scope and not given an appointment will be offered a FIT kit.

Testing requirement for visiting professionals entering care homes

As per the Care Home Visitors COVID-19 Testing Guidance, all professionals visiting care homes should be tested prior to entry, unless they are already testing twice a week in line with lateral flow testing procedures for NHS staff. Care homes received a supply of Lateral Flow Devices (LFD) to test visitors to care homes on the door.

As primary care contractors will now have access to regular testing through LFDs, patient-facing staff who are using LFDs twice weekly and who are following associated guidance on self-isolation and confirmatory PCR tests, in line with the SOP, will not need re-testing upon entering a care home.

They may be asked to confirm that they are testing twice weekly and for the date of their last test. If primary care staff are not carrying out twice weekly LFD testing, they should be tested with an LFD by the care home upon on the door. This also applies to any staff undertaking vaccinations.

11,000 iPads distributed to care homes in England   

NHSX has distributed 11,000 data-enabled iPads to care homes in England that applied and met the eligibility criteria. A package of support is available to ensure care home staff make the best use of the iPads, including to help residents to video call loved ones and to access video consultations and remote care when appropriate. The support includes a technical service desk, and guidance and weekly webinars from Digital Social Care. NHSX have also ensured that care staff can use the iPads to quickly and securely access NHSmail and other apps or tools to support residents’ care, health and wellbeing.

Blog: Supporting BME communities in a targeted pandemic response

The Lewisham Primary Care BME Network has worked together with the Do No Harm Collective to create coronavirus resources designed specifically to support BME communities. Vice chairs of the network, Julie Roye and Dr Magda Branker, explain why they thought the resources were needed.

Dates for your diary

January webinars on working with people and communities in PCNs

Our webinar series for colleagues working in primary care networks continues this month, helping PCNs to provide inclusive services for people and communities from the most marginalised groups, who experience the greatest health inequalities. They include:

• Tuesday 19 January, 4pm - 5.30pm. ‘Inclusion health self-assessment tool for PCNs’
• Tuesday 26 January, 12pm - 1pm. ‘A masterclass on surveys’
• Thursday 28 January, 10.30am - 11.30am. ‘Building and developing trusted connections with communities’
• Thursday 28 January, 4pm - 5pm. ‘Connecting with Inclusion Health Communities’

Wednesday 20 January, 1.30pm - 2.30pm. Digital inequalities and inclusion during COVID-19

Wednesday 20 January, 3pm - 4pm. COVID Vaccination webinar for Local Vaccination Services

Thursday 21 January, 11am - 12pm. NHS Reset: Ensuring a greener future for respiratory care

Wednesday 27 January, 1pm - 1.30pm. COVID-19 Vaccine for Cancer Patients

Link of the day

Team Diabetes 101 - When Coronavirus hit the UK and measures were being taken to put the UK into lockdown, a group of diabetes healthcare professionals planned an exciting new social media account to support the diabetes community.