10 December 2020

Dear colleagues,

COVID-19 vaccination programme

Tuesday’s scenes of the first patients receiving the COVID vaccine were genuinely inspiring and it is heart-warming to see NHS staff pulling together to protect patients and healthcare workers from this pernicious virus. We know the next phase of the vaccine rollout is daunting, but we are confident that primary care can rise to the challenge and we will do all we can to support you. We all have a part to play, regardless of whether you are directly setting up a vaccination site or supporting your local delivery team. The standard operating procedure for the deployment of local vaccination services has been published and describes the operating model and design requirements for the  safe delivery of COVID-19 vaccines in the community.

MHRA have issued further guidance about the use of the Pfizer BionTech vaccine in those with a history of allergy. The MHRA have also explicitly advised that a 15 minute observation period needs to be reinstated and we will consider the operational consequences of this for vaccination centres.

The chief pharmaceutical officer Dr Keith Ridge has written to CCG lead pharmacists and chief officers to set out the principles and expectations necessary to maintain integrity, and therefore safety, quality and effectiveness, of the COVID-19 vaccines. The novel characteristics of the first vaccine (Pfizer/BioNTech Covid-19 mRNA Vaccine BNT 162b2) make it essential that very careful attention is given to its receipt, storage, movement / transportation, and preparation.

The letter sets out the legal basis and expectations of The Human Medicines Regulations 2012, Regulation 174 for temporary authorisation of the supply of vaccine products, and what this means for GP leads, CCG lead pharmacists and other registered healthcare professionals in primary care teams. It also provides a model NHS COVID-19 Primary Care Vaccine Handling and Management Policy which will support practices and primary care networks to implement good governance.

Learning disability health checks

People with a learning disability die up to 27 years earlier than the general population. Recent publications have further highlighted that they could be at least 3 times more likely to die from Covid-19 and particularly those from diverse ethnic groups. We have to address these shocking and unacceptable inequalities. Annual Health Checks are an effective way of engaging with people at greatest risk and shaping a personalised response (health action plan).

We have heard, for example, that one GP detected an irregular heart rhythm during an annual health check and referral for further investigation found a large aneurysm and a heart valve defect which required urgent surgery.

The attainment of annual health checks has dropped to 1/5 compared to this time last year. However, there is now support to increase this through the General Practice Covid Capacity Expansion Fund and from the QoF QI module. Thank you for all you are doing and please ensure that annual health checks are being carried out.

Raj and Ali

COVID-19 updates and guidance

Addition of adults with Down’s syndrome to the Shielded Patient List

Since 2 November 2020, GPs have been supporting efforts to add adults with Down’s syndrome to the Shielded Patient List (SPL), so that they receive the right advice and support from the Government. This is increasingly urgent now a COVID-19 vaccine is being rolled out. Significant progress has been made however there remain many people left to be added. Therefore, CMO has decided that NHS Digital will from now on run the weekly SPL algorithm to include a search for adults with Down’s syndrome.

Patients identified in this way will be sent an easy read letter in the w/c 14 November which will be made available. GPs may want to discuss this with affected patients. GPs can remove patients from the SPL at their discretion via the usual process. Please also continue to identify and contact people considered clinically extremely vulnerable, including adults with Down’s syndrome, where they have not already been identified and added to the SPL. Thank you for your efforts in maintaining the accuracy of the SPL and ensuring those at highest risk receive the correct advice and support.

25% increase in PPE Portal order limits over the Christmas period

The DHSC Portal will be operational over Christmas. Their delivery partners (Royal Mail and their Pallet Carrier) will not be delivering on Christmas Day and Boxing Day. Orders made during this time should still be delivered within 5 days. To make allowance for any potential disruptions or increased need, DHSC have increased order limits by 25% for all providers, as of Tuesday 8 December, and until at least 4 January. Call the customer service team on 0800 876 6802 if you have any questions about using the PPE portal. The team is available from 7am to 7pm, 7 days a week, to help resolve your queries. The latest guidance for the PPE Portal, including order limits for the different types and sizes of provider, is available.

Brain and nerve complications are more common than expected in younger patients with severe COVID-19

People aged under 60 who are hospitalised with COVID-19 are more likely than expected to experience severe psychiatric symptoms. Research found that altered mental states such as psychosis are being reported in these younger patients. It confirmed that strokes and other neurological symptoms are common in severe COVID-19. You can read more about the study online.

COVID-19 Vaccination Programme – workspace

General practice

Workforce data – reminder to practices and PCNs

NHS Digital will extract the latest general practice and PCN workforce data from the National Workforce Reporting System (NWRS) on Thursday 31 December. Practices and PCNs should review their records and make any updates, including recording GP locums (practices) or commissioned services (PCNs), before then. This is a contractual requirement and a prerequisite for access to the Covid Capacity Expansion Fund. It is also crucial for planning new workforce supply and support to primary care teams.

Information on how to register and use the NWRS is available on the NHS Digital website with the latest published practice and PCN statistics.

Investment and Impact Fund 2020/21 – urgent requirement to sign up to PCN CQRS service

The Investment and Impact Fund (IIF), launched in October, represents a significant source of income for Primary Care Networks. It is worth £24.25 million in 2020/21, rising to at least £150 million in 2021/22, £225 million in 2022/23 and £300 million in 2023/24. Six indicators have been included in the 2020/21 scheme.

We measure PCN performance against some of these indicators using data extracted from practice systems via the Calculating Quality Reporting Service (CQRS). In order for practices to record their performance against these indicators, commissioners must have offered them the PCN service on CQRS. It is vitally important that commissioners offer this service to practices. If they do not, PCNs containing these practices risk not receiving IIF funding this year, as the PCN’s aggregate performance will fall below the lower indicator thresholds. If your practice is not signed up to this service, please contact your CCG as soon as possible to ensure that it is offered.

We are aware that some commissioners have not offered the PCN service in CQRS due to concerns about the automated payment system for PCNs. The majority of these issues have now been resolved and the service should be offered to all practices. It is also possible to sign up to the PCN service in CQRS to record performance against indicators without signing up for automated payments if required. Training is available here if the process for offering the service is unclear.

We would also like to encourage practices to familiarise themselves with the IIF and service specification indicators defined in the 2020/21 Network Contract DES. More detail about these indicators, and the codes used, can be found on NHS Digital’s website. If you have questions about how to offer, or sign up to the service, please contact england.gpcontracts@nhs.net.

2019/20 Pensions Annual Allowance Charge Compensation Policy

In November 2019, NHS England and NHS Improvement announced that clinical staff who go over their annual allowance for the 2019/20 tax year and who use Scheme Pays to pay the tax charge can be compensated in retirement for any reduction to their NHS Pension Scheme benefits.

If you are a clinician in England and received a pensions saving statement for the 2019/20 tax year or think you may have an annual allowance charge in respect of your NHS Pension Scheme benefits, you can find more information about the 2019/20 Pension Annual Allowance Charge Compensation Policy, who is eligible and how to apply on our website.

General practice – latest updates ​

Community pharmacy

Updated flu stock ordering guidance for pharmacies

The pharmacy guidance on accessing central flu vaccine stock has been updated to include details of those wholesalers with stock. Additional stock can be accessed from Alliance Healthcare, McKesson UK and PHOENIX Healthcare Distribution.

Flu vaccination for care home staff

Enhanced Health in Care Homes (EHCH) leads are being asked to encourage care homes staff to get their flu vaccination in December. To facilitate this, EHCH leads are asked to contact local pharmacies and explore vaccination options, including the pharmacist visiting the care home. Stocks of flu vaccine are available now at pharmacies, and e-booking is offered by some. A new blog by a community pharmacist outlines how her team has been working closely with local care homes to ensure teams are well protected this winter. Social care workers are a priority cohort for flu vaccination, and no ID is required. Guidance for social care workers and employers is available.

New pharmacy flu vaccine finder

A new community pharmacy flu vaccine finder will go live on the NHS website on Tuesday 15 December. The tool will allow users to find local pharmacies that provide the NHS commissioned service and check their eligibility.

Your pharmacy will be listed in search results if you have added this service to your NHS website profile. Please review your NHS website profile to check it accurately reflects whether you are providing seasonal flu vaccinations this year.

Registered profile editors can use the profile editor to add or remove the service from your profile. For further support, please contact the NHS website service desk.

Volunteers sought for new national panel to advise on PPE experiences

The Department for Health and Social Care (DHSC) National COVID PPE team is looking for volunteers from a range of roles within community pharmacy, to take part in a new national panel to discuss their experiences relating to personal protective equipment (PPE).

The panel is expected to help set up a long term, sustainable process for gathering information on PPE usage and inform decision making and improvement plans with frontline perspectives.

The panel will meet fortnightly initially, moving to monthly in the new year. To express an interest or request further information contact Moira.philpott@dhsc.gov.uk.

Primary care

Reminder: update the NHS 111 Directory of Services with Christmas and New Year opening hours

It is important that primary care providers update their NHS 111 Directory of Services (DoS) entry with accurate opening hours for the Christmas and New Year period (Christmas Eve, Christmas Day, Bank Holiday substitute day on Monday 28 December, New Year’s Eve, and New Year’s Day). 

Community pharmacy can use the DoS Profile Updater to update the DoS. General practice and dentistry should contact their local DoS Lead to update the DoS. Contact details for DoS Leads can be accessed via the DoS Provider and Commissioner Helpline 0300 0200 363. Providers should update their DoS entry as soon as possible.

EU Exit – medicines supply continuity

We and the Department of Health and Social Care (DHSC), who have overall responsibility for medicines supply have written to primary care and community pharmacy organisations reassuring colleagues that actions have been taken to help ensure medicines continue to be available and that any supply disruptions are mitigated once the United Kingdom leaves the EU on 31 December 2020.

Urgent and emergency MSK guidance update

Updated guidance with regard to recognition of urgent and emergency guidance which require onward referral has been published on the Arthritis and Musculoskeletal Alliance (ARMA) website. The guidance supports primary and community care practitioners in recognising serious pathology which requires emergency or urgent referral to secondary care in a patient who present with new or worsening musculoskeletal (MSK) symptoms.

Culturally diverse and all staff virtual common rooms

This is an opportunity for our NHS people to come together virtually and to invest some time in supporting each other during these challenging times. Open to absolutely anyone although specifically catering to the needs of our NHS staff from BAME communities and all staff working within the NHS across England, regardless of job role, organisational context or hierarchy and includes all final year students who have been working on the Covid-19 pandemic.  The Common Rooms are a safe and supportive environment hosted by an experienced and approved practitioner. More information is available on the Our NHS People website.

Webinars on working with people and communities in PCNs

Our webinar series for colleagues working in primary care networks continues next month. Building inclusive primary care networks in partnership with people and communities will help PCNs provide inclusive services for people and communities from the most marginalised groups, who experience the greatest health inequalities. You can book a space on the webinars on our events page.

Send in your festive pictures or videos

Remember to send in pictures or videos of your teams by 16 December for a chance to be included in our special festive video later in the month. We want to say thank you and to celebrate all your hard work and achievements. Please send to england.primarycare-covidcomms@nhs.net. We can’t wait to see them!

Dates for your diary

Friday 11 December, 2pm – 3pm. GatewayC webinar: Diagnosing Ovarian Cancer

Wednesday 16 December, 1:30pm -2:30pm. Webinar for Social Prescribing Link Workers on Combating Social Isolation through Creative Community Engagement

Thursday 17 December, 5pm – 6pm. General Practice Webinar with Ali and Raj. Please ensure you register to attend by 3pm on 17 December. You do not have to register again if you have booked for our previous GP webinars.

Link of the day

Position Statement on the Pfizer/BioNTech Covid-19 Vaccine from the British Islamic Medical Association