17 December 2020

Dear colleagues,

COVID-19 vaccine programme in primary care

This week has been a great achievement for primary care as people across the country visited local vaccination centres to get their first COVID-19 vaccine. It has been amazing seeing all the staff – nurses, paramedics, reception staff, practice managers, GPs and more - that have worked so hard to get their sites ready to deliver the vaccine to priority groups. For those of you have started this week, or are gearing up to begin soon, thank you for all you are doing to deliver such an important programme.

If you’re going to be starting vaccinating over the coming days and weeks and have any issues around mobilisation, please contact the ATOS helpline for support on 0300 200 1000 or vaccineservicedesk@england.nhs.uk. This is to ensure that all queries around mobilisation are resolved as swiftly as possible, especially over the weekend. You can also directly escalate to the National Operations Centre via the tracked email account england.covidvaccs@nhs.net which has 7 day cover in place.

We will continue to share resources and key information on the vaccination programme via the FutureNHS platform. We will also share learning from the existing sites for those who will start vaccinating in the new year.

Lateral flow antigen testing in primary care
Further to our update in the last issue of the bulletin, we have now sent a letter to all primary care contractors with information on how to order and receive deliveries of lateral flow antigen testing kits for staff. The letter is accompanied by the Standard Operating Procedure for primary care and a leaflet explaining how to take the test.

A reminder that you will receive an invitation to order lateral flow testing devices directly from Primary Care Services England (PCSE), who will be managing the ordering and delivery process, and once received, organisations should log on and complete their order as quickly as possible. The final closing date for orders across all contractors will be Wednesday 30 December.

Raj and Ali

COVID-19 updates and guidance

Reimbursement of additional PPE costs

The Department of Health and Social Care (DHSC) has published guidance on reimbursing primary care providers for the additional costs incurred in purchasing COVID-19 PPE. COVID-19 PPE is classed as the PPE that providers are required to use over and above business-as-usual (BAU) use, due to COVID-19 infection control guidance, rather than what would have been used pre-pandemic. Eligible primary care providers include General Practice, Dentistry and Community Pharmacy. Optometry costs have been covered through contracting arrangements.

Claims may be made for COVID-19 PPE purchased from 27 February to 31 December 2020 for use in delivery of NHS clinical services by 31 March 2021. There will be no further entitlement to reimbursement for PPE purchased after 31 December 2020 as this can be obtained free of charge from the DHSC portal.

New digital systems to support COVID-19 vaccinations by GPs

Working with NHS Digital we are enabling the national procurement of digital systems to help General Practices and Primary Care Networks manage the call and recall of patients for COVID-19 vaccinations. The systems will provide GPs with an additional method for managing initial vaccination appointments and recalls – alongside mechanisms already in place – supporting safe, rapid and efficient vaccination. Practices that use one of the new digital systems will be able to send automated text messages inviting patients to book appointments online. Patients will receive automatic reminders to book and reminders of upcoming appointments, increasing uptake.

The new digital systems are an additional resource for patients and practices. Patients can continue to book by phone, if they wish. It follows an NHS Digital invitation to suppliers on the Digital Care Services catalogue to express interest in supplying vaccination booking systems. Seven did so. Assurance of minimum system capability standards is currently underway. Some assured systems will provide additional functionality to practices – PCNs and CCGs should bear this in mind when comparing assured systems and deciding which to use.

It is expected that several suppliers’ systems will be available for PCNs to use this week – the first became available on Monday 14 December. Other suppliers will be able to apply in due course. There will be national funding for the digital services. Text messaging costs will need to be met locally but an additional £2m funding will be made available to CCGs/PCNs to fund it. Further details of booking systems for PCN vaccine sites are available.

Flu and the COVID-19 vaccine
The message for patients is that you still need to get the flu jab if you’re getting the COVID-19 vaccine, as the COVID vaccine will not protect you against the flu or stop you spreading the flu virus. You should still get your flu jab at the earliest opportunity to protect yourself and those around you.

You should get the flu jab as soon as you can from either your GP or local pharmacy. Do not delay getting a flu jab in anticipation of being offered the COVID-19 vaccine. To check whether you are eligible, visit www.nhs.uk/flujab. Guidance for social care workers on how to get the flu vaccine is available.

Ideally there should be a gap of at least seven days between the flu jab and either dose of the COVID-19 vaccination (which is given in two doses 21 days apart). If you are called to get a COVID-19 vaccination within seven days of receiving your flu jab, in the majority of cases, vaccination with the COVID-19 vaccine will proceed to avoid any further delay in protection. The suggested seven-day gap between the flu jab and COVID-19 vaccine is recommended so that if you experience any side-effects it will be easier to identify which vaccine caused them.

COVID-19 Vaccination Programme – workspace

Community pharmacy

Pharmacy Flu update

Following feedback from frontline health and social care staff that they have been struggling to access a flu vaccination because they are not covered by an Occupational Health Scheme, we have agreed with DHSC that they will update their guidance to allow community pharmacies to use vaccines from the centrally procured flu stocks to offer these workers a flu vaccination privately. This updated wording is now included on the website information relating to accessing central flu stocks and comes in to effect immediately.

Dentistry

Dental and orthodontic providers – changes to PPE portal order limits

The DHSC PPE portal now meets all the modelled requirements for FFP masks and gowns for dental and orthodontic providers. Updated order limits are available.

Primary care

CAS alert issued for use of Azithromycin in COVID-19 patients

A CAS alert has been issued about the effectiveness of Azithromycin in the treatment of COVID-19 positive patients. The Recovery Trial has found that the use of Azithromycin had no benefit on length of hospital stay or on 28-day mortality, when given to patients.

Those working in primary care are therefore advised that Azithromycin and other antimicrobials should only be used specifically in the treatment of COVID-19 infection within the established inclusion criteria and framework of a clinical trial. Azithromycin may continue to be prescribed within the licensed indications outside of a clinical trial, and within NICE and other associated guidelines.

Commissioners requested to review support for university practices

We have previously highlighted a possible need to support practices serving large student populations because of possible reductions in patient lists due to the pandemic. We are now requesting CCGs immediately review funding support needs.

Data on new registrations has confirmed significant reductions since the start of the 20/21 academic year with September’s levels down a third and October’s just 25 per cent of usual levels. Reductions continued in November.

The impact at the individual practice level is variable and will need to be considered but it is clear there are many operating with significant reductions, risking destabilising patient services and potential ongoing viability due to reduced incomes.

To ensure a consistent approach we have asked our regional Heads of Primary Care to share further information, including national principles of support discussed with the BMA’s General Practitioners Committee.

Work with Universities UK and other student partners suggests these reductions are a short term, practical impact of the pandemic and a social media campaign is planned for when students return in the new year to promote registration.

Dates for your diary

Friday 18 December 1pm – 2pm. National Mental Capacity Forum Webinar: The MCA and COVID Vaccinations in Care Homes

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

• Wednesday 6 January 2021, 1pm - 2pm. ‘Reaching out to communities at speed’ – Elliot Hall Practice Heroes project during COVID-19
• Wednesday 13 January 2021 12pm - 1pm. ‘A masterclass on conducting telephone surveys’
• Tuesday 26 January 2021 12pm - 1pm. ‘A masterclass on surveys’

Wednesday, 13 January 2021. 2pm - 3.30pm. Common Challenges and Proven Solutions for Teledermatology: (Part 2/3)

Link of the day

A message to primary care colleagues from a very grateful member of the public