23 February 2021

Dear colleagues,

Additional cohort of patients identified as at high risk from COVID-19

Last week we wrote to inform you about an additional cohort that had been identified by a new COVID-19 predictive risk assessment (QCovid®). This model combines a number of factors, including ethnicity and deprivation, to estimate a person’s risk from becoming seriously unwell from COVID-19. These patients have now been prioritised for vaccination and added to the Shielded Patient List. 

A letter was sent to GPs which contains important information about how this group has been identified and how they should be prioritised for vaccination, as well as the advice they should follow.

Patients identified by QCOVID® in the first cohort (aged 19-69) should now be visible in all GP systems, and have been sent a notification letter centrally. Patients identified in the second cohort (mainly those aged over 70) will start to receive letters and emails from Wednesday 24 February and high-risk flags will begin to appear against these people in GP IT systems from the same day. If any of these patients have not yet been offered vaccination, particularly those aged over 70, we encourage you to ensure that they receive one as soon as possible.

We have been made aware of concerns that some women with previous gestational diabetes have been advised to shield via the QCovid process. This will be appropriate for many as the model performs an individual assessment based on a wide range of risk factors, and also considers an individual’s risk in comparison to others of the same age and sex. In addition, where data (e.g. on ethnicity or body mass index) are incomplete the risk tool may default to a higher level for that category, which may influence the overall results. However, an active review to look at this group is now underway and further information will be communicated as soon as it is available.  

GPs can evaluate a patient’s risk with the most up to date information using the clinical tool and remove them from the Shielded Patient List if necessary.

As outlined in the letter sent to GPs last week shielding advice has been extended until 31 March. Last week the Government wrote to the existing cohort of 2.3m individuals on the Shielded Patient List to inform them of this extension. The new cohorts identified through the QCovid model, have already been advised to shield until the same date.

Next steps on the vaccination programme

On 20 February we published a further letter about inviting adult carers along with those in the above group for their vaccine. In addition to this, we have also included further details about vaccinating those with a learning disability and those with severe mental illness below.

Kiren and Ned

COVID-19 updates and guidance

Vaccinating people with a learning disability

Those with a severe and profound learning disability are eligible for the vaccine as part of cohort 6 and are an important patient group we must ensure we reach.

Multimorbidity is extremely common in this population, with a mean number of co-morbidities of eleven (Kinnear Glasgow). Therefore, a high proportion of people will fall into priority group 6 (Green Book Covid 14a) regardless of whether they have been flagged as having a serve or profound learning disability. However, many of these criteria can be hard to search for e.g. different types of congenital heart disease. The Green Book advises that clinical judgement should be used. So, we suggest that given the challenge of running complex searches to find small sub-groups, pragmatism and inclusivity is recommended.

Tailored invitation letters for local vaccination sites to use to invite people with a learning disability to their COVID-19 vaccination is available on the FutureNHS platform.

If you are vaccinating in a residential setting (such as care homes or supported living for people with a learning disability or mental health problems) and it is not possible for these patients to attend vaccination sites, PCN groupings should then work with CCG, ICS, local authority and other partners to find other ways to vaccinate. The most effective ways should be established to serve all of these residential settings and specific groups to determine the most appropriate vaccination delivery model for them. An additional payment has been made available for vaccinating in a residential setting. 

People with Severe Mental Illness (SMI) vaccine prioritisation

People with SMI face reduced life expectancy of 15-20 years when compared to the general population and have been disproportionately impacted by the coronavirus pandemic. As such, people with SMI are included in group 6 of the JCVI’s prioritisation list for the COVID-19 vaccination.

The JCVI green book defines SMI as: schizophrenia or bipolar disorder, or any mental
illness that causes severe functional impairment. PCNs should take an inclusive approach, working collaboratively with secondary care services and local VCSE organisations to ensure that all people with SMI can access their COVID-19 vaccination. This includes, but is not limited to, people with an eating disorder and those with a diagnosis of ‘personality disorder’.

Tailored invitation letters for LVS to use to invite people with SMI to their covid-19 vaccination is available on the FutureNHS platform.

Updates to the COVID-19 vaccination Enhanced Service

Updates have been made to the Enhanced Service for the COVID-19 vaccination programme 2020/21. These changes have been agreed with the General Practitioners’ Committee of the British Medical Association and expand the circumstances in which a primary care network (PCN) grouping can vaccinate eligible patients registered with other practices/another PCN grouping.

Under the revised terms and subject to commissioner approval, a PCN grouping can vaccinate eligible patients registered with another PCN grouping in a residential setting e.g. care homes for patients with a learning disability. PCN groupings can also vaccinate an eligible patient registered with a Defence Medical Services practice, if the patient requests to be vaccinated at a PCN designated site (as opposed to their Defence Medical Practice) and the PCN grouping is able to support this.

To reflect the additional supplements for vaccinations in care homes and other residential settings, we have included clarity on making additional discretionary payments available to GP practices. This is to support the delivery of or to incentivise vaccinations to under-represented groups in exceptional circumstances. There is further information on additional funding available to support vaccinations in residential settings here.

Guidance for investigating and managing individuals with a possible or confirmed COVID-19 Variant

In response to the emergence and spread of new SARS-CoV-2 variants of concern (VOC) and variants under investigation (VUI) in different countries and regions, specific precautions and actions are required in relation to the management of patients who have recently returned from areas where these VOC or VUI are known or are believed to be circulating, as well as their contacts. This guidance is for healthcare staff in primary and secondary care and provides advice on the investigation and management of patients who may be infected with a new SARS-CoV-2 VOC or VUI.

Post-vaccine waiting room animation   

This animation reinforces the importance of following COVID-19 guidelines after people have been vaccinated. If your site has access to plasma screens/TV please download the video from FutureNHS and play it on a loop for public viewing, ideally in the post-vaccination observation area. The video is subtitled and can be played on mute as well. Translated versions of the animations and posters will be available soon.

Utilisation of nationally recruited clinical and volunteer roles 

There is a large national workforce pool of trained and vetted candidates who are available to support local vaccination services on a flexible basis. These individuals can be accessed through Lead Employers in each Integrated Care System, who can help you to access the following roles:

• vaccinators, clinical supervisors and registered healthcare professionals from NHS Professionals
• volunteer vaccinators, patient advocates and post-vaccination observers supplied by St John Ambulance
• volunteer stewards supplied by NHS Volunteer Responders, led by Royal Voluntary Service
• clinical staff and GP returners who have offered to support the NHS vaccination programme.

We have asked that Lead Employers utilise the additional staff when workforce planning with primary care sites over the coming weeks. If additional resources are not needed at this time, Lead Employers have been asked to continue to engage with these staff about the progress of local vaccination activities and when workforce may be needed – this will also help to manage expectations of candidates waiting to be deployed. 

COVID-19 vaccination of patients prior to immunosuppression

Colleagues are asked to review the changes in the Green Book which provide national guidance around vaccinating patients before immunosuppression. Full reference to the guidance and further information is available if you are delivering the vaccines within a hospital hub or at a local vaccination site.

COVID-19 vaccination of patients who are HIV positive

The Green Book is clear that people living with HIV, at all stages of infection, should be offered the COVID-19 vaccination due to the associated immunosuppression. These individuals, because of their underlying health condition, are part of cohort 6 for COVID-19 vaccination as defined within the JCVI guidance.

It is expected that most patients will be invited for vaccination by their general practitioner, however, a small proportion have declined sharing their HIV status with their GP. Under these circumstances, HIV clinics should continue to engage with individuals and encourage and support them to share their HIV status with their GP. If the patient declines, the HIV clinic should facilitate vaccination in accordance with Immunisation Against Infectious Diseases (the Green Book), likely via a local vaccination hospital hub.

Guidance on vaccinating those aged under 18

The AstraZeneca (AZ) vaccine is not licensed for use in those under the age of 18. Should any young staff members or volunteers (aged 16-17) present to a vaccination centre for vaccination, they should be referred to their GP or local hospital hub where they can access the Pfizer vaccine which is authorised for this age group. If the Pfizer vaccine is unavailable, JCVI have recommended that the AZ vaccine can be used as an alternative in those aged 16-17 years. This is outside the license and must therefore be done under a PSD (by a medical prescriber) and cannot be done under a PGD or National Protocol.   

This guidance is also in line with the 13 February 2021 letter which describes that Pfizer is the vaccine of choice for clinically extremely vulnerable young people aged 16-17 years old.

COVID-19 Vaccination Programme – workspace

General practice

Applying for the 2019/20 Pension Annual Allowance Charge Compensation Policy

GPs retiring by 31 March 2021 who believe they are eligible to apply for the 2019/20 Pensions Annual Allowance Charge Compensation Policy can submit their application form via PCSE from Monday 22 February 2021 to Sunday 21 March 2021. Further details can be found here and on PCSE’s website. Application windows for other GPs will open after the mandatory scheme pays election deadline for 2019/20 closes on 31 July 2021. To qualify for the Policy you must first submit a scheme pays election (SPE2) form for 2019/20 to NHSBSA.

General practice – latest updates

Primary care

Supporting care homes with pulse oximetry

We are working closely with care home colleagues to ensure they feel supported to provide oximetry to residents who have been diagnosed with coronavirus. For more information on pulse oximetry for care homes the Care Provider Alliance have recently published their guide online. New e-learning materials can be accessed via e-Learning for Healthcare, and a recording of a webinar hosted by the AHSN Network is also available. To contact the national team or to request pulse oximeters for use in care homes (which should be via CCGs and coordinated by PCN clinical leads) email england.home@nhs.net. 

Celebrate International Women’s Day

On Monday 8 March, Prerana Issar, our NHS Chief People Officer and Samantha Allen, Chair of the NHS Confederation's Health & Care Women Leaders Network, will co-host a virtual event to mark International Women's Day 2021.

The event is free to attend and is open to women and their allies in health and care whatever their role, grade, ethnicity, gender identity, disability or sexual orientation. The programme for the day is designed to fit around busy working lives, so delegates are welcome to take part in as much or little of the event as they want to.

The theme for the day is #EverydayCourage in tribute to the courage being demonstrated by women in health and care during these extraordinary times. Find out more and register for your free place now.

Medicines and appliances home delivery service commissioned until 31 March 2021

The Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service has been commissioned from community pharmacies and dispensing doctors from 19 February until 31 March 2021 (inclusive). The service is available for all clinically extremely vulnerable patients on the shielded patient list living in England where family and friends cannot collect prescriptions or a volunteer can’t be organised, to ensure access to prescription medicines. This supersedes the announcement made on 5 January 2021.

Healthcare for migrant patients

PHE has updated its guidance on NHS entitlements for migrants, their dental health needs, and its COVID-19 migrant health guide. Health advice for migrant patients visiting relatives abroad is here.

Improved advice function on NHS e-Referral service

Following feedback, NHS Digital has enabled the NHS e-Referral Service to turn advice conversations into referrals, among other improvements.

Free online training: Freedom to Speak Up and Just and Learning Culture

The NHS People Plan set out the importance of giving our NHS people a voice - and that we should all feel empowered to speak up, knowing that when we do, our concerns will be heard. Mersey Care NHS Foundation Trust’s free online Just and Learning Culture training - as well as additional accredited learning packages - can help ensure your organisation has a fair, open and learning culture. Further resources can also be found on the Retention Hub.

The National Guardian’s Office has also launched the second module of its free Freedom to Speak Up e-learning package. Targeted at managers at all levels, it provides learners with the tools to foster a speaking up culture - with a focus on listening and understanding the barriers to speaking up.

Dates for your diary

Wednesday 24 February, 1pm – 2pm. Development of digital solutions for home-based and care home management

Wednesday 24 February, 1.30pm – 3pm. New advancements in technology and pathway redesign, within Teledermatology: Part 3/3 Webinar Series

Thursday 25 February, 10am – 11.15am. Flexible Working - the case for change in the NHS

Thursday 25 February, 2.30pm – 4.30pm. Building confidence in the vaccination programme among BAME communities

Thursday 25 February, 5pm - 6pm. General Practice webinar with Kiren and Ned

Monday 1 March, 1pm – 2.30pm. Interoperable medicines standards and EPS webinar

Monday 1 March, 5pm – 6.15pm. Ophthalmology playbook webinar

Wednesday 3 March, 1pm – 2pm. The IGPM progress update: Recognition, representation and membership

Wednesday 3 March, 1pm – 3pm. Wellbeing and the Primary Care Workforce: A collaborative event

Wednesday 3 March, 2.30pm – 5.45pm. Action for Change: Health inequalities: leading for equality

Friday 5 March, 12pm – 1.15pm. The opportunities for systems to improve patient outcomes using digital and data

Monday 8 March, 7.30am – 4pm International Women's Day 2021 Celebration with Prerana Issar, NHS Chief People Officer and Samantha Allen, Chair of the NHS Confederation's Health & Care Women Leaders Network

Tuesday 16 March, 9am – 5pm. NHS and the armed forces conference

Wednesday 17 March, 3.30pm – 5pm. Inclusion Health Self- Assessment tool live demonstration

Link of the day

The BBC Asian Network has created some great content on vaccines scams and made it available on social media