30 December 2020

Dear colleagues,

Today we have seen two major decisions that will shape and expand the COVID vaccination programme. This notification should be read alongside this system letter setting out changes to second dose vaccine scheduling and an expansion of first dose delivery. This note also reflects MHRA’s approval of a new Astra Zeneca vaccine.

Following a review of clinical evidence and the latest public health data, the JCVI and the Department of Health and Social Care have also published updated guidance for the NHS on the dose interval for the second dose of the Pfizer/BioNTech vaccine. It recommends the second dose of the Pfizer/BioNtech vaccine should now be scheduled for after three weeks but before 12 weeks after the first dose, and that the second dose no longer needs to be held in storage.

They recognise that this will mean we need to reschedule second doses for most of our current first dose recipients booked from next week (Monday 4 January 2021), but for the reasons set out today by JCVI and the Chief Medical Officers, doing so should substantially improve individual and population-level protection against COVID-19 over the next 3 months.

We understand that this will be a significant job for general practice at a busy time and we are grateful for your support in ensuring that we can offer protection to many more people because of this development.

To recognise that a delayed second dose will also delay payment to an unreasonable extent under the terms of the current Enhanced Service, we will agree with the British Medical Association (BMA) an amendment to offer payment for each dose instead. We are exploring ways to support rebooking of this cohort, recognising the complexity.

Today the MHRA has also approved for use the Astra Zeneca vaccine. This is another great step forward in the fight against coronavirus.  Once we have further details, we will be outlining the logistics for the dissemination of this vaccine from next week and describing how it can be used.

While the delivery model for the new vaccine will predominantly be through local vaccination sites (LVSs) and vaccine centres, the first supplies will initially be used in hospital hubs to ensure safety, before being more widely rolled out. This new vaccine opens up the possibility of reaching smaller care homes and the housebound 80+ cohort in a more manageable way, and the initial delivery of this needs to be targeted in this way.

We have asked all local COVID vaccination services to prioritise wherever possible care home residents and care home staff to ensure this priority group are vaccinated against the coronavirus as quickly as possible.

Local systems should be working to ensure that all healthcare workers falling into the JCVI priority cohort, including those in primary care, are able to access the vaccine from a local vaccination site or hospital hub as appropriate.

We appreciate the additional time and resources needed to deliver the vaccine in a care home setting, especially at such a busy time of the year. Therefore, we are providing an additional supplement of £10 per dose on top of the item of service fee for all vaccines delivered in a care home setting.

The supplement is applicable where the first dose was delivered before the end of January 2021.

The LVS SOP will be updated shortly to reflect the addition of Astra Zeneca and the change to the second dose.

We know today’s announcements offer new hope but equally we appreciate the further challenges they create on the ground in trying to deliver a vaccination programme at pace. We will continue to support you as best we can in an ever-changing environment.

We will also provide further advice about additional measures to ensure GP practices and PCNs are able to prioritise the vaccination programme appropriately, including removing unnecessary contractual burdens.

We will be hosting a webinar on Tuesday 5 January 2021, 5-6pm to provide further updates on the COVID-19 vaccine roll out. A link to join the MS Teams Live event can be found on FutureNHS.

Nikki and Ed

COVID-19 updates and guidance

Local Enhanced Service for Community Pharmacy Vaccination

We have had a great response from community pharmacy teams to deliver the vaccination and look forward to seeing the first pharmacy local vaccination services. We wrote to those pharmacy contractors who applied as part of the designation process on 18 December, published the Local Enhanced Service for Community Pharmacy and have now written to the designated sites rolling out the vaccine. To support community pharmacy on the vaccine rollout, we held a webinar on 23 December 2020. The slides and recording can be viewed on FutureNHS.

Operational priorities for winter and 2021/22

On 23 December 2020, Amanda Pritchard and Julian Kelly issued a letter providing information of the operational priorities for winter and beyond. With COVID-19 inpatient numbers rising in almost all parts of the country, and the new risk presented by the variant strain of the virus, it’s clear that this winter will be another challenging time for the NHS. The letter is intended to help you and your staff over the next few months by ensuring we have a collective view of the critical actions for the rest of this financial year and signalling the areas that we already know will be important in 2021/22.

Transportation of Pfizer BioNTech Vaccine BNT162b2 within PCNs

The Pfizer BioNTech vaccine is temporarily authorised under regulation 174 and 174A of the Human Medicines Regulations 2012, as amended. Certain conditions are attached to the temporary authorisation, including taking account of the fragility of the Pfizer BioNTech Vaccine BNT162b2, and providing specific directions for the handling of the product.

Recognising the public health importance of providing COVID-19 vaccination for care home residents from designated PCNs, the MHRA have supported the standard operating procedure (SOP) for COVID-19 vaccination in care homes.

The SOP sets out particular requirements. The transportation of vaccine is therefore specifically approved to care homes in accordance with the SOP, but the approval is only applicable to this care setting and does not extend to the transfer of this vaccine to other PCN sites such as between GP practices.

Home delivery of medicines and appliances during the COVID-19 outbreak

Following government’s announcement of further Tier 4 arrangements on 23 December 2020, the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service will be commissioned from 26 December 2020 to 18 January 2021 for clinically extremely vulnerable (CEV) patients living in the particular Tier 4 areas.

COVID-19 vaccinations and participation in research and surveillance studies

Patients participating in research and surveillance studies should not be prevented from receiving the COVID vaccine if they are eligible. These studies do involve regular asymptomatic testing for COVID-19, so if a study participant is awaiting a result from such a test they can still be vaccinated and should not be told to wait until the result comes back. These studies will be used to support vaccine surveillance in the UK and as such it is vital that participants can access the vaccine the same as anyone else.

A list of the main COVID-19 surveillance studies is available on the Department of Health and Social Care website.

Reminder to order lateral flow tests

Primary Care Support England (PCSE) has now sent direct invitations to all primary care contractors to place their orders for lateral flow tests onto the portal.

If primary care contractors (medical, dental, optometry and community pharmacy) have not yet placed their order, they should log onto the portal and complete their order as soon as possible, and by COP Wednesday 30 December to receive deliveries from early January.

Contractors who have not been able to place an order before the deadline will still be able to go onto the portal and order tests. However, deliveries of orders placed after the deadline may take place at a later date.

Each organisation should order one box for each patient-facing member of staff, for example if there are 10 patient-facing members of staff delivering NHS services within an organisation, the order should be for only 10 boxes of test kits.

SOPs and FAQs on lateral flow testing in primary care are available for further information.

Updated: top 10 tips for IPC and Testing

Key actions: infection prevention and control and testing has been updated to provider further clarity for boards and systems.

The key actions should be underpinned by the effective application of IPC guidance and apply across all care pathways outlined in the guidance.

COVID-19 Vaccination Programme workspace

General practice

New standard GMS, PMS and APMS contracts published

We have published new standard General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts, along with their contract variation notices. They incorporate all the contractual changes introduced since October 2019.

Commissioners will send these updates to GP practices to formally notify them of changes to their contracts.

Recording of ethnicity information

From 1 January 2021, it will be a contractual requirement for GPs to record patients’ ethnicity information in their patient record if a patient, or someone authorised on their behalf, provides it. It is optional for patients to provide the information and does not affect registration.

Where provided, GPs should record the information in coded form using one of the available categories, including if necessary “prefer not to say”. Ethnicity information is sensitive personal data and must be processed and used only for medical purposes in accordance with data protection legislation.

The GMS and PMS Regulations amendment is available online.

Cessation of Lloyd George Envelopes for babies, new patients and first entrants to NHS

As part of the Lloyd George digitisation programme, the production and distribution of Lloyd George envelopes for new patients, registrations of babies and first entrants to the NHS, will cease from 31 December 2020. The digitisation programme will reduce the burden associated with the movement of paper records. Practices will no longer receive transit labels to move patients' records when they leave a practice but, may still be able to order Lloyd George envelope via Primary Care Support England (PCSE) Online for records that cannot be scanned.

PCSE will be writing to GPs about the process. For further information, practices can contact PCSE Customer Support Centre.

General practice - latest updates

Dentistry and oral health

The latest issue of Your NHS dentistry and oral health update has been published today.

Dates for your diary

Tuesday 5 January 2021, 5-6pm with Nikki Kanani and Ed Waller to provide further updates on the COVID-19 vaccine roll out. A link to join the MS Teams Live event can be found on FutureNHS.

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’

Tuesday 12 January 2021, 1pm - 2pm. COVID Oximetry @home: an overview for primary care. 

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