7 January 2021

Dear colleagues,

The new Oxford AstraZeneca vaccine is being rolled out to general practice led services today making it easier to protect care home residents and other vulnerable people against COVID-19. This is yet another step forward in vaccinating our communities. To support with this rollout, we are delighted that a number of community pharmacies will pilot vaccination sites from next week with more coming on stream the week after.

This is an enormously complex vaccination programme using two new vaccines and is unlike anything the NHS has ever delivered before. The programme is initially focussing on sites that can deliver high volumes. This is in part because of the nature of both vaccines and the logistics needed, but also because we need to prioritise where we can get high numbers of people vaccinated quickly. As we rapidly roll out the programme further, we are looking at other delivery models.

We absolutely recognise that GP practices are under extraordinary additional pressure, especially those with the additional responsibility of delivering the vaccine. However, we need to reassure patients that they will continue to receive care when they need it and to encourage them to come forward with any health concerns. To support you in ensuring general practice remains fully and safely open for patients, including maintenance of appointments, we have outlined in this letter some additional support and next steps to help free up practices. This includes:

• delaying the planned introduction of the new standardised specification for extended access as part of the Network Contract DES – and the associated national arrangements for the transfer of CCG extended access funding.
• further funding for PCN clinical director support temporarily for Q4 (Jan-March 21)
• additional income protection measures to support reprioritisation

The number of people diagnosed with coronavirus continues to increase and is why it is imperative we vaccinate as many people as possible. Therefore, you should now be following the second dose schedule, delaying the second dose to 12 weeks after the first dose of either the Pfizer/BioNTech or Oxford/Astra Zeneca vaccine to increase take up. This is the approach supported by the Chief Medical Officers and also the Royal Pharmaceutical Society and the British Geriatric Society.

Along with the additional local vaccination sites which are coming on stream, seven vaccination centres will be established next week and patients in the relevant cohorts living near these sites will be sent letters inviting them to book an appointment. An example of the letter can be found on FutureNHS. Template letters will be published on FutureNHS tomorrow including in different languages and an easy read version.

Vaccinations for staff

We are also pleased to be able to provide further details on how primary care staff, both clinical and non-clinical, can get access to the vaccine to protect yourselves, your families and our patients. There are two routes for primary care:

By mid-January all NHS Trusts will be established as “hospital hubs” with a responsibility for COVID-19 vaccine delivery to all individuals within JCVI cohort 2b as set out in the updated Public Health England’s Green Book. This letter clarifies the details and process.

Secondly, to minimise wastage, local vaccination sites have been ensuring unfilled appointments are used to vaccinate healthcare workers who have been identified at highest risk of serious illness from COVID-19, which includes pharmacy, dental and optometry teams. Healthcare providers have been undertaking staff risk assessments throughout the pandemic to identify these individuals and it remains important that this is organised across the local healthcare system to ensure equitable access.

Raj and Ali

COVID-19 updates and guidance

Updated: Enhanced service specification – COVID-19 vaccination programme 2020/21

As the vaccination programme has developed, we have now published an updated version of the Enhanced Service Specification. It now reflects guidance published by JCVI on 30 December 2020, which covers the approval of the Oxford/AstraZeneca vaccine and, for both Pfizer/BioNTech and Oxford/AstraZeneca vaccines, recommends a second dose at up to 12 weeks after a first dose. Payment arrangements have consequently been changed so that practices are now eligible for an item of service payment for each dose.

COVID-19 Vaccine Oxford AstraZeneca – movement of vaccine

Further to the temporary Authorisation of the COVID-19 Vaccine Oxford AstraZeneca by the UK Department of Health and Social Care (DHSC) and Medicines and Healthcare products Regulatory Agency (MHRA) on 30 December 2020, we have written to general practice and pharmacists today to advise on additional operational flexibilities offered by the introduction of the AZ vaccine.

Post-vaccination observation period for Oxford/AstraZeneca

There is not a requirement for 15 minutes observation after administering the Oxford/AstraZeneca vaccine unless this is indicated after clinical assessment. 

The MHRA guidance about the use of the Pfizer/BioNTech vaccine in those with a history of anaphylaxis - and the 15 minute post-vaccination observation period for all patients - remain in place. Note also that patients should not drive nor operate machinery for 15 minutes after being vaccinated with either vaccine.

The Standard operating procedure: COVID-19 local vaccination services deployment in community settings has been updated to reflect the change.

Patient Group Direction for COVID-19 Vaccine AstraZeneca, (ChAdOx1-S [recombinant]) now published

The Patient Group Direction (PGD) has now been published for the administration of COVID-19 Vaccine AstraZeneca (ChAdOx1-S [recombinant]) to individuals in accordance with the national COVID-19 vaccination programme. This PGD is for the administration of COVID-19 Vaccine AstraZeneca by registered healthcare practitioners identified. A summary document has been published alongside.

Contractors who have not yet ordered lateral flow tests

The majority of primary care contractors have now ordered lateral flow tests for their patient-facing staff on the online portal, as set out in direct communication by Primary Care Support England (PCSE), who are managing the ordering and delivery process.

Deliveries to contractors who had ordered by 30 December have already started and will continue in the coming days and weeks.

However, there are still primary care contractors who have not completed their order. If contractors (medical, dental, optometry and community pharmacy) have not yet placed their order, it is important that they log onto the portal and complete their order as soon as possible, and by COP Sunday 17 January to start to receive deliveries from the following week.

Contractors will have received direct communications from PCSE to the registered email address who normally manages the business as usual supplies orders with PCSE. Contractors should ensure that they have checked these emails and that they avoid any duplicate orders.

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 – as one box contains 25 tests and it is enough for a member of staff to test for 12 weeks.

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

Co-administering the flu and COVID vaccines

During national lockdown, it remains very important that people continue to access essential services including vaccinations for babies, children and pregnant women as they are time critical and prevents serious illness and outbreaks. Please continue your efforts to invite and vaccinate as per the routine immunisation schedule. To use appointments efficiently, for adults who have not yet had their flu vaccination and are currently eligible for COVID vaccination, scheduling for both vaccinations to occur at the same visit is acceptable, as per the green book.

COVID-19 Vaccination Programme – workspace

General practice

Supporting physical health-checks for people with Severe Mental Illness

The NHS Long Term Plan commits to increasing the number of people with a Severe Mental Illness receiving a comprehensive physical health-check over the next three years to 390,000 people in 2023/24. We have worked with NHS Digital to establish a General Practice Extract Service (GPES) to robustly and accurately monitor delivery against this ambition. In November, General Practices were sent an invitation via the Calculating Quality Reporting Service (CQRS) to accept this invitation. We are asking GP practices to accept this extract to ensure robust data quality.

If practices have any technical questions regarding this collection, they can contact primarycare.domain@nhs.net. Queries regarding CQRS participation should be sent directly to support@cqrs.co.uk.

General practice – latest updates

Community pharmacy

New pilot launched to identify people with undiagnosed high blood pressure 

Community pharmacies in Chesterfield, Dudley and West Birmingham are piloting a new service to identify people with undiagnosed hypertension (high blood pressure) to help prevent cardiovascular disease (CVD) as part of the NHS Long Term Plan.

Anyone visiting a pharmacy who appears to be over 40, will be offered a free, on the spot blood pressure check. Those with suspected hypertension will be offered ambulatory monitoring or referred to their GP where appropriate, for ongoing care to manage their blood pressure.

Further pilot sites are expected to start in early 2021.The pilot will be evaluated to inform potential inclusion in the Community Pharmacy Contractual Framework.

Medicines delivery service commissioned for Clinically Extremely Vulnerable patients

Following the Government’s announcement of the national lockdown and advice for all Clinically Extremely Vulnerable (CEV) patients to recommence shielding, the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service has been commissioned from 5 January 2021 to 21 February 2021 (inclusive) for all CEV patients living in England.

This announcement supersedes the announcements made in December for this service provision to Tier 4 areas.

Pharmacies and dispensing doctors across England will be required to ensure those on the Shielded Patient List across the country can receive their prescription medicines and appliances at home. These contractors will receive the essential/mandatory service payments and can claim a fee for making a delivery to eligible patients during this period as set out in the service specification.

Dentistry

Your NHS dentistry and oral health update – 7 January 2021

The latest edition of the Your NHS dentistry and oral health update includes details about how the dental profession will receive the COVID-19 vaccine either as an NHS primary care, secondary care or private dental practice.

Dental professionals and their teams are defined by the Government as critical workers.

The Government website says "This includes, but is not limited to, doctors, nurses, midwives, paramedics, social workers, care workers, and other frontline health and social care staff including volunteers". Front line health staff includes dental professionals and their teams. 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

National flu vaccination programme update

Thank you for the work you continue to do in general practices and community pharmacies in vaccinating eligible groups for flu. The programme is continuing, so please offer vaccinations over the coming weeks to all eligible adults and children who have yet to be vaccinated.

The national call and recall system for the flu vaccination programme is this week writing to 50 to 64 year olds (not in at risk groups) who have not yet had their vaccination, in order to help achieve as high uptake in this cohort as possible. There is still some vaccine available for community pharmacies to order for this group – information on this is available in the Department of Health and Social Care (DHSC) stock guidance for pharmacies. If you are a general practice and have run out, please check with your local system for anyone who has spare vaccine before ordering, but there is still vaccine available from both Seqirus and Sanofi if required. To order please refer to the DHSC guidance for practices.

In addition, phone calls are continuing to those in at risk groups who have been sent a letter but have not yet taken up their vaccination. As a result, some individuals may receive a call from the NHS Immunisation Management Service on 0300 561 0230.

Deafness and Hearing Loss Toolkit for Primary Care

The Royal College of General Practitioners collaborated with The Royal National Institute for Deaf People and NHS England and NHS Improvement to develop an educational toolkit to support GPs and trainees deliver care to patients with hearing difficulties.

It covers how to recognise early symptoms of hearing loss, when to refer patients for hearing assessments, and aims to give GPs the confidence to innovate and make changes to primary care policy and practice.

The toolkit is part of the Deafness and Hearing Loss Spotlight Project, which aims to support GPs to implement the latest NICE Guidelines and NHS Accessibility Quality Standard and Guidance.

Dates for your diary

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 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)

Thursday 21 January 2021, 11am-12pm. NHS Reset: Ensuring a greener future for respiratory care

The NHS Confederation’s webinar in partnership with the Primary Care Respiratory Society will explore how we can make respiratory care greener and kinder to the environment whilst still focusing on the complete patient journey from prevention of disease and diagnosis, through to routine chronic care including the acute situation with a #nowastenoharm approach.

Link of the day

How logical is the UK’s vaccine priority ordering?