COVID-19: 20th December round-up for primary care
Thank you again to all those who have continued the huge task of vaccinating patients and staff against coronavirus. The pictures on social channels and in the media have been incredible.
This week we held supervised walk throughs of the care home vaccination model which included GP led pack down of vaccine to take it in to care homes. We are now rapidly rolling this out from tomorrow and further details can be found below.
The flu vacation programme also continues with many of you running clinics over the weekend. We are very grateful for all you are doing for your local communities in these unprecedented times.
This special Sunday bulletin outlines a number of important developments with regards to the COVID vaccine rollout and in response to the government’s announcement on further restrictions with parts of the country going into Tier 4.
COVID-19 vaccination in care homes
TheOver the next few days we will initiate the delivery of the vaccine through local vaccination sites to care home residents and their staff, starting with larger care homes. The roll out will begin during week commencing 21 December through wave 1, 2 and 3 sites, followed shortly by local vaccination sites in later waves. A letter has been sent to waves 1-3 sites with further details. The standard operating procedure for vaccination deployment in community settings has also been updated with a specific care home section.
We will be hosting a webinar on Tuesday 22 December at 1.30pm-2.15pm with further information.
Please order additional vaccine in order to vaccinate your care homes
We have written to all wave 1, 2 and 3 local vaccination sites offering additional batches of the COVID vaccine. If you would like a resupply please complete this webform on the local vaccination online site platform (Foundry) by 9.30am on Monday 21 December to request your delivery. Note that you do not need to have a Foundry account for your site to complete the webform.
Our priority is to now vaccinate our care home residents and staff, and continue to vaccinate over 80s and health care workers. You can order a full pack (975 doses) and pack down yourself, or order packs of 75 doses to take straight in to your care homes.
If we do not hear from you, we will assume that you do not want to receive a vaccine resupply delivery. We will let you know about any further vaccine resupply opportunities as they arise. We will confirm your orders by email after they have been processed by Foundry. Please do not book patients into clinics until you have received email confirmation from us.
6th dose of the COVID-19 vaccine
MHRA have produced further information on the 6th dose of the COVID vaccine and how this can be used. Consumables to support the use of the additional dose will be sent directly to designated sites, and added to second dose deliveries.
Healthcare professionals must always use the correct volume of diluent, and after dilution must aim to secure five full 0.3ml doses of this Pfizer-BioNTech COVID vaccine in line with the manufacturer’s instructions and as outlined in the Information for Healthcare Professionals. After that has been done, there may be potential for a sixth full dose with some vials due to variances in fill volume and the syringe/needle hold up volume combinations used. This should be subject to health care professional judgement on a case by case basis.
The manufacturer has stressed care should be taken to ensure a full 0.3 mL dose will be administered to the patient from the same vial. Where a full 0.3 mL dose cannot be extracted the contents should be discarded. The vaccine does not contain a preservative so it is best practice for all doses to be used as soon as possible after dilution, although all doses from a single prepared vial must be administered within 6 hours of the time of dilution. If further advice is required, in hospitals and vaccination centres please discuss with your Chief Pharmacist, and in local vaccination services, your Lead Responsible CCG Chief Pharmacist and Lead GP.
National protocol
The national protocol for COVID-19 mRNA vaccine BNT162b2 (Pfizer/BioNTech) has been published. This protocol is for the administration of COVID-19 mRNA Vaccine BNT162b2 by appropriately trained persons.
Reintroduction of shielding advice in Tier 4 areas
From 00:01 on Sunday 20 December, the government has introduced Tier 4 restrictions to some areas (London and parts of the South East). The DCMO has confirmed that shielding advice for Clinically Extremely Vulnerable (CEV) individuals will be reintroduced in these Tier 4 areas. This shielding advice is identical to that which was in place nationally from 5 November to 2 December.
Those at highest risk in Tier 4 areas and advised by government to shield are eligible for support including free delivery of medicines (where friends, family, or local volunteers are unable to provide help) and statutory sick pay where unable to work from home. CEV individuals in Tiers 1-3 should continue to follow the government advice for those at highest risk specific to each of these tiers.
The government is writing to all CEV patients affected by the shielding advice in Tier 4 areas to inform them of this guidance. Letters will be sent in the week commencing 21 December and will be published here. These letters will emphasise the importance of CEV individuals continuing to engage with the NHS, and confirm that they will be prioritised for the COVID-19 vaccination in advance of the general population (as per current JCVI guidance).
The government is aware that the letters to CEV individuals may face postal delays over the Christmas period. Patients for whom the NHS holds an email address will receive the letter via email this week. The government is planning to use national and local media to communicate the advice to patients quickly.
As during the previous period of shielding advice, this will be an inevitably difficult and worrying time for Clinically Extremely Vulnerable people. We anticipate that patients may have questions about the advice they should follow. We are very grateful for your continued efforts in supporting those at highest risk from COVID-19 during the pandemic and will be in touch to provide further updates as necessary.
COVID-19: 22nd December round-up for primary care
We appreciate that the announcement from the Government regarding new restrictions that took place over the weekend may place new pressures on some parts of primary care. However, we are confident that you will continue to make clinically led decisions about risk for different patient groups, in line with the Infection, Prevention and Control guidance already in place to support you to manage patients safely across all areas.
We have now republished the GP Standard Operating Procedure to reflect some of the latest updates and guidance and the seven priority areas set out in the £150m capacity expansion fund letter remain critical.
As people are moved into different Tiers, it is important they continue to access services when needed and understand how some of the changes may affect the ways that care can be accessed, including the use of online/phone consultations and face-to-face appointments when clinically necessary.
For vaccination sites in particular, in line with previous announcements, local enhanced services should where possible be re-purposed by agreement with CCGs to make funded capacity available for COVID 19 vaccination, and extended access and hours capacity can similarly be reprioritised to provide additional capacity.
Clinically Extremely Vulnerable patients in Tier 4 areas should now be shielding, and as the SOP confirms, practices should provide care at home where possible, or in infection controlled clinical settings where needed in line with IPC guidance.
A special thank you message
The commitment you have shown this year has been inspiring. Now, with the rollout of the COVID-19 vaccination programme, there is hope and you continue to work tirelessly to protect the most vulnerable in your communities.
Our festive video celebrates your dedicated teams and highlights the achievements of the primary care workforce. We received so many pictures and videos that unfortunately we couldn’t include them all. Thank you - we couldn’t do this without you.
COVID vaccination in care homes
This week we began to initiate the delivery of the vaccine through local vaccination sites to care home residents and their staff, starting with larger care homes. The roll out began this week through wave 1, 2 and 3 sites and will be followed shortly by local vaccination sites in later waves. A letter was sent to waves 1-3 sites with further details and the standard operating procedure for vaccination deployment in community settings was updated with a specific care home section. We have now sent a letter to workforce leads which confirms the roving vaccination model will be rolled out and details the specific arrangements that should be put in place to support this important piece of work.
Lateral flow testing in primary care
As described in the 16 December letter to primary care, Primary Care Support England (PCSE) started last week to send direct invitations to primary care contractors to order lateral flow testing devices for their staff.
Invitations to order are being sent in a staggered manner across NHS regions to ensure a smooth ordering process. Following receipt of an invitation, organisations should log on and complete their order as quickly as possible, with a final closing date for orders of Wednesday 30 December.
SOPs and FAQs on lateral flow testing in primary care are available for further information, as well as a brief guide for staff on how to self-administer the tests.
If primary care contract holders also hold contracts commissioned by CCGs for different NHS services (for example NHS audiology services) these providers can also order for the staff delivering those services through the PCSE portal.
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. This will provide each staff member with 25 single use test, enough for 12 weeks of testing. It is important that organisations order the correct amount, as orders in excess of this amount may prevent other primary care organisations from receiving on time enough test kits for their staff.
Home delivery of medicines service commissioned
People who are clinically extremely vulnerable in Tier 4 areas are advised by the Government not to go to a community pharmacy. Therefore a letter has been sent to community pharmacy providers to confirm that the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service will be commissioned in accordance with the home delivery of medicines and appliances during the COVID-19 outbreak: service specifications and guidance for all patients on the Shielded Patient List living in tier 4 areas from 21 December 2020 until 18 January 2020. This means that all pharmacies and dispensing doctors in England will again be required to ensure patients on the Shielded Patient List receive their medicines at home.
Questions about Patient Specific Directions (PSD) and Patient Group Directions (PGD)
We are receiving enquiries as to whether or not written PSDs are required for supply and administration of COVID-19 vaccination. To clarify, doctors as appropriate practitioners can supply prescription only medicines without prescriptions and administer injectables without directions (Human Medicines Regulations reg.214(1) and (2)(a)). This means that a PSD or another type of direction written or otherwise is not required as long as the GP is carrying out the whole process of clinical assessment, consent and administration. A clinical record of this should be made (in this case on the Pinnacle system) as is normal practice.
If tasks are being split with a different healthcare professional carrying out the clinical assessment and then the GP administering the vaccine, then this would require a written PSD to be in place to cover the other healthcare professional or trained member of staff administering the vaccine.
With a PGD the clinical assessment cannot be split from the administration and both of these need to be done by the same Health Care Professional authorised to work under the PGD.
NHS Discharge Medicines Service commencing in February 2021
The NHS Discharge Medicines Service (DMS) is a new essential service for community pharmacy contractors. Due to the impact of COVID-19 on the capacity of contractors, the service will now commence 15 February 2021. The service has been established to ensure better communication of changes to a patient’s medication when they leave hospital. Referring patients to community pharmacy on discharge will improve outcomes, prevent harm and reduce readmissions.
Regulations guidance has been published to support pharmacy contractors in providing the service, which they are asked to familiarise themselves with and prepare for implementation.
To support improving processes across hospital, community and primary care network pharmacy teams, a cross-sector toolkit will be published in January 2021 with information on the roles of community pharmacy, NHS trusts and PCNs.
New guidance explaining Community Pharmacy Regulations changes
The NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2020, published on 19 October 2020, introduced nationally agreed changes to the Community Pharmacy Contractual Framework for pharmacy and dispensing appliance contractors. New guidance for contractors explains these important changes, including the new NHS Discharge Medicines Service which starts 15 February 2021 and the promotion of healthy living.
It also sets out requirements for consultation rooms, electronic communication and remote access, pandemic treatment protocols, health campaigns and activities to be carried out in relation to dispensing that contractors will need to meet and the dates the changes come into force.
Reprioritisation of contractual activities
In recognition of the ongoing workload pressures for contractors during the COVID-19 pandemic, several activities under the community pharmacy contract have now been reprioritised.
- The Pharmacy Quality Scheme (PQS) 2020/21 Part 2 requirements will have a flexible completion date. Contractors will still make their declaration in February and get paid on 1 April, but they will have until the end of June 2021 to collate the evidence to demonstrate that they are compliant.
- The Community Pharmacy Assurance Framework will not run in 2020/21. This will run as normal in 2021/22.
- The NHS England and NHS Improvement set audit and the pharmacy specific audit will be waived for 2021.
- The Community Pharmacy Patient Questionnaire will be waived 2020/21.
- No action will be taken against contractors who have not updated the Data Security Protection toolkit for 2019/20, provided they are working to complete the toolkit for 2020/21.
Blog on community pharmacy work with local care homes
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.
Flu vaccinations – stock still available
Thank you for all the work you are doing in general practices and community pharmacies in vaccinating patients for flu. The flu vaccination programme is continuing and will do so into the new year, so please continue to offer vaccinations over the coming weeks to all eligible adults and children who have yet to be vaccinated.
There is still some vaccine available to order from the central stock. If you are a general practice please check with your local system for anyone who has spare vaccine before ordering from this stock.
Information on how to order is available in the DHSC stock guidance for general practices and community pharmacies.
COVID-19: 23rd December round-up for primary care
The vaccination programme continues apace, and we know many of you will be working over the Christmas holidays with more local vaccination centres stepping up next week.
It is so important that we vaccinate this priority cohort of patients as per the JCVI guidance as soon as we can unless there is a clinical reason as to why they cannot have the vaccine.
We have asked all wave 1, 2 and 3 local COVID vaccination sites to prioritise wherever possible care home residents and staff to ensure this priority group are vaccinated against the coronavirus as quickly as possible. We appreciate the additional time and resources needed to deliver this complex vaccine in a care home setting, especially at such a busy time of the year. Therefore, we will be 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 will be payable on completion of the second dose for all vaccines administered between 14 December and 31 January. Where exceptional circumstances (as defined in the enhanced service specification) means that only one dose was able to be delivered, and this dose was delivered on or before 10 January, the supplement will be payable on the first dose only.
Arrangements have also been put in place to support PCNs with additional workforce for care home vaccinations – at no cost to the PCN in specific circumstances. Further details of the additional workforce support can be found here. We also shared a care homes vaccination mobilisation support pack.
Further information on the reporting and payment arrangements will be made available shortly.
We hope that some of you will get some rest of the Christmas break. Thank you once again for the extraordinary efforts you have gone to over this year. You have been truly incredible. Can we particularly dedicate this bulletin to those who keep us afloat day in, day out. Our practice managers, reception and admin staff. Those who have been reading everything we send out, calling patients in to vaccination clinics, organising staff to ensure we can deliver despite the busiest of times. It is truly appreciated.
Novel variant of COVID-19
A novel variant of COVID-19 has been identified which has spread rapidly within the UK. Public Health England have published a technical briefing document on novel SARS-COV-2 variant which gives further information. They have assessed this variant as having substantially increased transmissibility with high confidence.
Further Tier 4 Areas Advised to Shield
The Government has decided that several areas of England across the East and South East will be moving into Tier 4 from 26 December. Shielding guidance for clinically extremely vulnerable people is to be reintroduced in these areas, as well as support including free delivery of medicines (where friends, family, or local volunteers are unable to provide help) and statutory sick pay where unable to work from home. You can find the tier of your local area here. Government will be writing to affected CEV individuals in Tier 4 areas to inform them of the advice and support available. It is expected that Government will also be sending text messages and emails to affected patients where the NHS holds the relevant contact information.
Change in process to access lateral flow tests for vaccination sites from wave 5
Staff working at vaccination sites becoming operational from January onwards should receive lateral flow antigen tests through their participating primary care contractors. In order to ensure that vaccination site staff can access lateral flow antigen tests, all individual primary care contractors working together in the PCN grouping delivering vaccinations should order tests for the staff working at the site as part of their ordering process for test kits through Primary Care Services England (PCSE).
This differs from what previously stated on the 16 December letter regarding deliveries of tests to vaccination sites, as the PCSE ordering system is now up and running. As contractors are asked to order one box of test kits for each one of their patient-facing members of staff, they should include in that order one box for each member of their staff working in their vaccination PCN grouping.
If there is any staff working at the vaccination site who have been brought in exclusively to work at the site, but do not normally work in any of the primary care contractors in the PCN grouping, the primary care contractors should agree one contractor who will order boxes of test kits for this staff as well.
Primary care contractors and their staff are reminded that recording of all results (positive, negative, invalid) from lateral flow devices is a statutory requirement. The results from the lateral flow antigen test for primary care staff should be documented at home by the individual using the NHS Digital online platform.
Community pharmacy explained
Community pharmacy is a critical part of primary care in England, but its role and relationship to the wider NHS is often poorly understood. This explainer from the King’s Fund looks at the community pharmacy sector in England, explaining how pharmacies are contracted and funded, the types of services they provide and future trends in the sector.
