COVID-19: 19th January round-up for primary care
Yesterday, the Government announced that people aged 70 and over and the Clinically Extremely Vulnerable (CEV) will begin receiving invitations for vaccinations.
The current deployment approach taken by the NHS is to offer COVID-19 vaccination as set out by the JCVI recommendations, and in sequential order by cohort. In order to support achievement of a vaccination offer to all individuals within JCVI cohorts 1-4 by 15 February 2021, and guided by the principles of minimising wastage, reducing inequality of access, and maximising pace, we are now moving to a more flexible approach across cohorts 1-4.
You should continue to prioritise vaccinating people from JCVI priority cohorts 1 and 2. We continue to expect all local vaccination services to administer the first dose of the COVID-19 vaccine to care home residents and staff in the older adult care homes for which the PCN is responsible by the end of this week (Sunday 24 January) at the latest, and to continue to prioritise over 80s including those who are truly housebound.
It is then permissible to offer vaccination to cohort 3 (75-79 year olds) and cohort 4 (70-74 year olds and the Clinically Extremely Vulnerable under 70). Advice to support vaccination of the Clinically Extremely Vulnerable will follow shortly. It is absolutely permissible, and indeed encouraged, to have reserve lists of recipients for every clinic, who can come in at short notice if vaccine is still available. It will make sense to have these reserve lists drawn from the ‘next cohort’ on the list – at the moment either cohort 3 or cohort 4.
In line with JCVI guidance and the statement from the Chief Medical Officers on second doses published on 30 December, vaccine supplied should only be used to deliver first doses of vaccine, with second doses being scheduled for the 12th week. It is supplied on the basis that it will be used immediately for vaccination of patients and not stored, since weekly deliveries are now being made.
What does this look like in practice?
- Minimising wastage
Vaccine should not be wasted. If there is vaccine supply and deployment capacity, but a degree of uncertainty on whether clinics will be full, further invitations can be made to individuals from the next eligible cohort (across cohorts 1-4) in order to utilise available supply. Vaccination beyond the current cohorts (1-4) can be offered if there is a risk that current vaccine stock will become unviable if not used. - Reducing inequality
Working closely with local partners, deployment should continue to minimise inequalities between different communities. Please do as much as you can to get vaccination to your highest risk populations, mindful of deprivation, ethnicity and all factors impacting COVID risk. This increased flexibility offers an opportunity to tackle inequity and begin reaching health inclusion groups. Communities with greater levels of vaccine hesitancy or other challenges around engagement and uptake will take longer to reach, so all local areas should ensure engagement is either underway or begins now.Every effort must be made to reach these groups using targeted local outreach and community champions as informed by local Equalities and Health Inequalities Assessments (EHIAs). Please ensure you work with your system partners, especially Local Authorities and Voluntary and Community Sectors in your area to ensure health inclusion. Please help us make sure no one gets left behind, and feed back on how the central team can help support excellent local work to ensure equity in vaccination rates.
- Maximising pace
Where there is vaccine supply and deployment capacity, this flexibility allows a pragmatic operational approach that enables opportunistic vaccination within cohorts 1-4, such as vaccinating partners of similar age from cohorts 3 & 4 who attend together, or those living in multigenerational households.As before, GPs and other primary care providers may receive queries from patients who belong in the new cohorts asking about getting the vaccine. The messaging remains the same for the public – that the NHS will be in touch when it is time for your vaccine. Please continue to reiterate these messages.
We are holding a webinar tomorrow at 3pm for Local Vaccination Services. Please register before 1pm on 20 January 2021.
Position statement around use of the COVID-19 vaccine AstraZeneca (AZ) to vaccinate housebound patients (13 Jan 2021)
There have been queries around the movement of the AZ Vaccine once the vial has been punctured; we have worked with the National Infection Prevention and Control team to agree a way forward that reduces the risk of microbiological contamination of the unpreserved AZ vaccine and therefore the risk of infection to patients. The following statement is our recommendation.
Vaccinating frontline social care workers
This letter on 14 January is further to the Operational Guidance: Vaccination of Frontline Health & Social Care Workers of 7 January 2021, which signalled the immediate requirement to vaccinate frontline social care workers.
In addition, the Standard Operating Procedure (SOP) for frontline community-based social care workers provides a framework for local systems to identify the eligible cohort of care workers in JCVI priority group 2, and the arrangements that should be put in place to enable them to access their COVID-19 vaccination.
Community pharmacy urged to continue flu vaccination programme
With community pharmacy vaccinating more people than ever before against the flu, contractors are urged to continue their efforts by encouraging as many as possible to get the flu jab to protect vulnerable people against co-infection of flu and COVID-19 and to reduce vaccine wastage.
Tips to help encourage uptake include:
- proactively targeting people coming into the pharmacy to encourage them to get the flu jab if they haven’t already had it;
- targeting people who collect prescriptions or call the pharmacy for advice, to ask if they have had the jab; and
- briefing team members about what the flu vaccine involves and why it is important, ensuring they are confident about booking appointments.
Lateral flow testing in primary care
Orders of lateral flow tests for those organisations ordering after the initial deadline of 30 December but before 17 January will be delivered from this week. Primary care contractors should still place orders on the PCSE portal if they have not done so to date. As the maximum amount of boxes of tests that can be ordered on the PCSE portal is now 27 (one box is for one member of staff), contractors who need to place an order for more than 27 members of staff should email pcse.urgentsupplies@nhs.net. Orders placed from today will be delivered as part of contractors’ BAU orders on their usual scheduled delivery day with PCSE. Contractors should ensure that they do not place duplicate orders on the portal, as these will be automatically removed
Primary care staff who are testing twice weekly with lateral flow devices are reminded that reporting of results (positive, negative or void) is a statutory requirement. Staff should report their results as soon as possible on the NHS Digital platform
A reminder that primary care contractors who are part of a PCN grouping for a vaccination site should ensure that they order tests for their staff working at the site as part of their order of LFD.
NHS Discharge Medicines Service cross sector toolkit published
The NHS Discharge Medicines Service (DMS) is a new essential service for community pharmacy contractors, commencing on 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 for a check of their medicines will improve outcomes, prevent harm and reduce readmissions.
In addition to the guidance available for pharmacy contractors, a cross sector toolkit has been published to ensure a cross-sector approach to service implementation. The toolkit has been developed to support clinical teams across hospitals, PCNs and community pharmacies in delivering the NHS DMS.
Relevant teams in the respective organisations should ensure that they read the toolkit and understand their role and responsibilities.
Testing requirement for visiting professionals entering care homes
As per the Care Home Visitors COVID-19 Testing Guidance, all professionals visiting care homes should be tested prior to entry, unless they are already testing twice a week in line with lateral flow testing procedures for NHS staff. Care homes received a supply of Lateral Flow Devices (LFD) to test visitors to care homes on the door.
As primary care contractors will now have access to regular testing through LFDs, patient-facing staff who are using LFDs twice weekly and who are following associated guidance on self-isolation and confirmatory PCR tests, in line with the SOP, will not need re-testing upon entering a care home.
They may be asked to confirm that they are testing twice weekly and for the date of their last test. If primary care staff are not carrying out twice weekly LFD testing, they should be tested with an LFD by the care home upon on the door. This also applies to any staff undertaking vaccinations.
COVID-19: 21st January round-up for primary care
Thank you for your continued efforts in delivering the largest vaccination programme the NHS has ever undertaken, as well as providing care to people across the country.
Another 65 pharmacy sites are joining the vaccination programme over this week and early next week with more to come. These sites will support the programme by expanding vaccination services into areas not yet covered by a vaccination site, helping us to vaccinate vulnerable people even faster.
Reminder calls following national COVID-19 vaccination booking letters being sent
The national NHS Immunisation Management Service is starting to call people that have received letters to book their COVID-19 vaccination appointments through 119 or www.nhs.uk, where they haven’t already booked an appointment. The number that people will see when receiving the call is 0300 561 0240.
The service will make it clear that if people have already had their first dose, they just need to wait for their local NHS services to contact them about the second dose. They will be clear that booking through 119 or www.nhs.uk is one option and they can wait to be contacted through their local GP services if they haven’t been already. The callers will remind people that they will not book people into appointments on the phone.
As always, the NHS will NEVER:
- ask people for their bank account or card details
- ask people for their pin or banking password
- ask people to prove their identity by sending copies of personal documents such as your passport, driving licence, bills or pay slips
If anyone believes they are a victim of fraud or identify theft they should report this directly to Action Fraud on 0300 123 2040.
Co-administration of flu and COVID-19 vaccine
Regarding the co-administration of the flu and COVID-19 vaccines, there is no evidence of any safety concerns, although it may make the attribution of any adverse events more difficult. Therefore, the green book advises that there should ideally be an interval of at least 7 days between the two to avoid incorrect attribution of potential adverse events. However, if this is not possible, then it is acceptable to give both together as the green book states that: “as both of the early COVID-19 vaccines are considered inactivated (including the nonreplicating adenovirus vaccine), where individuals in an eligible cohort present having received another inactivated or live vaccine, COVID-19 vaccination should still be considered.” This is to avoid any further delay in protection and to avoid the risk of the patient not returning for a later appointment.
COVID-19 vaccine and fertility
Royal College of Obstetricians and Gynaecologists have published information and advice for pregnant women about the COVID-19 vaccine, including an updated Q&A section. The College also released a press notice, responding to misinformation around the COVID-19 vaccine and fertility.
Flu vaccinations in community pharmacy
Thank you for the work you continue to do in community pharmacies in vaccinating patients for flu. The Department of Health and Social Care (DHSC) has confirmed that community pharmacies can now offer private patients and those covered by occupational health schemes a vaccine that has been centrally supplied, alongside NHS eligible cohorts. This is reflected in updated DHSC stock guidance for pharmacies.
Please retain some vaccines specifically for NHS eligible cohorts, as some may come forward later in the season, such as newly pregnant women or others who have not received their vaccine yet.
New standards for initial education and training of pharmacists introduced
The General Pharmaceutical Council has published new standards for the initial education and training of pharmacists, which have been welcomed in a joint letter from the Chief Pharmaceutical Officers of Great Britain.
The implementation of these new standards will transform the education and training of future pharmacists, so they are able to play a much greater role in providing clinical care to patients from much earlier on in their careers and they will be independent prescribers from their first day on the register.
The changes will help meet the increasing demand for high quality professional pharmacist skills from patients and the NHS. To ensure the whole profession is able to meet this demand, it is also important that all the current professional workforce has the opportunity to develop existing skills and experience as required, so that they too can practice at this enhanced clinical level.
NHS Community Pharmacist Consultation Service IT licence – extension to 30 September 2021
Additional funding has been agreed so that all regions can arrange an additional six months for the community pharmacy CPCS IT licence for the period 1 April 2021 – 30 September 2021, on behalf of contractors.
Since March 2020, Pharmacy Integration Fund resource has been provided to regions to fund the community pharmacy CPCS IT licence to allow contractors to offer the service without additional IT costs being incurred.
This funding was due to end on the 31 March 2021, after which point contractors would be required to purchase their own IT from the range of system suppliers in the market offering CPCS functionality. This change is part of a package of interventions that NHSE&I has made to support contractors during the pandemic. Further information will follow locally from NHSE&I regional teams.
