COVID-19: 23rd February round-up for primary care
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.
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.
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.
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.
COVID-19: 25th February round-up for primary care
Thank you for the work you are doing to deliver the vaccination programme and address vaccine inequalities in your area. We have written to CCGs to describe further national actions to enable and locally deliver community activity and engagement to support COVID-19 vaccination access and uptake, building on the vaccine uptake strategy. This includes details of additional funding to further support and enable locally led community engagement in all areas with health inequalities.
We have also written to commissioners to outline further opportunities to reach out to communities with lower uptake levels by operating temporary vaccination clinics in community venues. In particular, a large number of places of worship have expressed an interest in supporting the COVID-19 vaccination programme. We are asking local commissioners to support these venues to partner with existing PCN and pharmacy providers to host roving COVID-19 vaccination clinics.
PCN vaccination sites are also reminded that they should be focussing on cohort 6 for vaccination. As per the provisions of the Enhanced Service, the guidance is that only in exceptional circumstances should those in cohorts 7-9 be invited to a PCN site if patients in cohort 6 remain to be vaccinated and can be prioritised.
Downloadable Post-Vaccine Waiting Room Animations and Posters
All vaccination sites can now download short animations and posters to display in waiting room areas. Animations are available in 16 different languages (Arabic to follow) and each can be downloaded and shared across communities too. If your site is unable to play animation on a loop then you can display the posters which include a QR code linked to the videos on YouTube for the public to access. The animations are subtitled and can be played on mute as well. It is for sites to decide which language(s) to play in the waiting area.
The messages in the animations are vital to encourage people to continue observing the ‘hands, face, space’ guidelines even after receiving both doses.
New webinars on working with people and communities in PCNs
Our webinar series for colleagues working in primary care networks continues in March. Building inclusive primary care networks in partnership with people and communities will help PCNs provide inclusive services for people and communities from the most marginalised groups, who experience the greatest health inequalities. Three of these webinars are aimed at those new to engagement or who want some practical advice and ideas to enhance their current engagement activity. The fourth is offered as part of launching the new Inclusion Health self-assessment tool for PCNs which provides tips, advice and resources to support engagement with Inclusion Health communities.
For more details and to book a place, please visit booking link.
Health and wellbeing resources
Looking after the health and wellbeing of our NHS people is vital, to allow them to continue to help their patients, colleagues and loved ones. We’ve developed a range of options to support staff health and wellbeing. The offer has been accessed over 700,000 times by people from across the NHS and has something to suit everyone, including:
- Support now – access to helplines, a text line and various wellbeing apps.
- Support offers – access wellbeing support such as counselling and coaching, as well as support with bereavement, substance misuse, gambling and financial wellbeing.
- Support for all leaders – access coaching, mentoring and leadership support circles.
- Support for exec leaders – access 1:1 psychological support, mentoring, chief executive common rooms and stories from other leaders.
