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Following on from our COVID-19 Vaccination updates, NHS England, and Improvement (NHSE&I) have provided further information about the vaccination programme, although the Enhanced Service (ES) has still not been published yet.
Further information (including slides from all the NHSE&I webinars) is available on the FutureNHS Collaboration Platform, but here are a few key points:
Vaccination Sites
Following a huge response to the request for designated sites last week, there will be more than one type of COVID-19 vaccination site (i.e. vaccination centres outside of general practice) and vaccinations will be given in hospitals. Most vaccination sites being organised in the community will be run by GPs, although some will be run by community pharmacies and potentially other organisations will deliver the vaccine to people in need. A letter was sent to CCGs and PCNs earlier this week to confirm the inclusion of sites and outline the next steps.
Enhanced Service
The letter to CCGs and PCNs also explained how NHSE&I will be communicating the final version of the ES for the COVID-19 vaccination programme. It will be necessary for Practices to formally opt-in to the programme through the ES, and the combination of having a designated site and opting into the ES will ‘switch on’ the site for vaccine delivery.
Supplies and Consumables
In the next round of information from NHSE&I, they will issue a list of items that will be available from a central supply depot and delivered to vaccination sites. This will include items supplied for free into general practice as part of delivering the programme from central stocks. Items such as fridges and cool boxes that meet the cold chain standard (for example, for use in care homes) will be considered, so Practices are advised not to make any purchases for equipment or supplies for the COVID-19 vaccination programme.
NHSE&I is expecting the vast majority of the materials that are needed for a PCN designated location to be delivered to the vaccination sites, which includes all of the consumables related to the vaccine (e.g. needles, PPE, etc) so there’s no need for Practices to start ordering any additional PPE from the DHSE portal in order to prepare specifically for the COVID-19 vaccination programme.
Funding
£20million will be available through local commissioners to pay for some of the one-off setup costs that are attached to creating the site to be in a state of readiness; for example, that could include covering rent on a non-Practice site that has been identified. There may be a slight delay in the confirmation of some of those non-Practice sites as part of the designation process, because there will need to be a discussion in CCGs about how that £20million is spent to make those sites available, and to ensure that it’s good value for money for the funds to be spent in that way.
Call and Recall
Cohorts will be defined nationally, and GPs within the PCN model will run the call and recall service to invite Patients to come for the vaccination at a designated site. NHSE&I is not looking for GPs and PCNs to cover the initial cohorts at the moment, e.g. care homes and health and social care workers, it will be a self-select model for those people and alternative arrangements will be made for them to have their vaccination.
Booking Appointments
There will be a National Booking Service (NBS) for the COVID-19 vaccination programme, but it will not be the current NBS model used because it does not recognise the groupings of people or their eligibility. The general rule will be that Patients registered at a GP Practice will be entitled to have a vaccination if their cohort is identified, and they can only have a vaccination at the PCN site if their GP Practice falls within that PCN grouping. NBS will be used to invite cohorts who wish to have their vaccination at a large area vaccination site. Practices already have access to collaborative booking systems, but NHS Digital is working on a solution with clinical system providers so that Practices can book the appointments for the COVID-19 vaccination programme.
Start Date
The start of the mass vaccination programme hasn’t been confirmed yet, and will depend on the MHRA and the JCVI signing off the vaccines for approval, but NHSE&I will give 10 days’ notice of the arrival of vaccines to PCNs for vaccinations to start; allowing time for the full setup of the site, rostering of workforce rotas, invitation of Patients, etc. More notice will of course be given wherever possible, but it is dependent on decisions again by the MHRA and JCVI, and the JCVI will provide more details on the final cohort for prioritisation of the vaccine.
Recording the Vaccination
At the moment, there are 2 solutions for data collection (Pinnacle and Sonar), with extra integration in place for the data to be collected and sent to MHRA. It will take a little time to develop those changes with IT clinical providers (i.e. TTP, EMIS, etc.) and bring them on board. Data entry should flow seamlessly, and NHS Digital is working to ensure that points of care recorded in Pinnacle and Sonar will be seamlessly transferred to the GP Patient record – there should be no need for Practices to enter vaccination data in the Patient records, thus avoiding duplicate data entry. Access to Pinnacle and Sonar, as well as training on how to use it, will be provided as part of the mobilisation activity to allow PCN groups to offer vaccinations.
Pinnacle and Sonar are web based, so there is no need to update computer solutions for download software, but good internet access will be required. The vaccine will be scanned, so access to barcode scanners will be necessary, and that equipment will be provided to the PCN vaccination centres. It may be possible in the future to use existing GP systems, but that will be communicated when it is available. When using Pinnacle and Sonar, an Organisation Data Service (ODS) code will need to be used that identifies the individual Practice.
Vaccination Payment
Recording the vaccination on Pinnacle or Sonar will generate an automated payment process. Practices will need to make arrangements within their PCN grouping to identify a lead Practice for the purpose of receiving payments due under the ES, and they will get the money that is due to the Practices, they will also get a breakdown of how many vaccine doses were given to Patients that belong to the lists of all of the constituent Practices in the PCN grouping so that money can then be passed on accordingly. NHSE&I is expecting, in some cases, for Patients that aren’t registered with one of the local Practices to potentially be vaccinated by the PCN – for example, that might be when a clinician visits a care home there may be an opportunity to vaccinate a member of staff in that care home who isn’t a registered Patient of one of the local Practices.
In the collaboration agreement, that Practices will need to sign in order to work from the same site to deliver the vaccination programme, there will need to be an agreement on how that money will be dispersed between the PCN grouping Practices.
The payment schedule will be £25.16 for both vaccine doses when the second does has been given, but there will be a series of exceptional circumstances for payment of a single dose which will be subject to a manual claims process, e.g. if a Patient doesn’t come back for a second dose, the Practice will still get paid.
Communications and Engagement
When the publicity materials are available, which will be as soon as the vaccine has been approved by the MHRA and JCVI, a good communication process must be in place (which covers cultural relevance, diverse communities, and in simple, straightforward language) to effectively engage with the community. These materials for Practices to use, are aimed at gaining public confidence to engage in the vaccination programme and to get a good uptake of the vaccine – both amongst staff and Patients.
Primary care staff will be part of the healthcare workforce to be immunised quickly once the vaccine becomes available.
Next Steps
NHSE&I will, alongside the ES, publish a number of documents describing in more detail about how the supply of materials, tech and data solutions, workforce, etc. will be managed. Practices should have a point of contact at the CCG and/or PCN to liaise with about the programme who will also be able to advise what equipment (if any) Practices will be able to get and what will be reimbursed. NHSE&I will inform Practices precisely which vaccine will be available and when.
NHSE&I is still not expecting currently for Practices to open on Bank Holidays over the Christmas period, over and above what they already do for Extended Access.