- Primary care providers will be paid £15 for covid vaccinations from tomorrow, up from £12.58
- Calls for military support to be brought in due to staffing concerns
- NHS asked for huge expansion of vaccination programme
- Dropping GP pay-for-performance still under discussion
GP practices and pharmacies providing covid vaccinations will be paid around 20 per cent more over the next two months, as the NHS seeks to hugely speed up the process despite major constraints on workforce, HSJ has learned.
Several senior NHS leaders said the service should also now call in military support, as the government is expected to set an expectation of giving 3.5 million doses each week, having substantially expanded eligibility for booster and second doses.
GP practices will receive £15 for each jab given from Monday to Saturday – up from £12.58 so far in the programme – and £20 for Sunday and Bank Holiday vaccinations from 1 December to 31 January, HSJ has learned. Payments for housebound patients will also increase. It is anticipated the increases will also apply to community pharmacies giving covid vaccinations.
A formal announcement is expected in the next 24 hours.
The government yesterday announced all adults would be eligible for a booster dose, and after three months instead of six — substantially expanding the pool and likely demand. It wants the NHS to give 3.5million doses per week, according to reports.
Senior NHS leaders are now stressing vaccines will still be made available only by age bands or other criteria, not all at once, and that the most vulnerable should be prioritised, rather than only large numbers.
Many senior NHS leaders also underlined that it would be extremely difficult to reach the 3.5 million rate seen earlier in the year because at that point other health services were much quieter and covid restrictions meant there were more staff keen to work extra shifts, less burnout, and more volunteers and premises available.
One chief executive said it was “a very big ask, on top of many other very big asks”.
The increased fee for primary care vaccine providers, as well as compensating for expected increased costs, is intended to attract more primary care sites (or “local vaccination centres”) to rejoin the programme. Many dropped out in the summer, as there were fewer people to vaccinate and more other work. Early in the programme, around two thirds of vaccinations were provided by GP practices but that is now much lower.
Several primary care sources told HSJ said there was a “big risk” providers may still reject the additional funding, because of staff burnout, lack of capacity, and low morale.
BMA GP committee chair Dr Farah Jameel said: “GP teams will step up to protect and care for those most in need as we continue to face huge challenges – as we have throughout the pandemic. But 20 months in, many of us are exhausted and demoralised and will need substantial support.
“Additional funding is all well and good, but if practices physically don’t have the staff or time to dedicate additional time to the vaccine programme because they are also focused on other work their contracts bound them to do, it will do little to help. With a finite number of staff and hours in the day there is a limit to what practices can do.
“If the Government and NHSEI wants more practices to get involved again with vaccinating people with boosters, as many want to do at such a critical time, they need to be freed from bureaucracy and lower-priority, undeliverable targets – releasing time and staff so they can get jabs into arms as quickly as possible.”
Calls to suspend the GP quality and outcomes framework for the year — meaning practices would be paid the QOF regardless of performance on a series of recommended health checks and interventions — are still under discussion, it is thought.
Meanwhile, two senior NHS leaders involved in the vaccination programme called for military support to be called on in England. Staffing is likely to be a major limiting factor in expanding large “mass” vaccination centres, they said.
A local NHS chief executive said: “Army support would be very helpful.” Another pointed out the military was currently providing assistance to the programme in Scotland.
One local leader said “the workforce is not there and mass vaccination centres are maxed out already”, and that there was a risk the major expansion had been announced “without [anyone] having a scooby do how to implement it”.
It is thought NHSE has has acknowledged it may need military support but not yet triggered a request, and would do so when it has a specific ask.
With the emergence of the omicron covid variant in the UK, the government announced yesterday (29 November) that booster vaccines would be extended to 18-39-year-olds, with the minimum gap reduced to three months after the second dose.
Ruth Rankine, director of primary care at the NHS Confederation, said: “The booster vaccine will offer people significant extra protection against COVID-19 and NHS leaders and staff will do all they can to ensure those eligible for booster jabs get them.
“But, this is a significant expansion that adds to the complexity of an already challenging programme so we would encourage the Government to support front-line teams to play a critical role in ensuring the public get vaccinated as quickly as possible.
“They will also want assurances that the supply of vaccines matches the volume and timing of appointments as they are booked.”
NHSE did not want to comment.
But its chief executive Amanda Pritchard said at a King’s Fund’s conference yesterday that the programme was now “significantly more complex” than when it began, because “we’re delivering primary, secondary, third and booster vaccinations along with a schools programme as well… And that is now being done alongside all the many other demands on the NHS”.
She said: “I thought it probably would be worth saying a few words about the Omicron variant and partly because I know people will be concerned – not least NHS staff who have worked so hard to care for now more than half a million covid patients in hospital as well as many more in the community, and they’ve done such a fantastic job rolling out the covid vaccination programme.”
Substantially increasing the rate of vaccination is likely to require several other changes to the process, HSJ was told by those organising the programme locally.
This includes making deliveries more flexible to more rural smaller sites can be properly served, and/or allowing supplies to be moved between sites more easily. This particularly applies to the Moderna vaccine, which at present comes in larger packages. Another option is to return to using AstraZeneca/Oxford, which has largely been phased out, but is also available for smaller sites and in good supply.
The requirement to observe people for 15 minutes after they are vaccinated with Pfizer or Moderna could also be dropped, if national agencies decide the record allows this, as it makes the process slower and more complex, and takes space.
Flexibilities on staffing — such as confirming employment for longer periods, or exemptions from pensions tax penalties for overtime — and permission to deprioritise other work, both in QOF (see above) but in other NHS services too — are also on the wish list.
Updated at 4.50pm on 20 November with quote from BMA GP committee chair.
30 November 2021