As the first ecstatic news reports arrived announcing the arrival of the vaccine we had eagerly been waiting for, we had a distinct feeling of unease.
Once again, we heard uninformed politicians overpromising that the “NHS was on standby to deliver”. Instead of sharing the optimism projected by the media, the knot in our stomachs grew stronger as we listened, thinking to ourselves: “No, we’re not.”
Each year, general practice rolls out a huge influenza programme. Vaccines are ordered in January and patients get booked in from September onwards, even though they’re unlikely to catch flu until around Christmas at the earliest.
Each surgery has this rehearsed, like a finely oiled machine. Practice managers co-ordinate it, practice nurses deliver it. And herein lies the magic and power of general practice – we know our patients.
This simple fact is not understood by policy makers. We know how to communicate best with our communities. We know this because we have been doing it day in, day out for decades, meaning we know how to organise a flu clinic to result in the highest uptake of a vaccine in our individual population.
“Trust and honest planned communication is vital for a successful vaccine rollout. Without it, any vaccine programme will fail.”
Therefore, it is aggravating, to have constantly changing, last minute orders from NHS England: “Vaccines must be delivered from 8am til 8pm, 7 days a week,” we are told.
“Practices must work with their networks and will only receive the payment once both vaccines are given,” we are informed. “This vaccine should take priority over routine work.”
We are actively depriving general practice of its autonomy – its magic – the very thing that could make this all work.
The specifications for this rollout have been released to GPs late in the evening, sometimes still containing tracked changes and requiring a response within one to two working days. It gives the impression of chaos at the top, which hardly inspires confidence in a smooth rollout on the ground.
Coordinating a worldwide first of this nature is an unenviable task and we appreciate it is an evolving situation. NHSE needs to recognise, however, that an efficient rollout will not be achieved by keeping GPs in the dark.
It is unacceptable to release key specifics of the programme to GPs (to enable them to decide if they can participate), while simultaneously running a press narrative that all GP surgeries are ready to go from 14 December. This is simply not true.
GP practices will once again suffer the brunt of poor planning and execution from the department of health and NHSE. At best, we have an extremely difficult logistical task; at worst a recipe for wastage of this precious vaccine, a loss of public confidence and no doubt a huge amount of blame directed towards general practice.
Many GPs have huge reservations around the feasibility of the programme and may not sign up to deliver the vaccine – mainly because the arrangements for their patients are still unclear.
As doctors on the ground, we can tell you this will result in thousands of patients phoning their practices on Monday morning, potentially blocking the lines for other ill patients. Patients will get frustrated and vent to our already fatigued reception staff, but most worryingly, they may lose confidence in the vaccine itself.
Combine this with directives to halt routine work to prioritise the vaccine, and chaos ensues. GPs know that as soon as routine work stops, urgent, unplanned demand rises – manifesting as unmanageable on-calls for doctors and high A&E attendances. It is not a long-term strategy for delivering this vaccine.
GPs do more than dish out painkillers for arthritic knees. We improve the long-term health of our patients. No one will notice if blood pressures, diabetes and cholesterols are not actively managed for a year or two. However, ignoring them is increasing risk of strokes, heart attacks and possibly cancer. Life expectancy has stalled in our country. If we stop our routine work, deaths will rise from other causes and the nation’s health will suffer.
Now is not the time for a full overhaul of general practice. But what’s making delivering the vaccine harder is the total lack of investment and understanding of what general practice is about. Ask us what we need to make this a success, and then deliver the resources necessary, rather than trying to dictate it centrally.
Given the eye watering sums paid to the private sector to deliver track and trace and the like, I suspect the government will be pleasantly surprised what good value for money primary care can offer.
The decision that those over 80 should be first in line for the vaccine ahead of the staff administering the vaccines defies logic. A third of people are asymptomatic from Covid-19. An estimated one in 100 people have it, meaning there is a reasonable chance some vaccinators will have and pass on the very condition they are vaccinating against. Logic dictates we vaccinate the vaccinators remembering the old adage: first, do no harm.
The justification (references 20-23 in the government press release) used for de-prioritising frontline staff claims that infectivity in care homes is greater than hospital settings, but the references do not formally make such a comparison.
To be clear, the care home epidemic has been devastating in every wave of the illness thus far, especially the first, for which we have the most complete set of data. Both care home residents and staff therefore demand the highest level of protection. However, recommendations to prioritise hospitalised inpatients and vulnerable outpatients, as well as to de-prioritise frontline staff, must be made with these specific groups in mind, rather than by making indirect conclusions using another group’s data.
Trust and honest planned communication is vital for a successful vaccine rollout. Without it, any vaccine programme will fail. We are therefore imploring the government to listen to primary care staff. We can tell you the potential pitfalls and their solutions, we can provide the resources needed to do this locally and, for goodness sake, vaccinate the vaccinators first.
Dr Lizzie Toberty is a GP in the North East of England. She is a member of the GP committee at Dauk.
Dr Duranka Perera is a junior doctor in the East of England. He is the Treasurer for the Doctors’ Association UK