GPC England guidance to seasonal vaccination programmes
Email sent to members on 11th August 2023.
Please see statement from GPC Chair, Dr Katie Bramall-Stainer on GPC England guidance to seasonal vaccination programmes.
I wanted to write to you urgently about rumours and confusion circulating with regard to the start dates of our Autumn/Winter 23/24 vaccination programmes. You will all have placed and paid for your vaccine orders; booked ‘Flu clinics across many weekends and started to book many thousands of your most vulnerable patients into those clinics already, in line with the Winter Plan published by NHSE on 27 July.
Let us look at the facts:
Last Friday, NHS England published its enhanced service specifications for the vaccination programmes:
- the COVID programme commences on 1 September and concludes on 29 February 2024
- the Influenza programme commences on 1 September and concludes on 31 March 2024.
Clarification over influenza programme start date
Section 3.1 of the Enhanced Service Specification states:
This enhanced service is for the Commissioner (NHSE) to commission the provision of seasonal influenza vaccinations to Patients. This ES begins on 1 September 2023 and shall continue until 31 March 2024 unless it is terminated in accordance with paragraph 3.2.
In line with the above, practices should proceed with any Flu clinics they have already arranged and proceed with contacting eligible patients to fill those scheduled Flu clinics, in anticipation of the delivery of the influenza vaccines next month.
The wording of the Enhanced Service is clear: the period of eligibility for claims commences from 1 September. Once our vaccine orders have arrived and are in our fridges, we need to enact our comprehensive plans to get them into the arms of our registered lists ahead of this winter, to help protect the vulnerable and wider population.
Whilst Section 3.4 states:
This enhanced service may be updated from time to time as the vaccination programme develops and is subject to Ministerial Decision.
The contract stipulates 1 September, and that has not changed, nor have DHSC or NHS England formally communicated with us or the profession that a change is anticipated. Any suggestion of a postponement at such short notice will cause widespread confusion, and delays to patients getting much needed vaccines. I am also writing to Maria Caulfield MP, minister for vaccinations and immunisations to emphasise our concerns today.
COVID-19 vaccination tariff cut
In the letter to the Minister, I also signal my deep concern at the Government’s decision to cut the resource for the COVID vaccination programme by over 25% this winter, even as a new highly infectious COVID-19 variant emerges. On Tuesday, the UK Health Security Agency published its press release from the JCVI regarding persons who will be eligible for a COVID-19 booster vaccine in autumn 2023.
JCVI’s modelling and evidence is based on the routine immunisation tariff of £10.06 per patient. The decision to reduce the tariff of the COVID-19 vaccination programme to £7.54, over 25%, leads the BMA to advise upon its own assessment that this regrettably makes the delivery of the COVID vaccination programme financially unviable for practices and PCNs. We therefore strongly urge you to consider the viability of participation in the COVID-19 vaccination programme.
Cutting the resource to the COVID-19 vaccination programme threatens the safety of vulnerable patients and undervalues general practice and the communities we serve. We know little of the novel strain Eris (BA 2.75) variant - but we do know that it is remarkably infectious compared with Omicron. Such short-sighted action by the Government will ultimately lead to practices and PCNs deciding that they cannot participate in the programme as presently commissioned.
We are aware of systems in the country where PCNs have already advised local commissioners that they will not be embarking on the COVID-19 vaccination programme, and will instead be consolidating their efforts on delivering the influenza programme and meeting patient need. In those systems, local commissioners have put in place alternative arrangements. We regret that this may not be as successful a campaign as we saw in recent years as delivered by general practice within their communities, to the patients they know best, and who in turn trust them too - but this is ultimately in the gift of the Government to change.
Co-administration of vaccines 'By Default'
Where the JCVI advises co-administration of both vaccines by default, if a practice/PCN is only signed up to deliver the Influenza programme - which it must do by 23:59 31 August - then a single administration becomes the default for that practice.
Satisfying the terms of the enhanced service
Unless the Government determine to vary the published service specification as per section 3.4, section 11.2.1 (b) is satisfied - so long as the patient is in a targeted group to receive the vaccine as per JCVI recommendations, and the vaccine is administered between 1 September and 31 March 2024.
11.2.1. The Patient who received the vaccination(s) was a Patient at the time the vaccine was administered, and all of the following apply:
(b) the Patient in respect of whom payment is being claimed was within an announced and authorised cohort at the time the vaccine was administered, unless exceptional circumstances apply as set out at paragraph 9.7 and the vaccination was administered after the announced and authorised date for the vaccinations to take place
Letter to the Vaccines Minister
I am writing to Maria Caulfield MP to urgently consider the issues above. We are acutely aware of the increased overheads and costs impacting on GPs and practices, of the record NHS waiting lists driving demand across general practice in England, where we collectively see over a million patients every single day, and where just under half of those appointments are delivered on a same-day urgent-care basis.
Hospitals cannot afford a rise in acute admissions, and England as a society cannot afford to ignore the lessons of recent history. I am offering to urgently meet the minister to explore these concerns further, and work together to develop an effective winter immunisation plan to protect our patients.
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