COVID-19: 16th March round-up for primary care
Amazing progress has been made in the vaccine rollout, but it is absolutely critical that we continue to vaccinate within the priority cohorts and ensure we don’t move to lower cohorts until we have done everything possible to reach cohorts 1-6; in particular, cohort 6 (people with underlying health conditions).
We know there might be some reticence with these patients, but it is vital that nobody is left behind. We have seen some excellent examples of proactive work to reach these patients, including special clinics for people with learning disabilities and dedicated teams going out to target homeless communities, but we need to do more, particularly for patients with severe mental illness. It is important to note that there is currently no contract in place for vaccinating below cohort 9 so you must not do so.
The success of our flu vaccination programme
Our flu vaccination programme has been an incredible success. General practice and community pharmacy teams have given the flu vaccine to over 19 million people – that’s over 4 million more than last year. We want to say a huge thank you for all your hard work in keeping people in your communities safe – you really are going above and beyond.
Shielding update
The Government is expected to give more detail later this week on advice to clinically extremely vulnerable patients after 1 April – the current advice to shield runs until 31 March. The Government’s COVID response ‘roadmap’ has previously indicated it anticipates that it will no longer be necessary to advise shielding beyond the end of March. We will keep you informed of announcements and implications via this bulletin.
AstraZeneca COVID-19 vaccine and blood clots: review of safety data
In a review of all available safety data from over 17 million people vaccinated with AstraZeneca vaccine in UK and EU, there was no evidence of an increased risk of blood clots among people vaccinated with its vaccine.
The MHRA have also released a statement advising that people should still go and get their COVID-19 vaccine when asked to do so, and EMA have also stated that there is no indication that the reported blood clots were caused by the AZ vaccine.
COVID-19 Clinical Risk Assessments
You will already be aware of the online tool that can help clinicians better understand how at-risk a person may be of catching coronavirus and being admitted to hospital or catching coronavirus and dying. The COVID-19 Clinical Risk Assessment Tool is powered by QCovid®, a coronavirus risk prediction model created by the University of Oxford.
Clinicians can use the tool to risk assess individual patients or review those assessed as part of the COVID-19 Population Risk Assessment. Details of patients who were risk assessed, but who did not meet the agreed threshold for addition to the Shielded Patient List, are available here.
There are instructions for individuals and practices to follow before using the tool, including the requirement for a Data Protection Impact Assessment (DPIA) and privacy notice in place that covers the tool’s use. A template DPIA and privacy notice have been provided to support you to do this.
Reminder to place an order of lateral flow devices
All primary care contractors are reminded that they should place their order for lateral flow devices (LFDs) on the PCSE online portal by Sunday 21 March to receive a delivery as soon as possible in the following weeks. This order is to re-supply primary care staff with a new box of 25 tests, which will enable them to test for another 12 weeks. More information on how to order tests can be found on the PCSE website.
JCVI advises prioritising homeless people and rough sleepers for COVID-19 vaccine
New advice has been issued from JCVI to prioritise homeless people and rough sleepers for the COVID-19 vaccine. Many people who are homeless or sleeping rough are likely to have underlying health conditions which would place them in priority group 6.
The JCVI advises that local teams consider a universal offer to adults experiencing homelessness and rough sleeping alongside those in priority group 6. We have issued mobilisation guidance which will provide local vaccination services more detail on how this should be implemented.
Advice for women following COVID-19 vaccination
A recent BMJ article reported that advice in the US is that breast screening appointments should be scheduled to take place before women receive a first dose of COVID-19 vaccine or four to six weeks after the second dose where possible.
Public Health England (PHE) advise that breast screening service personnel should be aware of the potential for enlarged nodes following a COVID-19 vaccination. However, the advice regarding the scheduling of mammograms has not altered. There is currently no requirement for women to be advised to wait for a period of time following a COVID-19 vaccination before attending a screening appointment.
Women with noted lymphadenopathy at screening must always be recalled for assessment even if they report recent vaccination. This is to ensure that no other pathology exists. It may be useful for clinicians at an assessment appointment to determine the date of a COVID-19 vaccination and the arm in which this was given, where enlarged lymph nodes are being investigated. PHE will continue to monitor the evidence in this emerging area and take advice from relevant experts. Updates will be issued as necessary.
National provision Steward Volunteers for PCNs, GP practices and community pharmacies
All vaccination providers in England can now directly book NHS Volunteer Responders (NHSVR) Steward Volunteers from the national pool (except the North East and Yorkshire region, which books through Lead Employers). The programme is delivered for the NHS by Royal Voluntary Service (RVS) and the GoodSAM app.
We recommend using NHSVR Steward Volunteers because they are rapidly available and easy to book online, paid expenses and supported by RVS, ID-checked, trained and have NHS high-vis clothing, and are fully insured when booked through the GoodSAM app.
View the step-by-step guide to requesting Steward Volunteers, which includes a link to the GoodSAM portal.
COVID-19 Local Vaccination Services waste management
It is vitally important that vaccination sites segregate all waste into the proper waste stream. Doing so reduces pressures on the waste services infrastructure, reduces the impact on the environment, significantly reduces costs, and ensures compliance with relevant waste regulations. All waste should be disposed of into the allocated consumables and stored securely on site or transferred to another site as required (e.g. roving vaccinators) following each vaccination session. The principles of the COVID-19 waste management SOP should be followed.
GPHC confirms Summer and Autumn 2021 pharmacist registration assessment dates
The General Pharmaceutical Council (GPhC) has announced dates for the Summer and Autumn 2021 registration assessments. The Summer assessment sittings will take place on 27, 28 and 29 July 2021 and the Autumn assessment sitting will take place on 16 November 2021. Assessments will be delivered through Pearson VUE, mainly at test centres in Great Britain.
The provisional registration of pharmacists will be extended to January 2022, to enable trainees from the 2020/21 cohort to apply to join the provisional register once their training is satisfactorily completed, so that they can take up offers of employment at the same time as they usually would, from 1 August 2021.
Dates for your diary:
Thursday 18 March, 8pm – 9pm. The role of the PCN/GP practice pharmacist in implementing the GP referral pathway to the Community Pharmacist Consultation Service (CPCS)
COVID-19: 18th March round-up for primary care
COVID-19 vaccination deployment next steps on uptake and supply
We have written to all Local Vaccination Sites and Vaccinations Centres to update you on the latest position on vaccine supply and deployment over the next six weeks. The Government's Vaccines Task Force have notified us that there will be a significant reduction in weekly supply available from manufacturers beginning in the week commencing 29 March, meaning volumes for first doses will be significantly constrained. They now currently predict this will continue for a four-week period, as a result of reductions in national inbound vaccines supply.
We have opened up national booking to everyone aged 50 and over, so over this next period it is vital we focus on vaccinating those in cohorts 1 – 9, who are most vulnerable to COVID-19, as well as delivering to the agreed schedule significantly increased numbers of second doses, which double from the beginning of April.
Our vaccination delivery programme was designed to be flexible, scaled up and diversified in line with fluctuating international vaccine supplies. Thank you for your continued efforts, and, as ever, we are hugely grateful for everything that you are doing to make the NHS's part in the delivery of this programme the success that it is.
Next steps for the Clinically Extremely Vulnerable
As you are aware, the current advice to patients identified as clinically extremally vulnerable (CEV) is to shield until 31 March 2021. As this date approaches, the Department of Health and Social Care is writing to patients to inform them of next steps once current guidance expires.
The letter confirms that shielding will be paused from 1 April. It should be noted that the letter recommends that extra precautions are still taken by individuals, even after they receive both doses of the COVID-19 vaccine.
Nationally we will continue to update the Shielded Patient List, so it is important that you continue to add and remove patients (as appropriate), as it may be necessary to identify this cohort in the future. Details on how to add and remove people from the SPL are available in full on NHS Digital’s website.
We will continue to keep you informed, should anything change in relation to the policy for the clinically extremely vulnerable, to enable you to make appropriate arrangements from a patient perspective.
Thanks once again for all your continued efforts to protect and support individuals who are at high risk during this pandemic.
Vaccinating housebound patients
Local vaccination sites should consider how they can reach people who are housebound or who will require significant support to access services. Recognising the circumstances that contribute to people being unable to leave their homes encompasses a range of factors which could include illness, frailty, surgery, mental ill health, lack of practical support or nearing end of life.
During the past and the most recent lockdown people may have experienced social and health-related changes, others will have lost the support they may previously have relied on. There may therefore be additional individuals who are housebound or unable to access services without significant support since last March who may not be appropriately marked as such in GP registers.
We would urge you to consider how these people can be reached and offered a vaccination to ensure that no individuals are left behind as we move into other cohorts. This should include both in-home services where appropriate as well as steps to connect people to local support services.
Home delivery of medicines and appliances during the COVID-19 outbreak
We have written a letter to community pharmacies and dispensing GP practices to confirm that the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service will be commissioned from 16 March 2021 to 30 June 2021 (inclusive) for anyone living in England who has been notified by Test and Trace to self-isolate. The service specifications and guidance for the service has also been updated accordingly.
