COVID-19 vaccination programme
This week, as lockdown restrictions are beginning to ease in varying ways across the UK, those aged 45 and over in England are now eligible to book an appointment via the NHS national booking service to receive the COVID-19 vaccination. Practice groups can now invite these patients for their first vaccination if they have sufficient supplies alongside continuing with second vaccinations to those patients who are due to receive it.
This follows a statement published by the Joint Committee on Vaccination and Immunisation (JCVI) on phase 2 of the COVID-19 vaccination programme, which recommends that the most effective way to minimise hospitalisations and deaths is to continue to prioritise people by age.
GPC England and NHSE/I have agreed an extension to the existing enhanced service specification for practice sites to administer vaccinations to patients between the age of 18 and 50. The service specification arrangements for this second phase of the programme will mirror the arrangements for the first phase, and sites will still get the £12.58 item of service fee for each vaccine administered. Read more about the next phase of the vaccination programme here.
JCVI have also advised that individuals aged 18 to 49 years, in particular males in certain black, Asian or ethnic minority (BAME) communities, those with a BMI of 30 or more (obese/morbidly obese), and those experiencing socio-economic deprivation, should take up the offer of vaccination, as data has indicated that there is an increased risk of hospitalisation for this group.
In addition, the Moderna vaccine has begun to be delivered across more than 20 vaccination sites in England, following use in Scotland and Wales, for those aged 18-29 who are eligible, providing another alternative to the AstraZeneca vaccine in line with updated MHRA guidance last week.
Vaccinating during Ramadan
NHSE/I has published guidance on supporting COVID-19 vaccine uptake during the Islamic month of Ramadanwhich began on Monday 12 April 2021. The guidance aims to help vaccination sites build confidence, reduce barriers to access and support the uptake of the COVID-19 vaccine amongst Muslim communities during the month of Ramadan.
Read more about the latest changes, including the arrangements for the second phase of the vaccination programme and what practices need to do, in our updated guidance page about the COVID-19 vaccination programme.
Nearly 41 million COVID-19 vaccinations have now been delivered in the UK, and the latest data report shows that as of 15 April over 34 million doses have been given in England.
PRINCIPLE trial on COVID treatment
Inhaled budesonide is not currently being recommended as standard of care but can be considered (off-label) on a case-by-case basis for symptomatic COVID-19 positive patients, aged 65 and over OR those aged 50 or over with co-morbidities, in line with the published Interim Position Statement. This Interim Position Statement clarifies that this includes co-morbidities that are 'consistent with a long-term health condition from the flu list’.
What is the background to this new Therapeutic Alert?
The PRINCIPLE trial reported a 3-day median benefit in self-reported recovery for patients with COVID-19 in the community setting who received inhaled budesonide. The impact on hospitalisation rates or mortality has not been established, but the evaluation is ongoing, so recommendations may change as more data become available. The current Therapeutic Alert is based on a decision by the Chief Medical Officer after consideration of the evidence.
What does this mean in practical terms?
There is no expectation that inhaled budesonide will be routinely prescribed for patients in the eligible cohorts with COVID-19. Advice to patients on the management of COVID-19 has not changed. However, as stated in the Therapeutic alert, prescribers may consider prescribing it to reduce symptoms in eligible cohorts who are being managed in the community. This would be on a case-by-case basis using a shared decision making approach.
Where a decision is made to prescribe, prescribers are asked to ensure that the patient understands how to use the inhaler properly. As patients will be self isolating, this may be via video link (see below).
Patients will need to ask a friend or relative to collect the inhaler. If this is not possible, they can access the NHS Volunteer Responders service. They will also be eligible for free delivery if other routes are not possible.
For pharmacists and dispensing doctors
Additional supplies of the Pulmicort 400 Turbohaler (AstraZeneca UK Ltd) are now available to be ordered as needed through business as usual routes from wholesalers.
Information for patients
Information for patients can be found here, including a link to videos explaining correct inhaler technique from Asthma UK.
Flu vaccination programme 21/22
We have now received confirmation from NHSEI that there will not be central procurement of flu vaccine for the coming year’s scheme, but the at-risk group will be extended as it was this year. Practices should therefore, where this is possible due to the late notice, take this into account when placing orders. The annual flu reimbursement letter was updated on 1 April. A copy of the latest version can be found here. The letter confirmed that those aged 50-64 year old will be included in the 21/22 flu programme and also confirmed the inclusion of a QIVr vaccine (Supemtek).
GP Career Support Hub
The GP Career Support Hub is a central information point with resources to support GPs at all stages of their career - from newly qualified doctors to those approaching the end of their career. It provides information, guidance and support on career development, learning, mentoring, appraisals, career options/flexibility, wellbeing, pay and pensions to enable GPs to realise fulfilling, rewarding and exciting careers in general practice.
Call for swift action to remove GMC’s power to appeal tribunal decisions
Thirteen leading healthcare organisations, including the BMA and five royal colleges, are calling on the UK government to act to remove the General Medical Council’s power to appeal against decisions by medical practitioners’ tribunals. The government agreed in 2018 that the power, which duplicates similar powers held by the Professional Standards Authority (PSA), should be scrapped. Its abolition is included in draft legislation to reform the way healthcare professionals are regulated, on which the government is consulting. The healthcare bodies have told Matt Hancock, health and social care secretary for England, that the move is urgent and should be made now, by including it in the forthcoming health and social care bill.
Weekly COVID-19 data update
The BMA’s Health Policy team has started producing a weekly summary of key data on various aspects of the pandemic. The data is from external published sources (with links to the relevant data/study) and can be shared. The latest summary is attached.
National e-Referral Service (e-RS) advice and guidance webinar (England)
To support mobilisation of advice and guidance (A&G) services as per the 2021/22 operational planning guidance, the NHSE/I is hosting a webinar for clinicians and system leaders about the National e-Referral Service on Tuesday 20th April 2021, 4.00pm-5.30pm.
The session will include an overview from NHS Digital on recent improvements that have been made to the NHS e-Referral Service A&G function, and will also share experience and learnings from clinicians working in primary and secondary care who have successfully implemented an A&G service, focusing on Cardiology, Gastroenterology and Urology.
If you would like to attend, please register here.
If you have any feedback with regard to the e-RS, generally speaking or regarding the A&G function specifically, please let the BMA Workforce and Innovation Team know via firstname.lastname@example.org.
Elected BMA representatives from both primary and secondary sit on the monthly e-RS Optimisation & Improvement Clinical Council. We can therefore feed examples of both good and bad practice into this group and seek resolutions to both local and national issues and concerns.
GPC UK regional elections
The deadline for voting for seats to the General Practitioners Committee (GPC) UK in the Durham and Cleveland region is 12pm, Monday 19 April. To submit your vote please visit https://elections.bma.org.uk/
If you live or work in the Durham and Cleveland region and do not have access to the voting, please contact email@example.com and the team will be able to assist.
If you do not have a BMA web account?
To vote in this election you must have a BMA web account, if you do not have one please click here to create one. Please follow the link to ‘request a temporary non-member account’ and email your temporary membership number to firstname.lastname@example.org to get access to vote in this election.
If you have any queries regarding the election process, please contact email@example.com.
I was interviewed on Sky News on Monday 12 April (13.30pm) speaking about the latest on the delivery of covid vaccinations ahead of the over-45's being invited for their jab this week. When asked about the level of take up, I said: "Practices are continuing to work really hard to deliver the vaccination programme and the vast majority of people are coming forward. At the moment we are focusing primarily on the second doses. There is always potential that some people may not come to an appointment and there are more patients asking for information about side effects which they are happy to help with. We want to ensure patients understand that this is still a very effective and safe vaccine and it’s in their best interest to be protected from this deadly virus."
GP workload pressures
The headline story yesterday on BBC Look North (Yorkshire) was the workload pressure experienced by GP practices. I was interviewed for the lunchtime news and evening bulletin and highlighted the rise in workload as a result of dealing with significant pressures with insufficient workforce. I appeared on BBC Leeds at 7.05am and 8.05am on Thursday, and again at 5.15pm to discuss the current pressures facing general practice and the need for more long-term investment.
Easing of lockdown restrictions in England
Brian McGregor, GPC England member and chair of the BMA Yorkshire Regional Council, was interviewed on BBC Radio Humberside (from 2hrs 10mins on the easing of lockdown restrictions. Urging people to act with caution, Dr McGregor said: "It's important still just to remember there is still some infectious disease out there, all be it in smaller numbers, and to behave as if you are still trying to prevent the transmission of that disease."
Easing lockdown restrictions in Northern Ireland
Tom Black, Chair of NI Council, has released a statement ahead of the NI Executive’s announcement about exiting lockdown, expected later today, where he said: “We have seen that the rest of the UK has lifted restrictions, so today’s news will be very welcome to the Northern Ireland population. Unlike the rest of the UK we share a border with the Republic of Ireland and, as infection rates in the Derry and Strabane border area is currently showing us, greater coordination on public health measures is needed between the two jurisdictions to help minimise further outbreaks. He was interviewed on BBC Radio Foyle Breakfast (1:17:28) on exiting lockdown and the rising Covid-19 case numbers in the Derry and Strabane District Council area. NIGPC chair Alan Stout was interviewed on U105 news bulletins yesterday about the Executive’s approach to easing lockdown.
NHS pressures data
In response to NHS data on waiting lists in England, David Wrigley, BMA council deputy chair, said: “Today’s statistics are a stark reminder that, despite falling Covid-19 infection rates and the progress of the vaccination campaign, the health service remains in an incredibly precarious state.” Read the full BMA statement here. I was also interviewed on LBC radio about this last night where I said: "These figures have devastating consequences for people who are waiting for hospital procedures and they have a knock-on effect on community services because they need continued care from GP and nursing teams while they wait."
Read the latest GP bulletin here.
Read the latest Sessional GPs newsletter here.