The BMA said rearranging appointments for tens of thousands of patients would cause ‘huge logistical problems’ for practices. It said existing appointments should be honoured and that it would support GPs if they decided to vaccinate those patients who were due to have a second jab next month.
The decision to delay appointments to 12 weeks after the first jab follows updated advice from the Joint Committee on Vaccinations and Immunisations (JCVI) that as many people as possible in at-risk groups should receive the first dose of the vaccine. As cases continue to surge across the country it is hoped that vaccinating greater numbers with one dose of either the Pfizer or Oxford/AstraZeneca jab will provide more people with short term protection against the virus.
The DHSC said on Wednesday that the decision would also extend to cover anyone with an appointment for a follow-up jab after 4 January. A letter from NHS England chief executive Sir Simon Stevens yesterday advised that appointments should be shifted to the week before the 12-week deadline ‘in most instances’, however it said that clinical discretion could be applied if needed.
Meanwhile, Pfizer released a statement on Wednesday saying that its vaccine was not intended to be taken 12 weeks apart. It said the vaccine’s safety and efficacy had not been evaluated on any dosing schedule other than 21 days between jabs. It added that ‘there are no data to demonstrate that protection after the first dose is sustained after 21 days’.
A number of GPs on Twitter said that ‘at least’ appointments for next week should remain in place, with many saying it would be impossible to rearrange so many vaccinations at such short notice.
I think clinical discretion here is that this is logistically impossible.. Can’t cancel and rebook all these patients in the next 2 days. Makes sense to move to 12 week spacing thereafter though to offer more people some protection as soon as we can. https://t.co/JGxRfBK5Aw
— Rammya Mathew (@RammyaMathew) December 30, 2020
Oxford GP Dr Helen Salisbury invited health secretary Matt Hancock to come and help her practice with the task of rearranging appointments. She said her PCN would need to cancel and rebook 1,160 jabs, which would be around 193 hours work.
Can I ask @MattHancock to come & do a shift on our phones, ringing our 80+ pts to explain that their 2nd dose of vaccine has been cancelled?
Our PCN needs to cancel 1160 appts & rebook another 1160. At 5 mins per phone call, that’s 193 hours work. Not to mention the grief & anger
— Dr Helen Salisbury (@HelenRSalisbury) December 30, 2020
Professor Steve Cox, chair of the RCGP’s Mersey Faculty and a GP in St Helen’s, Merseyside, said on Twitter that his practice would not be rearranging second immunisations for over-90s because the ‘carer logistics were too great’.
One GP-led vaccination site in Kent said that it had secured agreement with its CCG to continue second vaccinations as planned next week.
Continue vaccines as planned for next week.
Agreed by CCG ????@teamgp
Common sense prevails@Kent_LMC @NHSEngland @DrSimonHodes @NHSKMCCG thank you! It wasn’t feasible to change at this late stage
— Yvette Doc ?? #WearAMask (@yvettedoc50) December 31, 2020
The BMA said that scores of GPs had contacted it to say the decision to delay second doses for those already vaccinated would have a ‘detrimental impact’ on the wellbeing of their most vulnerable patients.
GPs on Twitter also raised concerns about the medico-legal implications of waiting for 12 weeks to administer the second dose, particularly given that patients had already consented to the second dose three weeks after the first and in light of Pfizer’s statement about how its vaccine should be used.
BMA GP committee chair Dr Richard Vautrey said: ‘It is grossly and patently unfair to tens of thousands of our most at-risk patients to now try to reschedule their appointments. Local leaders are telling us that is unprofessional and impractical to amend the appointments for thousands of frail elderly patients, particularly those booked and who have already made arrangements to have their second vaccination in the next two weeks.
‘The decision to ask GPs, at such short notice, to rebook patients for three months hence, will also cause huge logistical problems for almost all vaccination sites and practices. For example, to make contact with even just two thousand elderly or vulnerable patients will take a team of five staff at a practice about a week, and that’s simply untenable.
‘The government must see that it’s only right that existing bookings for the oldest and most vulnerable members of our society are honoured, and it must also as soon as possible publish a scientifically-validated justification for its new approach.’
On Wednesday NHS England confirmed that PCNs would now be paid after each dose of the vaccine is delivered, rather than after both have been administered, because the change to a 12-week gap between doses would ‘delay payment to an unreasonable extent’.