The change in the vaccination programme follows the approval of the Oxford/AstraZeneca vaccine for use in the UK on Wednesday and is in line with updated advice from the Joint Committee on Vaccinations and Immunisations (JCVI).
The new guidance means that second doses of the jabs will now be administered up to 12 weeks after the first, rather than as soon as possible as was previously the case. All four UK countries will be adopting this approach.
In England, under the current enhanced service PCNs are paid £12.58 per dose but would only receive payment after the second dose had been administered. They will also receive an additional £10 per dose delivered in care homes up until the end of January 2021.
However an NHS England primary care bulletin sent on 30 December said that, given appointments for second doses will be delayed to facilitate more people getting a first jab, this would also ‘delay payment to an unreasonable extent’. It said it would change the enhanced service so that networks were paid after each dose.
NHS England has also asked GPs to contact all patients who have already been vaccinated in primary care and rearrange their second vaccine appointment to just before 12 weeks after the first dose. This does not apply to those scheduled to have a second dose between now and 4 January, whose appointments should remain in place.
The bulletin said NHS England understood that moving appointments would ‘be a significant job for general practice at a busy time’ and it was looking at how it could support practices with this task.
Vaccinations for NHS staff
Meanwhile, a letter from NHS England chief executive Sir Simon Stevens to GPs and health service leaders on Wednesday said that local healthcare systems should also now be rolling out the vaccine to healthcare staff, including those in primary care, immediately – either at hospital hubs or PCN sites.
The letter said priority should be given to those ‘at high risk of acquiring infection, at high individual risk of developing serious disease, or at risk of transmitting infection to multiple vulnerable persons or other staff in a healthcare environment’.
Sir Simon’s letter also said that, while the Oxford vaccine would predominantly be delivered through local PCN vaccination sites in the longer term, the first supplies that will be available from 4 January ‘will initially be used in hospital hubs to ensure safety, before being more widely rolled out’.
NHS England said it would write to practices next week setting out how the Oxford vaccine would be made available in primary care.
Sir Simon’s letter said that NHS England expected to be able to vaccinate everyone in the nine priority groups ‘by late spring’, based on current vaccine supply forecasts.
NHS England also indicated that there could be changes to the GP contract to help practices free up time to deliver the vaccination programme. The primary care bulletin said NHS England would be providing ‘further advice about additional measures to ensure GP practices and PCNs are able to prioritise the vaccination programme appropriately, including removing unnecessary contractual burdens’.
On Wednesday the BMA said that GP practices should be given the flexibility to ‘reprioritise other services’ to focus on the vaccination programme.
The JCVI’s updated advice published on 30 December now says that the second dose of the Pfizer vaccine should be provided between three and 12 weeks after the first dose and the Oxford vaccine between four and 12 weeks later.
Sir Simon’s letter said that most recipients should be booked in for the second dose during ‘the last week of that 12 week period’, although clinical discretion can be provided locally if needed. Anyone scheduled to have the vaccination from now onwards should also be given a second dose appointment for the same timeframe.
The shift in the programme means that hundred of thousands of people who have already received the first vaccine dose may not now have their second dose until March.
The JCVI’s updated advice on the vaccines also recommended that pregnant women at risk of exposure to the virus or at high risk of complications, as well as breastfeeding women, should be offered the vaccine.
Surge in cases
The changes to the vaccination programme come as COVID-19 cases continue to surge across the UK. At a Downing Street press briefing on Wednesday, England’s deputy CMO Professor Jonathan Van Tam said that the country was in a ‘very dangerous position’.
Cases of the new variant of COVID-19 are still rising rapidly in London, the south east and east of England and are significantly higher than the older variant. There are also signs that cases of the new variant are beginning to accelerate in other parts of the country, which was behind the government’s decision to put all of England into tier 3 or tier 4 on Wednesday.