Mword Issue 75 - Dr Michelle Drage's latest update for GPs and practice teams

3 December 2020

1. So here is what (we think) we now know.
2. Access to the "General Practice Covid Capacity Expansion Fund".
3. New ICS legislation.
4. Help with Covid-19 plasma donation.

1. So here is what (we think) we know so far.

The Enhanced Service Specification

• As with all Enhanced Services, this NHS Enhanced Service (ES) contract is voluntary. NHSEI has set the time of 23:59 hours on Monday 7 December for you to sign up to the contract, BUT there are still far too many questions to be able to make a truly informed decision on the deliverability of this contract, which appears to include challenging or even penalty clauses. We are therefore currently analysing the ES papers and will share further comments on Monday, in good time before the 23.59 deadline.
• The details of the current ES (which of course may be amended in the light of any emerging developments) are set out in the specification and letter.

Vaccines

• The Pfizer BioNTech vaccine was licensed yesterday by the MHRA.
• The Moderna (7m doses) and Oxford AstraZeneca vaccines (100m doses) are expected to be licensed in the near future, but these vaccines will not become widely available until 2021.
• Plans to deliver the vaccine programme will be determined by the characteristics of the vaccine and its mobility.
• Given that the only vaccine which is ready now for roll-out is the Pfizer BioNTech product, vaccinations will of necessity take place at centres which have the capability to store it in freezers at minus 70 degrees Celsius. (see Eligibility below)
• Unlike the other two products, the Oxford AstraZenica vaccine is likely to be practice-friendly in its distribution and storability since it can be kept in vaccine fridges for up to 6 months, is ‘mobile’ and comes in packs of 80-100 doses.
• General practices should be given 7-10 days’ notice of vaccines we are expected to deliver. The GP vaccination programme is highly unlikely to happen before the year end. Which means Christmas is on for you and your staff. Be joyful.
• Meanwhile, It is unclear whether the delivery programme will be amended to more closely resemble the flu vaccination programme once the AstraZeneca vaccine comes on stream. Ditto the ES.

Eligibility

• Eligible groups for the vaccine will be prioritised according to guidance and advice set out by the Joint Committee on Vaccination and Immunisation.
• The Pfizer BioNTech vaccine has limited mobility which is unlikely to lend itself to roving or local vaccination sites. This will initially be used to vaccinate acute trust staff and health and social care staff on-site at approved trust or mass vaccination sites.
• Primary care and roving delivery models are expected to be mobilised once a more mobile vaccine (such as the Oxford AstraZeneca one) becomes available. This will then allow for more straightforward vaccination of care home residents and staff, people aged 80 and over, and the housebound.

Known unknowns

• We are awaiting/ expecting the following documents:
  • Template indicative vaccine
  • Collaboration agreement
  • Updated reference guide
  • The consent
  • Pre and post vaccination information
  • PGDs for each vaccine
  • Draft temporary staff contracts
  • MOUs for sharing staff
  • Details of the local workforce contacts

We will keep you informed of developments in what I am sure you are aware this is a fast moving and ever-changing arena.

2. Access to the “General Practice Covid Capacity Expansion Fund” – The £150m (nationally).

NHS England has announced an additional £150m non-recurrent funding across England to support seven priorities in the expansion of general practice capacity. These resources are non-recurrent, must be spent by 31 March 2021, and are likely to be the last additional funds that general practice can expect in this financial year (except for arrangements for potential COVID vaccine delivery).

All practices across the capital should receive a share of the nearly £25m allocated to London priorities, and after much work by Londonwide LMCs and your local LMC, NHS England has emphasised the importance of simplicity of administrative processes in order to ensure that the capacity enabled by these resources is deployed swiftly to support general practice. Four of London’s five STP areas have now agreed and communicated the mechanism for practices to access these funds and we are working with the fifth.

3. New ICS legislation.

Last week NHS England launched a consultation on new legislative proposals - intended to place ICSs (Integrated Care Systems) on a statutory footing and advance the longstanding aim of integrating health and care under their Long Term Plan. Yes, it’s still being rolled out, folks. The suggested changes set out in the full document could have significant implications for primary care and therefore general practice, with potentially dramatic changes to CCGs (Clinical Commissioning Groups), funding arrangements, and co-operation between providers. We will be responding as Londonwide LMCs and will share our thoughts to inform any response you may wish to send in as either an individual, or practice team. Please feel free to share your comments and thoughts on the proposals to help inform the development of our response.

And finally,

4. Help with Covid-19 plasma donation.

NHS Blood and Transplant (NHSBT) are responsible for running the national Covid-19 convalescent plasma collection programme and treatment trial, which has six Covid-19 convalescent plasma donor centres in London. They have asked for help in reaching out to GP and practice staff for convalescent plasma donation. The acknowledged higher infection rates amongst GPs and NHS staff has led NHSBT to identify you and your team as key donors, as well as routes to share information on donation with patients.

NHSBT is taking donations at its donor centres and collaborating with the RECOVERY and REMAP-CAP trials – more details here. If you wish to donate, please call 0300 123 23 23 – say you work for the NHS and you will be prioritised. You might also wish to add text and a link to your practice website: “If you’ve had coronavirus or the symptoms, you can donate plasma for a trial which could save the lives of people who are still ill, click here to offer to donate. Further details can be seen here.” There is also an information card which can be used as a leaflet.

We will continue to update our interactive Covid-19 Vaccination Guide and microsite https://www.lmc.org.uk/covid-19 (or just type lmc.org.uk/covid-19 into your browser) as new information is made available, and we will continue to escalate queries from practices at a local and national level. Please get in touch here at mword@lmc.org.uk if there are issues you would like us to raise which are not already covered and remember to use the Beam to LMC app to highlight the pressures you are under.

And our Londonwide LMCs Living Guide continues to provide invaluable information to help you navigate regulatory changes and guidance around the huge range of matters including contractual requirements, workload prioritisation, and practice finance during the current pandemic. I encourage you to continue to use it.

As ever I welcome your feedback at mword@lmc.org.uk, and as always, know that my team of experts and leaders here at Londonwide LMCs are by your side.

Keep well. Stay safe.

With best wishes

Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs