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Vaccination service redesign – is the NHS ready?

DDA think-piece responds to NHS England market engagement process

July 29th 2022

Tagged: DDA news political news England

By Dr Richard West, DDA chairman

In a recent communication, NHS England has invited expressions of interest to participate in a market engagement process to support the future design of Covid vaccination and other immunisation/vaccination deployment.

The DDA believes this could have a detrimental effect on the healthcare of the population, and on the sustainability of general practice.

General practice has been one of the core components of the NHS since its inception. It is based upon a list system, so that every patient in England has their own general practitioner. The general practitioner then takes a holistic view of that patient and responsibility for their health.

Vaccinations are a cornerstone of this service. Vaccinations are usually among the first reasons why a child visits a GP. They were applauded during Covid as a turning point.  In rural areas, it was general practice that provided the majority of Covid vaccinations. Examination of vaccination uptake shows that in Suffolk, there was a correlation between distance from home to vaccination centre and vaccine uptake. Uptake was also better where patients attended their own general practice, rather than mass vaccination centres or pharmacies.

This data suggests that mass vaccination campaigns may work in large open settings, but face distinct challenges in remote, rural, coastal and island settings.

The care opportunity
Vaccine appointments in general practice are an opportunity for general health improvement: the safeguarding opportunity of the child vaccination appointment; the reminder about an overdue chronic disease check. Practices have used vaccination campaigns to do health screening for atrial fibrillation, for example, and for routine vaccination catch-up.

For a minority of patients, vaccination requires the expertise of a skilled general practitioner to properly explain the benefits and risks. In these situations, access to a senior practitioner is key to delivering a service which meets the needs of all patients.

GP funding
The funding of general practice is a highly complex and based on a ‘basket’ of remunerated and non-remunerated activities. Vaccination services make an important contribution to overall GP remuneration, supporting employment of the wider health team. Remove this income, and some practices may struggle to survive in their current form.

The Dispensing Doctors’ Association believes that redesigning the NHS vaccination programme will lead to lower vaccination rates in rural areas. Due to the complexity and cost of providing a vaccination service in rural areas, it is questionable how attractive the service will be to a profit-making organisation.

The DDA believes that patients should not be penalised by changes to the NHS vaccination service and, at the very least, there should be a full public consultation to understand the ramifications.