Urgent update on COVID vaccine arrangements

1 January 2021

I’m taking the unusual step of writing to you on New Year’s Day following NHS England’s instruction to cancel second Pfizer doses from Monday in order to retain stocks to give first doses to a larger number of people.
   
This is not the start to 2021 we would have wanted, especially when GP workloads are already at unbelievable levels and you’re stretched to your limits.
   
I understand how frustrating this is for you and your teams, especially when you were following the original guidance and supporting your patients in making these appointments. I also understand that this is not just going to be a case of cancelling some patients and then rebooking a new cohort for their first jab – and that the task of explaining these changes to vulnerable and elderly patients cannot be underestimated.
    
I want to share more information about the case put forward by the Joint Committee for Vaccination and Immunisation, supported by the four Chief Medical Officers of the UK (940 KB PDF). It clearly sets out the reasons that have swung the decision for the new arrangements. 

This might feel uncomfortable and it will be hard work, but it is the right thing to do for our patients and the health of the wider population.
  
So much of what we do in general practice is in the interests of our patients' long-term health and lives but these are effective interventions with immediate impact.
  
The current infection surge – and its impact on the NHS and patients' lives - makes it imperative to protect as many people as possible, as quickly as possible. People will still need to receive two doses but releasing the ‘reserved for second dose’ vaccine will release, we are told, close to a million more doses, which means we can give more first doses to higher numbers of our vulnerable patients and get healthcare workers vaccinated more quickly.
  
The modelling shows you need to vaccinate 250 people aged over 80 with the first dose in order to save one life. The decision to delay the second dose is particularly important when we can’t guarantee that the Oxford/AstraZeneca vaccine will be available at high volumes straight away.
    
England Deputy Chief Medical Officer Jonathan Van-Tam has also urged a closer look at protection/effectiveness data - the cited efficacy rates of 54% for the first dose of the Pfizer vaccine include infections in the first 9-10 days which would have happened before the vaccine became effective. Remove these from the data and first dose protection for the Pfizer vaccine is around 89-91%, only marginally below that for two doses (though we are told the protection will last for longer with two doses).
 
I hope this provides you with more background on the issues. NHS England’s guidance does allow for some clinical discretion for practices to go ahead with second vaccinations where necessary and, of course, there will be some who decide to do this and their decision must be respected.
 
The next few weeks were always going to be difficult and we now have an additional hurdle to overcome, but I really hope you can persevere because the ambitious COVID vaccination programme will not be successful without general practice playing its part.
 
Whilst it may not feel like it from where we're standing at the moment, we are making progress - as demonstrated by the announcement of the Oxford/AstraZeneca vaccine and the brilliant work by practices over the country in delivering the Pfizer vaccine over the last few weeks.
 
We know we need a larger workforce in order to achieve what is necessary and so the College is also campaigning hard to overcome the unnecessary red tape that thousands of retired GPs are facing in trying to return to the frontline.

I’ve written this opinion piece for today’s Daily Mail. We had no say over the headline but I hope the article itself conveys the important message that at a time when GPs need all the support they can get, it’s ridiculous that the skills and expertise of highly qualified doctors are being under-used or going to waste. 

On behalf of the College, I thank you again for everything you are doing for your patients and for our profession.
    
Very best wishes for the year ahead, the NHS will overcome this virus - thanks in large part to the contribution of general practice and the efforts of hardworking and dedicated GPs.


Post written by

Professor Martin Marshall, Chair of RCGP Council

Professor Martin Marshall is Chair of the Royal College of General Practitioners and a GP in Newham, East London. He is also Professor of Healthcare Improvement at UCL in the Department of Primary Care and Population Health. Previously he was Programme Director for Population Health and Primary Care at UCLPartners (2014-2019), Director of Research & Development at the Health Foundation (2007-2012), Deputy Chief Medical Officer for England and Director General in the Department of Health (2006-2007), Professor of General Practice at the University of Manchester (2000-2006) and a Harkness Fellow in Healthcare Policy. 

He is a Fellow of the Royal College of Physicians of London and of the Faculty of Public Health Medicine and was a non-executive director of the Care Quality Commission until 2012. He has advised governments in Singapore, Egypt, Canada and New Zealand, has over 230 publications in the field of quality improvement and health service redesign and his primary academic interest is in maximising the impact of research on practice. In 2005 he was awarded a CBE in the Queen’s Birthday Honours for Services to Health Care. 

A co-founder and driving force of the Rethinking Medicine movement, Martin has a passionate commitment to the values of the NHS, patient care and ensuring the GP voice is central in a time of great change. When he’s not working, he likes being outside, preferably on a mountain or a coastal path with his wife Sue and their puppy. 

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