Helen Salisbury: Managing vaccine expectations

A drug company’s press release about the success of its covid-19 vaccine has led to a welcome feeling of optimism, as we face the grim statistics of rising cases in the UK and the highest death toll in Europe.12 The news was followed swiftly by a new part of the GP contract, which practices would have to sign up to before offering the vaccine to patients. We’re meant to be ready by December, although most of us doubt that the vaccine will be in our hands so soon.

Many GPs feel sidelined in the pandemic response, believing that work we should have coordinated in primary care was instead outsourced to multinational contractors who did a poor job at a very high price.34 While we’ve been looking after patients in the community, and caring for people with long covid, we could have done more given the right resources. GP surgeries could have been local testing hubs, and we could have worked with public health teams on testing and tracing.

Now, at last, we have a chance to contribute. Each year we run flu vaccination campaigns, so this is familiar territory. Our admin teams are confident that they can scale up the process to provide this new vaccine, despite having to offer two doses per patient.

There has been some unnecessary anguish, as the initial contract specifications showed all the signs of being rushed out with inadequate consultation. In particular, a stipulation that all patients should be observed for 15 minutes post-vaccination, sitting two metres apart, set us scurrying around with tape measures and calculators, and some practices just didn’t have the space to offer this service. Two days later this precaution was dropped: the only current restriction is on driving immediately after vaccination.

The frontrunner vaccine needs to be stored at –80°C and then lasts only five days in the fridge. It’s possible that other, more stable vaccines will be available before the programme begins, but for now we’ve been asked to commit to opening from 8 am to 8 pm, seven days a week, and to delivering a minimum of 975 vaccines a week. In our building we think that we can deliver the vaccine with a few extra staff, while continuing to offer a normal service to our patients, but we’d struggle to open for 84 hours a week. And the price tag attached may not cover the costs incurred.5

We are a city practice and hope to host the service for our primary care network, but some rural networks cover large geographical areas, and a single site would mean a lot of travel for patients, possibly reducing uptake. One of the attractions of general practice is having the autonomy to find sensible solutions for the patients you serve, and we still hope for more flexibility in the permitted arrangements. An unnecessarily prescriptive contract may prevent GPs from signing up—but, if we’re informed of the technical constraints (vials per delivery, doses per vial, shelf life at fridge temperature) and are allowed to develop our own plans, I’m confident that we can deliver this vaccine.