GPs delivering vaccines at their own practices is not widespread, despite NHS England guidance in January permitting this for the AZ vaccine. But many GPs do want to do it as standard.
At last month’s UK LMCs conference, a successful motion from Waltham Forest LMC called on the BMA’s GP Committee to ‘proactively negotiate with NHS/DHSC a direct enhanced service so that if an annual Covid-19 vaccination programme is required it will be contracted with and delivered by individual general practices’.
Meanwhile, Pulse’s latest survey reveals 58% of 260 GPs in England who are not currently vaccinating patients at their own surgeries would like to do so.
Professor Linda Bauld, a public health policy expert and behavioural scientist at the University of Edinburgh, says this benefits patients: ‘It is better for patients to go to a practice they are familiar with, particularly the older and more vulnerable groups.’
During a House of Commons debate in April, health secretary Matt Hancock was asked why this wasn’t possible. Mr Hancock replied: ‘That is the first I have heard of that concern. I will take it away and ensure it is looked at properly.’
The MHRA last week authorised an extension of the storage time for the Pfizer vaccine at fridge temperature, meaning it can now be kept at +2 to -8C for a month – up from five days. NHS England said the ‘additional flexibility’ would make it easier to plan vaccine clinics and pop-up vaccination sites.
Moving Covid-19 vaccination to practice level would also make it easier to deliver flu jabs at the same time – an approach ministers appear keen on.
Of 398 England-based GP partners responding to Pulse’s survey, 80% said they wanted to be able to administer the two jabs together at their own practice.
A Government-funded study looking at the co-administration of flu and Covid vaccines is in its early stages. Experts say it’s not clear if the JCVI will authorise it this year or await more evidence.
Dr David Strain, a consultant in older adults’ medicine and clinical lead for Covid at the Royal Devon and Exeter Hospital, is working with flu vaccine manufacturers on co-administration.
Two companies are currently looking at combining the vaccines in one shot, he says. ‘That would be akin to MMR – one injection, three antigens – you’d produce a response to three different things.’
However, MMR uses the same technologies. None of the current flu vaccines matches up with the way Covid vaccines are built (either using mRNA – as with Pfizer and Moderna – or adenovirus, as with the AZ vaccine).
‘So we are looking at two different technologies. We don’t even know if we’ll be able to use the same adenoviral virus vectors next year as we don’t know if people will become immune to those, which could reduce vaccine effectiveness.’
Theoretically it would be possible to combine different technologies in the same jab, says Dr Strain, as long as they are kept at the correct temperature and don’t interact – which is ‘the biggest risk’.
The other option would be for GPs to give the flu jab in one arm and the Covid jab in the other, which would also help identify which vaccine caused any reactions observed, says Dr English.
But Dr Strain warns it is possible the flu vaccine could cancel out the effects of the Covid vaccine if co-administered.
‘If your immune system suddenly becomes stimulated by the flu and you get the typical fever quickly – would that trigger you to wipe out [AZ’s] chimpanzee adenovirus before it has had a chance to produce the coronavirus protein?’