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GP teams should make ‘at least’ four Covid vaccine visits to care homes



GP teams should deliver Covid-19 vaccinations in care homes across a ‘minimum’ of four visits, NHS England has said.

New guidance also clarified that written consent is not required for each patient.

It comes as the patient group direction under which GPs will deliver Covid vaccinations has today been published – ahead of rollout this week.

In new standard operating procedures for practices signed up to deliver the programme, NHS England said that a ‘minimum four visit schedule is recommended’ to vaccinate care home residents and staff.

This is ‘subject to the vaccine being approved for deployment in care homes’, it added.

The guidance said: ‘As a principle, providers should seek to minimise the number of unnecessary visits to care homes to mitigate potential risk to residents. A minimum four visit schedule is recommended.’

The first would be to deliver the first dose to ‘all or most’ residents and staff on site, with a second one week later to vaccinate those unavailable on the first day, it added.

The third visit would be to deliver a second dose to the first cohort, scheduled according to the time period specified by the vaccine manufacturer, and the final visit would ‘capture outstanding doses one week later’.

The guidance added: ‘A regular follow up visit until mass population coverage has been achieved may be required, PCN’s should agree an ongoing rolling process with care homes.’

PCNs should consider a mobile or ‘roving’ vaccination team to deliver the service to care homes as well as ‘what assistance other providers such as community/district nursing teams could’ provide to vaccinate the cohort, it said.

However, providers are ‘responsible’ for ensuring any staff are ‘appropriately trained and the appropriate documentation is place for indemnity purposes’, such as honorary contracts or staff sharing arrangements, it added.

And PCNs and roving vaccination teams should ‘consider’ Covid testing before visiting care homes to ‘mitigate the risk of vaccinators testing positive on arrival’, NHS England said.

It added: ‘[This] could have implications for the whole vaccination team leading to disruption of the planned session and potential vaccine waste’.

The guidance also said that for care home vaccinations:

  • PCN clinical leads should be ‘available for advice’ but the registered GP practice ‘would normally be the first contact for advice around adverse reaction
  • PCNs should ‘encourage’ care homes to ‘maximise’ staff and resident flu jabs ahead of Covid vaccination to ensure seven days between flu and Covid jabs
  • PCNs should encourage care homes to begin ‘informal conversations’ regarding consent, including with relatives, ahead of formal consent when vaccine type is confirmed
  • Care homes should seek informed consent four to five days before the vaccination team attend. 

Meanwhile, the document also confirmed that there is no need for written consent from patients in any setting.

It said: ‘Chapter 2 of the Green Book states consent must be obtained before administration of all vaccines. The guidance in this chapter is based both on the current legal position and the standards expected of health professionals by their regulatory bodies. 

‘There is no legal requirement for consent to immunisation to be in writing and a signature on a consent form is not conclusive proof that consent has been given, but serves to record the decision and the discussions that have taken place with the patient or the person giving consent on a child’s behalf.’

However, it added that informed consent should be recorded on the online Pinnacle system and the patient should be provided with written information about the vaccine.

GPs were last weekend given the green light to start delivering Covid vaccinations in the week commencing 14 December.

However, NHS England last week said that the rollout of the Pfizer vaccine would not begin in care homes, despite residents and staff being the JCVI’s first priority group.

It followed the Welsh Government announcing that they are not yet able to vaccinate care homes, while care home residents in Scotland will be vaccinated against Covid from 14 December.