GPNs have told Nursing in Practice they were not asked their views on the DES contract for general practice to deliver the Covid-19 vaccine, despite its likely impact on their workload.
The direct enhanced service (DES) – an opt-in, nationally negotiated service over and above those provided under usual contracts – said general practices will have to administer the Covid vaccine to care home residents and staff, and housebound patients through home visits.
It was agreed by the British Medical Association (BMA) General Practitioners Committee in England with NHS England and NHS Improvement, and published yesterday evening. But prominent nurses have told Nursing in Practice and said on Twitter neither the BMA nor NHS England consulted with them.
The RCN has told Nursing in Practice that it has was not involved in the DES, but has contributed to planning and development of the vaccine implementation and legislation as part of other consultations.
Nurses have since raised concerns particularly because the DES is likely impact on their already heavy workloads. Nurses are largely responsible for administering vaccines and this is a busy winter, with the Government requiring the largest ever flu jab programme because of Covid-19.
Professor Alison Leary, chair of healthcare and workforce modelling at London South Bank University, said that NHS England ‘would have been wise to consult GPNs around the logistics of this roll out’ and that it is ‘concerning they did not’.
Vicki Abrahams, a practice nurse based in Manchester, raised concerns that she and her colleagues ‘have no more staff’ to deliver the vaccinations, adding that services may have to ‘stop to deliver this’.
She continued: ‘The fact remains that whilst GPs are busy with telephone consultations and a small amount of face-to -face, the nursing teams remain fully operational seeing a constant stream of patients.’
Claire Carmichael, a practice nurse based in Portsmouth, pointed out that ‘GP staff are already under massive pressure right now’ with a ‘backlog of patients’, adding that ‘the rollout of this on top is going to be tough’.
Responding to concerns on Twitter, NHS England director of primary care Dr Nikita Kanani said that she understands the NHS England nursing team worked with the RCN and the RCN GPN Forum.
But the RCN GPN Forum responded: ‘Unfortunately Nikki, the reality is – GPNs are not mentioned in the guidance – the ‘biggest group of immunisers’ and is not clear whether we have been consulted on the DES.’
RCN GPN Forum chair Ellen Nicholson told Nursing in Practice: ‘The Covid DES rightly discusses the challenge and logistics in delivering a wide scale vaccination programme to the population, and covers payment schedules and the implications.
‘What appears to be lacking from the guidance is the recognition of the largest body of expert vaccinators, the general practice nursing workforce,’ she added.
Louise Brady, the clinical development lead for the Royal British Legion’s six care homes, is worried that opt-in nature of the DES means the workload might shift onto community and social care nursing.
She said: ‘A few GP practices have said that they can’t opt in because they haven’t got the capacity. What are social care providers going to do if practices opt out of the DES? Will it come under community trusts? Will organisations have to organise their own Covid-19 vaccinations?’
She continued: ‘RCN members have no assurance that the BMA and the RCN are working collaboratively on vital and critical communications around fast speed novel vaccine developments.
‘Nursing is the largest workforce and nurses across all fields will be expected to take on the lion’s share of the work,’ she added.
Nursing in Practice has contacted NHS England for comment.
Update: This story was updated at 2.45pm on 11/11/20 with the comment from the RCN.