COVID-19: This week’s updates for community pharmacies (1)

COVID-19: This week’s updates for community pharmacies (1)

January 11, 2021

Latest news, information and guidance from NHS England and NHS Improvement (NHSE&I) for primary care teams.

1. NHSE&I Primary Care Bulletin updates – COVID-19: 6th January round-up for primary care

As announced by the Government on Monday night, England has been placed into a nationwide lockdown. We want to start by saying thank you to all frontline staff who are working tirelessly under significant pressures as the infection rate begins to rise again due to the new coronavirus variant. We understand your frustrations and will do everything we can to help you over the coming weeks and months.

Shielding advice for Clinically Extremely Vulnerable people
The Government has reintroduced shielding advice for Clinically Extremely Vulnerable (CEV) people across all areas of England from 5 January. This shielding advice is expected to be identical to that which was in place nationally from 5 November to 2 December, and which was already in place in areas under Tier 4 restrictions. This advice does not alter if an individual has received the COVID-19 vaccination.

CEV people will be eligible for support to stay at home including free delivery of medicines (where friends, family, or local volunteers are unable to provide help) and statutory sick pay where unable to work from home.

The Government will be writing to all CEV individuals in England to inform them of the advice and support available (including individuals already advised to shield as part of Tier 4 restrictions). This letter will be published here and will emphasise the importance of CEV individuals continuing to engage with the NHS, and confirm that they will be prioritised for the COVID-19 vaccination in advance of the general population (as per current JCVI guidance). It is expected that Government will also be sending text messages and emails to affected patients where the NHS holds the relevant contact information.

We know that this may be a difficult and worrying time for CEV people. We anticipate that patients may have questions about the advice they should follow. We are very grateful for your continued efforts in supporting those at highest risk from COVID-19 during the pandemic and will be in touch to provide further updates as necessary.

The introduction of the new Oxford/AstraZeneca vaccine
This week we began the use of the new Oxford/AstraZeneca vaccine. Another great step forward in protecting our communities from COVID-19. Local vaccination services will begin vaccinating patients with this new vaccine according to supply and we again want to thank you for resilience and adaptability to such a fast-moving programme. Currently the Oxford/AstraZeneca will be delivered through the designated sites.

In response to recent changes the Standard operating procedure: COVID-19 local vaccination services deployment in community settings has been updated.

Updated Patient Group Direction for COVID-19 mRNA vaccine BNT162b2 (Pfizer/BioNTech)
This Patient Group Direction (PGD) is for the administration of COVID-19 mRNA vaccine BNT162b2 30 micrograms in 0.3ml to individuals in accordance with the national COVID-19 vaccination programme. It was first published on 11 December 2020 and was updated 5 January 2021.

Deployment of COVID-19 Vaccine Oxford/AstraZeneca for pharmacy teams
This letter sent on 31 December 2020 from Keith Ridge, Chief Pharmaceutical Officer for England, outlines the implications for governance, handling and preparation of the vaccines for pharmacy teams.

Guidance for COVID-19 vaccination in care homes that have cases and outbreaks
There is clear evidence that those living in care homes for older adults (nursing and residential) have been disproportionately affected by COVID-19. This guidance outlines the general principles and considerations for vaccinating in care homes that have an outbreak of COVID-19 infection.

Support for Community Pharmacy sites on Pinnacle, Outcomes4Health point of care system webinar – Thursday 7 January 2021, 7-8pm
A webinar has been arranged for community pharmacy sites going live in January to demonstrate to their nominated administrators the Pinnacle, Outcomes4Health point of care system. The focus of the webinar will be to learn how to navigate the landing page to set up users and identify an individual to be vaccinated. This session will demonstrate data capture in sites and to demonstrate administrator functionality.

New pilot launched to support hospital patients to continue to stop smoking after discharge
new pilot in the Oldham area is testing the referral of patients to community pharmacy, to continue the stop smoking journey they started in hospital, as part of the NHS Long Term Plan commitments.

People can choose the community pharmacy they wish to be referred to on discharge from hospital. After referral, the pharmacist or trained pharmacy team member will arrange an initial consultation to discuss their quit progress and review the nicotine replacement therapy (NRT) or medication prescribed by the hospital team and make any necessary adjustments.

Further pilot sites are expected to start in early 2021.The pilot will be evaluated to inform potential inclusion of a smoking cessation service in the Community Pharmacy Contractual Framework in the near future.

Date for diaries: Thursday 7 January, 7-8pm:
Support for Community Pharmacy sites on Pinnacle, Outcomes4Health point of care system

2. COVID-19: 7th January round-up for primary care

The new Oxford AstraZeneca vaccine is being rolled out to general practice led services today making it easier to protect care home residents and other vulnerable people against COVID-19. This is yet another step forward in vaccinating our communities. To support with this rollout, we are delighted that a number of community pharmacies will pilot vaccination sites from next week with more coming on stream the week after.

This is an enormously complex vaccination programme using two new vaccines and is unlike anything the NHS has ever delivered before. The programme is initially focussing on sites that can deliver high volumes. This is in part because of the nature of both vaccines and the logistics needed, but also because we need to prioritise where we can get high numbers of people vaccinated quickly. As we rapidly roll out the programme further, we are looking at other delivery models.

The number of people diagnosed with coronavirus continues to increase and is why it is imperative we vaccinate as many people as possible. Therefore, you should now be following the second dose schedule, delaying the second dose to 12 weeks after the first dose of either the Pfizer/BioNTech or Oxford/Astra Zeneca vaccine to increase take up. This is the approach supported by the Chief Medical Officers and also the Royal Pharmaceutical Society and the British Geriatric Society.

Along with the additional local vaccination sites which are coming on stream, seven vaccination centres will be established next week and patients in the relevant cohorts living near these sites will be sent letters inviting them to book an appointment. An example of the letter can be found on FutureNHS. Template letters will be published on FutureNHS tomorrow including in different languages and an easy read version.

Vaccinations for staff
We are also pleased to be able to provide further details on how primary care staff, both clinical and non-clinical, can get access to the vaccine to protect yourselves, your families and our patients. There are two routes for primary care:

By mid-January all NHS Trusts will be established as “hospital hubs” with a responsibility for COVID-19 vaccine delivery to all individuals within JCVI cohort 2b as set out in the updated Public Health England’s Green BookThis letter clarifies the details and process.

Secondly, to minimise wastage, local vaccination sites have been ensuring unfilled appointments are used to vaccinate healthcare workers who have been identified at highest risk of serious illness from COVID-19, which includes pharmacy, dental and optometry teams. Healthcare providers have been undertaking staff risk assessments throughout the pandemic to identify these individuals and it remains important that this is organised across the local healthcare system to ensure equitable access.

Updated: Enhanced service specification – COVID-19 vaccination programme 2020/21
As the vaccination programme has developed, we have now published an updated version of the Enhanced Service Specification. It now reflects guidance published by JCVI on 30 December 2020, which covers the approval of the Oxford/AstraZeneca vaccine and, for both Pfizer/BioNTech and Oxford/AstraZeneca vaccines, recommends a second dose at up to 12 weeks after a first dose. Payment arrangements have consequently been changed so that practices are now eligible for an item of service payment for each dose.

COVID-19 Vaccine Oxford AstraZeneca – movement of vaccine
Further to the temporary Authorisation of the COVID-19 Vaccine Oxford AstraZeneca by the UK Department of Health and Social Care (DHSC) and Medicines and Healthcare products Regulatory Agency (MHRA) on 30 December 2020, we have written to general practice and pharmacists today to advise on additional operational flexibilities offered by the introduction of the AZ vaccine.

Post-vaccination observation period for Oxford/AstraZeneca
There is not a requirement for 15 minutes observation after administering the Oxford/AstraZeneca vaccine unless this is indicated after clinical assessment.

The MHRA guidance about the use of the Pfizer/BioNTech vaccine in those with a history of anaphylaxis – and the 15 minute post-vaccination observation period for all patients – remain in place. Note also that patients should not drive nor operate machinery for 15 minutes after being vaccinated with either vaccine.

The Standard operating procedure: COVID-19 local vaccination services deployment in community settings has been updated to reflect the change.

Patient Group Direction for COVID-19 Vaccine AstraZeneca, (ChAdOx1-S [recombinant]) now published
The Patient Group Direction (PGD) has now been published for the administration of COVID-19 Vaccine AstraZeneca (ChAdOx1-S [recombinant]) to individuals in accordance with the national COVID-19 vaccination programme. This PGD is for the administration of COVID-19 Vaccine AstraZeneca by registered healthcare practitioners identified. A summary document has been published alongside.

Contractors who have not yet ordered lateral flow tests
The majority of primary care contractors have now ordered lateral flow tests for their patient-facing staff on the online portal, as set out in direct communication by Primary Care Support England (PCSE), who are managing the ordering and delivery process.

Deliveries to contractors who had ordered by 30 December have already started and will continue in the coming days and weeks.

However, there are still primary care contractors who have not completed their order. If contractors (medical, dental, optometry and community pharmacy) have not yet placed their order, it is important that they log onto the portal and complete their order as soon as possible, and by COP Sunday 17 January to start to receive deliveries from the following week.

Contractors will have received direct communications from PCSE to the registered email address who normally manages the business as usual supplies orders with PCSE. Contractors should ensure that they have checked these emails and that they avoid any duplicate orders.

Each organisation should order one box for each patient-facing member of staff, for example if there are 10 patient-facing members of staff delivering NHS services within an organisation, the order should be for only 10 boxes of test kits – as one box contains 25 tests and it is enough for a member of staff to test for 12 weeks.

SOPs and FAQs on lateral flow testing in primary care are available for further information.

Co-administering the flu and COVID vaccines
During national lockdown, it remains very important that people continue to access essential services including vaccinations for babies, children and pregnant women as they are time critical and prevents serious illness and outbreaks. Please continue your efforts to invite and vaccinate as per the routine immunisation schedule. To use appointments efficiently, for adults who have not yet had their flu vaccination and are currently eligible for COVID vaccination, scheduling for both vaccinations to occur at the same visit is acceptable, as per the green book.

New pilot launched to identify people with undiagnosed high blood pressure 
Community pharmacies in Chesterfield, Dudley and West Birmingham are piloting a new service to identify people with undiagnosed hypertension (high blood pressure) to help prevent cardiovascular disease (CVD) as part of the NHS Long Term Plan.

Anyone visiting a pharmacy who appears to be over 40, will be offered a free, on the spot blood pressure check. Those with suspected hypertension will be offered ambulatory monitoring or referred to their GP where appropriate, for ongoing care to manage their blood pressure.

Further pilot sites are expected to start in early 2021.The pilot will be evaluated to inform potential inclusion in the Community Pharmacy Contractual Framework.

Medicines delivery service commissioned for Clinically Extremely Vulnerable patients
Following the Government’s announcement of the national lockdown and advice for all Clinically Extremely Vulnerable (CEV) patients to recommence shielding, the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service has been commissioned from 5 January 2021 to 21 February 2021 (inclusive) for all CEV patients living in England.

This announcement supersedes the announcements made in December for this service provision to Tier 4 areas.

Pharmacies and dispensing doctors across England will be required to ensure those on the Shielded Patient List across the country can receive their prescription medicines and appliances at home. These contractors will receive the essential/mandatory service payments and can claim a fee for making a delivery to eligible patients during this period as set out in the service specification.

National flu vaccination programme update
Thank you for the work you continue to do in general practices and community pharmacies in vaccinating eligible groups for flu. The programme is continuing, so please offer vaccinations over the coming weeks to all eligible adults and children who have yet to be vaccinated.

The national call and recall system for the flu vaccination programme is this week writing to 50 to 64 year olds (not in at risk groups) who have not yet had their vaccination, in order to help achieve as high uptake in this cohort as possible. There is still some vaccine available for community pharmacies to order for this group – information on this is available in the Department of Health and Social Care (DHSC) stock guidance for pharmacies. If you are a general practice and have run out, please check with your local system for anyone who has spare vaccine before ordering, but there is still vaccine available from both Seqirus and Sanofi if required. To order please refer to the DHSC guidance for practices.

In addition, phone calls are continuing to those in at risk groups who have been sent a letter but have not yet taken up their vaccination. As a result, some individuals may receive a call from the NHS Immunisation Management Service on 0300 561 0230.

3. COVID-19: 10th January round-up for primary care

Tomorrow sees the opening of seven vaccination centres across the country. This is in addition to the 100s of local vaccination sites lead by primary care networks and hospital hubs which are already up and running and the community pharmacy sites that will begin next week.

We appreciate this process is happening in parallel, with many local vaccination centres contacting patients but it is necessary to be able to drive through the vaccination programme at pace.

The initial sites were chosen from those ready to vaccinate large numbers of people quickly to give a geographical spread covering as many people as possible.

The first seven sites are:

  • Ashton Gate in Bristol (South West)
  • Epsom racecourse in Surrey (South East)
  • Excel Centre in London (London)
  • The Centre for Life (North East and Yorkshire)
  • Etihad Tennis Club in Manchester (North West)
  • Robertson House in Stevenage (East of England)
  • Millennium Point in Birmingham (Midlands)

These sites will work hand in hand with GPs, pharmacies, hospitals and care homes to offer vaccines to everyone in the top four priority cohorts, saving thousands of lives.

Letters have been sent to people aged 80 or over who have not yet received a vaccination and live 30 to 45 minutes drive from one of the seven new sites and explain how they can book a slot – over the phone or online through the national booking service. The online booking service is available via this link.  Examples of the letters can be found on FutureNHS.

The letters explain that people may have also been contacted by their GP services and if they have booked with them, they should take no further action and continue with their original booking. In order to avoid duplication or confusion, the system has been designed so that letters only go to patients who have not yet had their vaccine. However, if an overlap does occur, whereby a patient already has an appointment booked at an LVC, they can disregard the letter.

Information on which patients have not been vaccinated is drawn from GP records so it is important that you keep these as up to date as possible.

We have produced further information and materials to assist with any concerns you or your  patients may have about when and where to get the vaccine along with example communications.

Please continue to work with your regional system leads to ensure a coordinated approach to the vaccination programme in your area.

We thank you again for all your hard work. We know this has been another busy weekend for all of you


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