GPs are beginning to step back from the Covid vaccination programme due to rising pressures and the need to switch focus to local patients requiring care.
Doctors have warned that England’s primary care system is in danger of being overwhelmed in the aftermath of three lockdowns, with surgeries facing a huge backlog of demand from sick people who avoided using health services during these periods. The shift to digital consultations has also placed greater strain on services, GPs say.
Confronted with these pressures, many primary care networks (PCNs) made the decision in March to opt out of phase two of the national vaccination programme, which aims to immunise all adults under 50, with mass centres and pharmacies taking on the main burden of this responsibility.
“For many groups of GP practices the decision to opt out was driven by the release of pent-up demand from patients who had been holding off seeking GP care,” said Dr Michelle Drage, CEO of Londonwide Local Medical Committees, which represents almost 1,100 practices across the capital.
GPs have administered the bulk of vaccines to England’s first nine priority groups and will continue to provide second doses to those individuals still waiting to receive them.
But with this stage of England’s vaccination programme approaching an end, understaffed and overworked GPs have now begun turning their attention back to primary care and their ill patients.
In London, Dr Drage explained, this decision was also influenced by the acknowledgement that the capital has an overrepresentation of younger, more mobile people who are easily able to travel to mass vaccination centres.
“Having used their close geographical proximity and unique relationship with local communities to vaccinate the older and more clinically vulnerable patients, many London practices felt they needed to focus their capacity on burgeoning demand for essential GP services,” she added.
Dr Ollie Hart, the clinical director of Heeley Plus PCN, in Sheffield, said his network hadn’t signed up to phase two of the national programme due to the need to focus efforts on restoring primary care services.
“We’re very proud of what we’ve done and moved very quickly to vaccinate 16,000 of our highest at-risk people, twice,” he said. “It’s taken a lot of commitment and resources, and it’s a huge volume of work.
“We feel that volume of work needs to be redirected back to our main purpose in caring for our patients, especially amid the rising demand.
“It should be much simpler to organise and deliver vaccines to the younger, more mobile groups, and it now feels right to pass on that responsibility.”
Overall, more than 75 per cent of vaccinations administered in England to date have been delivered in primary care, according to the Royal College of GPs (RCGP).
However, Dr Kirsty Baldwin, a GP in Leeds, said “lots” of practices were “stepping back” from the vaccine programme as they were “no longer able to sustain the loss of the staff time in the face of unprecedented demand”.
A source involved in co-ordinating London’s PCNs told The Independent that there is still tension in the different networks, between GPs, who want to carry on providing vaccinations for younger patients, and senior officials who, on behalf of each PCN, have chosen to opt out of phase two.
The Royal College of General Practitioners (RCGP) said that “as far as we are aware, the majority of GPs are keen to continue their involvement in the Covid vaccination programme, but GPs know their patients best and they will make those decisions in the best interests of their local populations.”
There are also concerns about how under-resourced practices will juggle their growing patient backlogs alongside this year’s flu vaccine programme, which begins in September, especially after the NHS decided in January to include healthy 50-64 year olds among those eligible for a jab.
Dr Simon Hodes, a GP in Watford, said: “There are concerns about where the resourcing and staffing will come from to deliver this in general practice without disrupting routine care, and without adequate funding.” He said an autumn booster programme for Covid would further add to GPs’ workload.
Nonetheless, many health leaders and GPs are fearful that, even with renewed focus on primary care services, it won’t be enough to bring back the sector from breaking point.
“There just aren’t enough hours in the day,” said Dr Ayan Panja, a GP in St Albans. “I’ve no idea how we are going to catch up on the backlog and each time a GP retires or leaves it leaves the rest of us carrying more of the burden.
“We need a recovery plan and strong reliable leadership. The recovery plan would mean manageable workload, sustainable income and a happy workforce. It’s not easy.”
UK news in pictures Show all 50 1 /50 UK news in pictures UK news in pictures 7 June 2021 A pedestrian wearing a face covering walks over Westminster Bridge near the Houses of Parliament in central London AFP/Getty UK news in pictures 6 June 2021 Isobel Salamon, founder of the Edinburgh Cinema Club, poses alongside the Leith Trainspotting murals in Quality Yard, Leith, Edinburgh, for the programme launch of the Cinescapes Festival which starts on July 4 with a Trainspotting 1 and 2 double bill PA UK news in pictures 5 June 2021 A long exposure photograph captures the rotation of the earth as the stars blur into circles over Knowlton church ruins in Dorset Nick Lucas/SWNS UK news in pictures 4 June 2021 Balloonists take flight during the opening of the Midlands Air Festival in Alcester, Warwickshire PA UK news in pictures 3 June 2021 Members of the Household Cavalry during the Major General’s annual inspection of the Household Cavalry Mounted Regiment in Hyde Park, London PA UK news in pictures 2 June 2021 Hannah Vitos of the Blenheim Art Foundation, poses for a photograph next to artist Ai Weiwei’s Gilded Cage (2017) sculpture in the grounds of Blenheim Palace in Woodstock, Britain Reuters UK news in pictures 1 June 2021 People swim in the Sky Pool, a transparent swimming pool bridge across two exclusive residential blocks standing next to the US Embassy in Nine Elms, in London, Tuesday, June 1, 2021 AP UK news in pictures 31 May 2021 People enjoy the hot weather at Brighton beach Reuters UK news in pictures 30 May 2021 People venture into the sea as they enjoy themselves during a hot day on Brighton Beach AP UK news in pictures 29 May 2021 Swimmers at the Stonehaven Open Air Pool in Aberdeenshire, which reopens after lockdown restrictions were eased PA UK news in pictures 28 May 2021 Britain’s Prime Minister Boris Johnson gestures as he meets Hungary’s Prime Minister Viktor Orban at Downing Street in London REUTERS UK news in pictures 27 May 2021 White Pelicans in the sunshine in St James’s Park, London PA UK news in pictures 26 May 2021 Boats are seen at Southsea Moorings in Portsmouth Reuters UK news in pictures 25 May 2021 York Glaziers Trust employees Kieran Muir (left) and Emily Price (right) remove a stained glass window panel at the start of a new five year, £5m project to conserve York Minster’s South East Transept and its medieval St Cuthbert Window PA UK news in pictures 24 May 2021 Dark rain clouds above an oast house at Bewl Water reservoir near Lamberhurst in Kent during one of the rainiest Mays on record, with the UK seeing 131 per cent of the usual month’s rainfall already PA UK news in pictures 23 May 2021 The Premier League trophy with the Manchester City club colour ribbons on, at Etihad Stadium, prior to the last Premier League match of the season. City will finally pick up the trophy after they won the league on 11 May Getty UK news in pictures 22 May 2021 Gary Kenny lifts the Buildbase FA Vase Trophy after Warrington Rylands won the FA Vase Final against Binfield at Wembley Stadium Getty UK news in pictures 21 May 2021 A family buffeted by the wind whilst crossing the the Millennium Bridge in London, with wind and rain forecast to ravage the UK on the first Friday that people have been allowed to meet in large groups outside in England PA UK news in pictures 20 May 2021 Devon And Cornwall Police Demonstrate Their Skills For Policing The G7 Summit Getty Images UK news in pictures 18 May 2021 An employee stands before a costume for the Queen of Hearts by Bob Crowley on display at the Alice: Curiouser and Curiouser exhibition at the Victoria and Albert Museum in London PA UK news in pictures 17 May 2021 Passengers prepare to board an easyJet flight to Faro, Portugal, at Gatwick Airport after the ban on international leisure travel for people in England was lifted following the further easing of lockdown restrictions in England PA UK news in pictures 16 May 2021 Emergency workers at the scene of a suspected gas explosion, in which a young child was killed and two people were seriously injured, on Mallowdale Ave Heysham which caused 2 houses to collapse and badly damaged another PA UK news in pictures 15 May 2021 Pro-Palestinian activists and supporters let off smoke flares, wave flags and carry placards during a demonstration in support of the Palestinian cause as violence escalates in the ongoing conflict with Israel, in central London AFP via Getty UK news in pictures 14 May 2021 Member of staffs tighten screws and paint a Marlin skeleton, before it goes on display at the Natural History Museum in London, as the museum prepares to reopen to the public on 17 May, following the further easing of lockdown restrictions in England PA UK news in pictures 13 May 2021 A worshipper at the Baitul Futuh Mosque in Mordon, south London, ahead of Eid al-Fitr. The celebration marks the end of the Muslim month of fasting, called Ramadan. PA UK news in pictures 12 May 2021 A couple have wedding photos taken in Westminster, London Getty UK news in pictures 11 May 2021 The sun rises on Coquet Island, off Amble on the Northumberland coast, where as many as 35000 seabirds cram onto this tiny island to breed PA UK news in pictures 10 May 2021 Newly elected for a second term Mayor of London Sadiq Khan during his signing in ceremony at Shakespeare’s Globe Theatre on London’s Southbank PA UK news in pictures 9 May 2021 People mill around St. Michael’s tower on top of Glastonbury Tor as it is seen through blooming yellow rapeseed on a day of mixed weather in Glastonbury, Somerset PA UK news in pictures 8 May 2021 Wales First Minister Mark Drakeford elbow bumps newly elected MS Labour candidates Elizabeth Buffy Williams, Rhondda, left, and Sarah Murphy, Bridgend & Porthcawl Labour, right, as they meet in Porthcawl, Wales PA UK news in pictures 6 May 2021 A group of five Sisters from Carmelite Monastery in Dysart cast their vote in the Scottish Parliamentary election at Dysart Community Hall, West Port, Dysart PA UK news in pictures 5 May 2021 Leader of the Labour Party Sir Keir Starmer (centre) with West Midlands Metro Mayor candidate Liam Byrne (far right) and Labour Deputy Leader, Angela Rayner (far left) during a visit to Birmingham, whilst on the election campaign trail PA UK news in pictures 4 May 2021 Artists Heather Ackroyd and Dan Harvey stand within 100 oak saplings which form part of a living art installation entitled Beuys’ Acorns by the UK-based artist duo, outside the Tate Modern in London PA UK news in pictures 3 May 2021 Scottish Liberal Democrat leader Willie Rennie feeds the Gentoo penguins during a visit to Edinburgh Zoo on the campaign trail for the forthcoming Scottish Parliamentary Election on May 6 PA UK news in pictures 2 May 2021 Chelsea players celebrate their fourth goal during the Women’s Champions League semi-final second leg against Bayern Munich, at Kingsmeadow Stadium in south west London. The Blues won the game 4-1, (and the tie 5-3 on aggregate) sending them through to their first Champions League final AFP/Getty UK news in pictures 1 May 2020 Demonstrators during a march through London during a ‘Kill the Bill’ protest Angela Christofilou UK news in pictures 30 April 2021 Shoppers queue outside Primark in Belfast as shops reopen and hospitality is able to open outdoors in Northern Ireland where lockdown restrictions have begun to gradually ease PA UK news in pictures 29 April 2021 Specialist operators at the Royal Air Force Museum Cosford, near Telford, Shropshire, clean the Hawker Hunter aircraft displayed within the museum’s National Cold War Exhibition, during annual high-level aircraft cleaning and maintenance PA UK news in pictures 28 April 2021 Millions of tulips in flower near King’s Lynn in Norfolk, as Belmont Nurseries, the UK’s largest commercial grower of outdoor tulips, offers socially-distanced visits to its tulip fields at Hillington to raise funds for local charity The Norfolk Hospice Tapping House PA UK news in pictures 27 April 2021 Paula Laughton checks one of the newly installed Lego models in the new Lego Mythica land at Legoland Windsor Resort PA UK news in pictures 26 April 2021 A red panda rests on a tree at Manor Wildlife park, which reopened its doors as lockdown restrictions continue to ease, in Tenby, Wales Reuters UK news in pictures 25 April 2021 Sheep climb the hillside as flames from a moor fire are seen on Marsden moor, near Huddersfield AFP via Getty UK news in pictures 24 April 2021 Supporters protest against Manchester United’s owners, outside English Premier League club Manchester United’s Old Trafford stadium in Manchester AFP via Getty UK news in pictures 23 April 2021 People enjoy the warm weather at City Hall near Tower Bridge in central London PA UK news in pictures 22 April 2021 Uyghurs during a demonstration in Parliament Square, London, which is being held ahead of a House of Commons debate, bought by backbench MP Nus Ghani, on whether Uyghurs in China’s Xinjiang province are suffering crimes against humanity and genocide PA UK news in pictures 21 April 2021 People walk at the Taihaku Cherry Orchard in Alnwick REUTERS UK news in pictures 20 April 2021 People stand in front of anti Super League banners outside Anfield as twelve of Europe’s top football clubs, including Liverpool, launch a breakaway league Reuters UK news in pictures 19 April 2021 Women enjoy sunny weather in Greenwich, amid the coronavirus disease (COVID-19) outbreak, in London, Britain, Reuters UK news in pictures 18 April 2021 Stephen Maguire (right) of Scotland interacts with Jamie Jones of Wales during day 2 of the Betfred World Snooker Championships 2021 at The Crucible, Sheffield PA UK news in pictures 17 April 2021 Prince Philip, Duke of Edinburgh’s coffin, covered with His Royal Highness’s Personal Standard arrives by Landrover Defender at St George’s Chapel carried by a bearer party found by the Royal Marines during the funeral of Prince Philip, Duke of Edinburgh at Windsor Castle Getty Images
NHS figures show that practices in England delivered almost 5 million more appointments in March 2021 than the previous month, and nearly 3 million more than in March 2019. In total, 28.4 million appointments were booked in March – one of the highest figures on record.
Despite government efforts to address rising patient demand through increased recruitment, the number of full-time GPs in England has fallen by nearly 2,000 in recent years to just under 27,000.
Primary care deals with around 90 per cent of patient contacts for under 10 per cent of the national NHS budget. GPs also provide more than 300 million patient consultations each year, compared to 23 million carried out by emergency departments.
“Public attention on NHS pressures always seems to focus on hospitals, but we must not ignore the pressures in general practice as this will have dire consequences for the wider NHS and the care of our patients,” said Professor Martin Marshall, chair of the RCGP. “General practices keep the rest of the NHS standing.”
Dr Drage has meanwhile called for “an immediate end to over-promising to patients by national leaders, and an honest conversation about what the service can safely deliver with finite resources in the face of a still very live pandemic and the increased ill health that will follow it.”
She added: “General practice, with its capacity already overloaded before the pandemic, is on its knees.”
