NHS England revealed the new direct enhanced service (DES) this week, to guide general practice preparations for a Covid-19 vaccination programme, which could start as early as December.

The contract covers a number of key areas, including how practices will work together, which staff can administer the vaccination, payment details, timescales, and the provision of the vaccine itself.

Practice managers have been going through the details since Monday (9 November) – and while there is some excitement and optimism, there are also worries about the additional workload and pressures, and some unanswered questions. 

Management in Practice spoke to four practice managers about what they make of the DES. 

Emma Jacobs, practice manager at the Walnut Tree Health Centre, Milton Keynes

Emma Jacobs, like many of her practice manager colleagues, said she has spent the last 48 hours doing little else than working through the official documents, as well as ‘advice, summaries and guidance from supporting bodies and peers’.

‘It is exciting that we may have this vaccine that offers some hope to 2021. As practice managers (PMs), we are keen to support the pandemic and the crisis, however the short notice and unanswered ‘what ifs’ mean there is a lot to focus on in the coming days,’ she said. 

Under the DES, practices will need to work as part of primary care network (PCN) ‘groupings’, and jointly nominate a single site to deliver the Covid-19 vaccinations. 

The selected site will be expected to provide the service between 8am and 8pm ‘seven days per week, including bank holidays’ if vaccine supplies allow, and each site will be expected to administer ‘a minimum of 975 vaccinations’ every week. 

Ms Jacobs added: ‘We will talk with partners, practice colleagues, primary care networks (PCNs), federations and clinical commissioning groups (CCGs) about how we can work collaboratively to deliver this. 

‘But there are still so many unknowns – what will uptake be; do we really have to be open 8am-8pm when we don’t know about the supply chain or the demand? There are both operational and strategic considerations and we are part of all of these conversations.’   

She also said that it has already been ‘an incredibly tough year’ for everyone and practice managers, like many NHS staff, are ‘really feeling the unprecedented workload pressure’. 

‘As a practice we have successfully delivered our best flu campaign in my memory and I think practices and PCNs and local health communities can work collaboratively to deliver the [Covid] vaccine when it is ready for roll out,’ she said. 

‘But we must do this based on local population needs and funding must be forthcoming to support the additional significant demand and costs on primary care as we try to catch up and continue with delivering our day-to-day safe, effective care.’

Hafiza Bhabha, practice manager at Petworth Surgery, West Sussex

Hafiza Bhabha said her practice is currently working with its PCN to ‘configure a plan of action’.

‘The DES is of course an additional workload and a huge responsibility. I have already spent 15 hours on it and remuneration is not yet clear, although if costed correctly, it will be a generous income,’ she said. 

The new contract states that practices will be paid £12.58 per dose administered, with the full £25.16 being paid after the second required dose has been given.

Her PCN is also facing ‘some significant operational challenges’, mainly because it is in a rural area.

‘We have geographical challenges, lack of public transport systems and very remote patient dwellings. A single designated site, as the specifications suggests, would not provide equitable access for our local population. We are trying to work with our local CCG and NHSE to see how we can eliminate unnecessary challenges.’

She added: ‘As a healthcare manager I want to contribute positively to the national programme, and I’m motivated by the thought of our ‘normal’ daily life returning by spring 2021 – if the programme is successful. 

‘I am not deterred from completing the work, as long as we are supported by NHS England, our local CCG and of course the national press.’

Denise Smith, practice manager at Merepark Medical Centre, Stoke-on-Trent

Denise Smith said the need to prepare for the Covid-19 vaccination programme, while the flu campaign is ongoing, has increased the workload for practice managers. The short notice, other deadlines and staff exhaustion has not made it easier, she added. 

NHS England said clinical commissioning groups (CCGs) will be given £150m to support GP practices with managing routine demand, while they also takes on the task of delivering the Covid-19 vaccination campaign.  

Ms Smith said: ‘We are still in the middle of this year’s flu campaign and are also preparing for 2021 in advance, by ordering flu vaccines for next year. This is time consuming and takes a lot of planning, especially this year with social distancing and off-site flu clinics.

‘Taking part in the PCN level campaign with seven other practices in our SMASH PCN [where there is] variable enthusiasm and engagement, with little information and details that might change at any minute, is quite daunting.’ 

She added: ‘However, this is an opportunity for practice managers to save the world as we know it by collaborating, planning, organising and co-ordinating! And let’s hope we get Christmas off.’

Ann Stewart, practice manager at St Gabriel’s Medical Centre, Prestwich

Ann Stewart said ‘there are currently more questions than answers’ arising from the DES. However, her practice is ‘using the lessons learned in thinking differently at the start of the pandemic’ to guide its approach in supporting the Covid-19 vaccination programme in their area. 

‘From a PM perspective, I anticipate supporting the process in terms of call and recall, ensuring data is entered into the patients’ notes as soon as possible to minimise risk of duplication, working with practice staff to free up time for delivery, and agreeing with our CCG and NHSE what workload can be stood down to enable all this to happen,’ she said.  

In the DES, NHS England said its ‘ambition’ is that general practice will remain fully open and accessible to all patients, but acknowledged that ‘the additional workload of a Covid-19 vaccination programme may require practices to prioritise clinical activity’. 

Ms Stewart added: ‘I joined the NHS many years ago to do the right thing at the right time for patients, and for me, despite the unknown workload, this is the right thing at the right time.’