The winter vaccine rollout got underway on Monday with health boards under pressure to bring forward Covid and flu jags to care home residents, over-75s, and those with weakened immune systems as a "precautionary measure" due to uncertainty over the impact of the highly-mutated BA.2.86 strain of Omicron, which has now been detected in Scotland.

On the original timetable, these individuals would have been invited for vaccinations from mid-October onwards.

Beyond Covid variants, however, another storm is brewing amid growing fears among doctors in the Highlands that its vaccine delivery is heading into crisis.

The background

This is the first winter where responsibility for all vaccinations – from routine childhood immunisations to flu and shingles jags for the elderly to travel vaccines – has fully transferred from general practice to health boards.

This arrangement dates back to the 2018 Scottish GP contract negotiated between the Scottish Government and BMA Scotland.

Among the changes it ushered in was an agreement that vaccine delivery would shift to health boards. The goal was to free up GP time for other duties, such as patient consultations.

In urban regions such as Greater Glasgow and Lothian, health boards have already been administering the vast majority of vaccinations via hospital clinics or venues such as town halls and sports centres for the past two years.

In rural and island communities, however, many GPs continued to provide at least some vaccines in-house on the basis that this was more convenient for patients and thus more likely to maximise uptake.

That leeway came to an end in March this year, however, when the Vaccine Transformation Programme (VTP) was fully implemented. 

It is important to understand that GPs in the Highlands overwhelmingly voted to reject the 2018 contract. Vaccinations were not their only reason for opposition; one of the most polarising aspects was a controversial funding formula which saw rural practices receive zero uplift in income while surgeries in the urban Central Belt – especially more affluent, middle class areas – gained disproportionately.

Anger lingers on that Highland GPs have been saddled with a contract "designed for the needs of urban practices".

What now?

In recent months, rumblings of discontent have been growing louder amid claims that the health board delivery of vaccinations is failing.

The Herald understands that a recent paper on the VTP authored by Dr Jenny Wares – a public health consultant employed by NHS Highland – has become a major talking point after it concluded, in essence, that vaccinations were not being delivered as well as they should be and alternative options should be explored.

The document is not publicly available, but doctors who have been in meetings where it was discussed say that NHS Highland's leadership have been quick to downplay it as "not an official NHS Highland paper".

Endorsing such findings would, of course, put NHS Highland on a collision course with the Scottish Government and BMA.

However, doctors speaking to The Herald in confidence describe a system that is "really struggling" even before the winter rollout.

Examples of problems include a baby boy who faced delays in getting his 'six-in-one' immunisation, which protects against diphtheria, tetanus, whooping cough, polio, hepatitis B and Haemophilus influenzae Type B – a potentially life-threatening bacterial infection.

Infants are supposed to be given three doses of the 'six-on-one' at eight, 12 and 16 weeks, but in this case the boy was 15 weeks old before he got his first dose.

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Another case saw a diabetic man trying 10 times to book his pneumococcal vaccine via the phoneline "but his calls were never answered".

Longer journeys to vaccine clinics are also blamed for deterring patients.

One Highland GP said: "It is a big issue. We are expecting to see a fall in coverage, worse in frail and deprived population."

An NHS source familiar with the situation added: "It is clear that it cannot be delivered safely and reliably in remote rural areas and that is putting the success of vaccination in these communities at risk, in my view. But there seems to still be a state of denial at both board and government level."

The Scottish Workload Allocation Formula (SWAF) developed for the 2018 contract was highly divisive. Red dots show practices whose income fell, by up to 87.6 per cent, under the formula, with green dots showing practices whose income increased by up to 62.6 per cent (Image: RuralGP.scot)

Attempts by GPs to raise the issue directly with Health Secretary Michael Matheson have been rebuffed so far, but SNP MSP Fergus Ewing – who represents Inverness and Nairn – is said to be more sympathetic.

Mr Ewing told The Herald he is due to meet with NHS Highland representatives and has asked the board "to rethink" its vaccine programme.

A spokesman for NHS Highland said: "We recognise that there are still improvements that can be made in the design of our vaccination service to maximise the opportunities for people across Highland to receive their vaccination, and we are working hard to make those improvements. We are committed to delivering vaccinations as close to the local communities as possible."

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