This article appears as part of the Inside the NHS newsletter.
A few weeks ago, our Inside the NHS newsletter reported that the transfer of vaccinations from GPs to the health board in Highland was not going as smoothly as hoped.
This week, The Herald has obtained an internal report which describes "significant challenges" and raises questions about exactly how the region ended up in its current predicament.
The report
The internal document, dated July 7, sought to evaluate how Highland was coping with the transition to health board-led vaccine delivery, which took effect from March 1st.
Under the Vaccine Transformation Programme (VTP), all vaccinations – from adult shingles jags or travel vaccines to childhood immunisations and the winter flu and Covid rollouts – were to be provided by the health board via community clinics, instead of GP surgeries.
The move follows agreements struck by the Scottish Government and BMA Scotland as part of the 2018 Scottish GP contract – a contract which Highland GPs opposed.
The report, entitled 'Vaccine delivery challenges post VTP in NHS Highland', notes that operational teams are going "above and beyond to try to deliver within challenging circumstances" and that concerns have been "regularly escalated internally within NHS Highland".
This includes concerns "regarding the ability to effectively replicate and deliver what had been in place prior to the transfer to health board delivery within NHS Highland given our remote and rural geography".
It notes that 30 out of the 65 GP practices within the Highland Health and Social Care (HSCP) footprint are located in "very remote rural" villages an hour's drive from settlements of 10,000-plus people.
Given that the current aim is "to be accessible for patients minimal travel" this means that vaccinators "are required to travel to more remote areas to deliver very low volumes of vaccines... [which] is inefficient and does not represent a sustainable service".
In some cases this means journeys of 116 miles one-way from Wick to Lochinver.
The report contains case studies highlighting ongoing issues. These include warnings that baby vaccination clinics are "simply not sustainable" in some locations due to the travel time to inoculation ratio.
In one case, vaccinators travelled 11 hours to provide jags to just four infants at a GP surgery where doctors wish to continue providing vaccinations in-house, but – under current arrangements – are blocked from doing so.
Staffing challenges "have impacted on all aspects of the immunisation programme", it adds. The shingles and pneumococcal programme for adults commenced later than usual on June 27 and will not be completed within the 2022/23 season because "staffing challenges" made it too difficult to run it alongside the Spring Covid booster campaign.
Read more:
- Inside the NHS | Is Highland’s vaccine rollout unravelling already?
- Leaked report reveals 'significant challenges' in Highland as child vaccinations dip
- Analysis: BA.2.86 'one of the most immune evasive' variants
According to the report, more than 1,500 Spring Covid booster appointments were cancelled due to staffing shortages, scheduling mix-ups or problems with venues.
In addition, 64 childhood vaccination clinics were cancelled between March 1 and May 10. New figures from Public Health Scotland indicate that coverage for a range of childhood immunisations, including MMR for five-year-olds starting school, had fallen to 86.5% by June this year.
The impact on patients was illustrated by examples including a family of Afghan refugees requiring childhood immunisations and travel vaccines who were expected to wait nearly four weeks for an appointment or travel 109 miles to a vaccine hub in Inverness despite having no car.
In another case, a 47-year-old man requiring a tetanus jag after a dog bite gave up after being told he would have to wait 13 days for a clinic appointment out of his local area, while a 37-year-old woman with possible rabies exposure was eventually referred to hospital for vaccination due to a lack of timely clinic availability.
Questions
The potential for a decline in coverage for vaccine-preventable diseases, from measles to tetanus, is a serious public health issue.
One of the bulwarks against that was Scottish Government guidance enabling an "options appraisal" where it was considered potentially necessary for GP surgeries to continue delivering services which were supposed to have passed to the health board. This included where evidence suggested it could be safer, more affordable, and more effective.
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Prior to the pandemic, a review "illustrated the likely need for a hybrid approach" in the Highlands. Following an options appraisal by Argyll and Bute HSCP – to the south of the NHS Highland region – a "small number of GP practices continue to deliver vaccinations in keeping with local need".
Yet, for reasons that remain unexplained, no such options appraisal was conducted by Highland HSCP. The result is that GPs from Caithness to Lochaber are now unable to provide vaccines to their patients – even if they want to, and it makes more sense.
Someone, somewhere dropped the ball.
NHS Highland acknowledges that "improvements can be made in the design of our vaccination service to maximise" vaccine uptake and it is "working hard to make those improvements".
The fix seems obvious: get GPs back on board.
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