NHS vaccinators in rural Scotland are travelling ‘hundreds of miles’ to carry out vaccinations that local GPs ‘are perfectly capable of doing’, legislators warned.
The Scottish Government was asked whether the provision of health services across the Highlands and Islands region meets the needs of local communities, with some MSPs arguing that vaccinations in rural areas should go back to being delivered by GPs.
As part of the 2018 GP contract negotiated by the BMA, some services, including vaccines, were removed from general practice and became the responsibility of multi-disciplinary teams employed by NHS boards.
Jamie Halcro Johnston, Conservative MSP for Highlands and Islands, said that the transfer of vaccination from GPs to NHS Highland has been ‘fraught with difficulty’.
He said: ‘NHS vaccinators are travelling upwards of 100 miles to carry out vaccinations that local GPs are perfectly capable of doing.
‘As winter approaches and new vaccination schemes are rolling out, what steps is the Scottish Government taking to ensure that the efficacy of vaccinations in Scotland’s remote, rural and island communities is significantly improved?’
Cabinet secretary for NHS recovery, health and social care Michael Matheson said that he recognised that there are ‘some specific challenges’ with vaccination programmes in rural areas.
He added: ‘However, the member will be aware that the change was instigated in NHS Highland as a result of the BMA’s negotiations on the GP contract.
‘The organisation wanted vaccinations to be removed from GP practices and to be done by the NHS. That was the approach that has been taken and which was agreed to.
‘Clearly, there have been some challenges around that. I know that we are continuing to engage with NHS Highland to try to address those issues and to make sure that a proper vaccination programme is delivered as locally as possible to constituents across the Highlands.’
Conservative MSP for Highlands and Islands Edward Mountain argued that the 2018 contract review ‘was not supported by GPs across the Highlands, who want to carry out vaccinations themselves’.
He added: ‘On that basis, will the cabinet secretary renegotiate that agreement in order to allow rural areas to get the vaccination cover that we deserve and that we are not getting?’
Mr Matheson said: ‘I recognise the ongoing concerns. However, the member will appreciate that the GP contract applies across all GP practices in Scotland. That formed the basis of the approach.
‘I recognise the concerns that the member is raising about the matter and I am not dismissing them.
‘However, the GP contract applies across all GP practices in Scotland. It is difficult to provide carve-outs for specific areas because of the difficulties that that creates.
‘Notwithstanding that, we are continuing to engage with NHS Highland and it is continuing to engage in looking at how it can address some of the local concerns.’
BMA’s Scottish GPC chair Dr Andrew Buist told Pulse that when the contract review was negotiated there were ‘protections in place’ for health boards who would struggle to deliver the vaccines, specifically the option appraisal which would identify areas where it was going to be difficult for them to provide the service.
He said: ‘Back in 2017 a number of Highland GPs voted against those changes in the contract but the majority of GPs in Scotland in favour of it.
‘But there were protections that were supposed to be utilised by health boards to recognise that in some geographical areas it would be very difficult for boards to provide the service and it would make more sense in those situations for the practices to continue to do it.
‘But that doesn’t mean every single practice in Highland would do that.’
He also said that the vaccination transfer programme part of the GP contract was ‘probably one of the most successful things that we have done’, adding: ‘It has freed up GPs to do other things.
‘In very rural areas it might make sense for GPs to continue doing the vaccines if they have capacity and the boards are struggling to get to these areas, but for the majority of GPs passing this workload makes much more sense.’
A spokesperson for NHS Highland told Pulse: ‘In line with the new GMS contract, NHS Highland continues to embed the vaccination service which has been established.
‘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.’
Meanwhile, in England, the BMA’s GP Committee has demanded an investigation into the Government and NHS England’s ‘mismanagement’ of this year’s vaccination programmes.
翻译：
It trikes me that there is a difference between ‘responsibility to deliver the service’ and ‘giving the vaccinations’; and that NHS Highlands was somewhat short of the ability to organise supply and negotiate with Highlands GPs in rural areas to ‘give the vaccinations’ that the NHS body had the responsibility to deliver.
NHS Managers who cannot organise and negotiate should probably step down, and go find a job that they are capable of doing?
Make way for governance by clinical staff who know what they are doing and have the required capabilities.