IF you were to choose the worst possible time to overhaul Scotland's flu vaccination programme, the middle of a viral pandemic would surely be it.

But the reason most flu vaccinations are being delivered by health boards this winter, rather than GPs, has nothing to do with Covid.

In fact, it stems from the new Scottish GP contract agreed between the Scottish Government and BMA trade union back in 2018.

Driven by concerns over recruitment and retention within general practice, doctors' leaders and ministers negotiated a deal that would see immunisations transferred from GP practices to health boards as of 2021, with delivery via health and social care partnerships (HSCPs).

The idea was to reduce GP workload - but to many GPs, the move seemed doomed and unnecessary.

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Back in early January, well before the Covid threat materialised, the Herald reported on calls from GPs to be given an 'opt-in' for vaccinations amid fears that uptake rates for flu, meningitis and measles would drop if elderly people could no longer get the jag at their own practice.

In the end, Covid only ended up accelerating the centralisation of vaccinations.

Dr John Montgomery, a GP at the David Elder Medical Practice, located in one of Glasgow's poorest communities, said: "It's a blindingly obvious thing for us to do because patients know where to come.

"Particularly for Deep End practices like ours - if you take vaccinations outwith the practice setting the take-up rate is going to fall."

His practice has already completed flu vaccinations for the at-risk 18-64 population, which were delivered by appointment at the Govan practice.

He says the "cherry on the cake" for the health board system, when it begins vaccinating 55 to 64-year-olds in phase two, will be how to identify those who have already been immunised through their GPs.

"If there are even enough vaccines come December for the 55-64 group, you have to find a way to sift out the healthy from the unhealthy so that they don't get vaccinated twice."

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Dr Montgomery says time was wasted back in March and April "when we realised flu was going to be a problem", although some health boards have been quicker off the mark and better organised.

Some patients in their 80s in the Highlands, for example, were vaccinated at the start of October.

While the kind of mass vaccination sessions which saw hundreds of patients immunised in a single day at their local GP surgery would no longer be possible due to the cleaning and physical distancing requirements of Covid, Dr Montgomery says he believes GPs could still have delivered the programme.

"The real concern this year for general practices was the delivery through premises; not people saying they couldn't do it due to workload.

"So if HSCPs could have provided premises where necessary, carried out the risk assessments, given us district nurses to vaccinate the housebound, and provided a proper callback system so that the most vulnerable got it first, we could have done it.

"If this was happening pre-2018, we'd be sorting it out ourselves, locally."