FAMILY doctors are pushing for a greater role in the delivery of the Covid vaccine amid warnings that relying on health boards and community hubs could slow down the process and disadvantage vulnerable patients.

From tomorrow, GP practices across Scotland will begin inoculating the over-80s, starting with the oldest patients on their list, with Nicola Sturgeon predicting that this age group should be fully vaccinated within four weeks.

Unlike England however, where the programme is GP-led, it is unclear to what extent general practice will be involved in immunisations going forward, in the other priority age groups over 50 and for high-risk shielding patients.

Nor is it the case that all GP practices will be carrying out Covid vaccinations to the over-80s, as they are not obliged to do so and a small number have opted out.

HeraldScotland: James Shaw, from Dundee, was one of the first people over 80 in Scotland to receive the Oxford vaccine, but many GP surgeries are still waiting on initial supplies with the programme moving to primary care settings tomorrowJames Shaw, from Dundee, was one of the first people over 80 in Scotland to receive the Oxford vaccine, but many GP surgeries are still waiting on initial supplies with the programme moving to primary care settings tomorrow

Under the terms of Scotland’s unique GP contract, negotiated between BMA Scotland and the Scottish Government in 2018, responsibility for vaccinations transferred from GPs to health boards, to be delivered through regional health and social care partnerships (HSCPs).

This is how the winter flu programme was delivered this year, although many GP practices continued to vaccinate adults aged 18 to 64 with underlying conditions.

The centralisation of the scheme faced a barrage of criticism, however, with some elderly people facing long journeys on multiple buses to reach vaccination hubs, appointment letters dispatched by a private contractor on behalf of National Services Scotland turning up late, and NHS Greater Glasgow and Clyde and NHS Lanarkshire in particular coming under fire for using a recall system that meant 65-year-olds were invited weeks ahead of those in their 90s, who were most at risk from flu.

READ MORE: Anger over flu vaccine rollout that will see oldest get jags last 

Dr John Montgomery, lead clinician at the David Elder Medical Practice, is among those keen to avoid any of these errors being repeated with the Covid vaccine rollout.

His practice, in the Govan area of Glasgow, has received its first batch of 100 Oxford vaccine doses and they intend to vaccinate all their patients over 80 - with the exception of those who are housebound - on Tuesday.

He said: “The uptake looks like its going to be excellent. The advantage with this vaccine is that people don’t have to wait around for 15 minutes after its done, like they do with the Pfizer vaccine, so patients can turn up for their appointment and be in and out in minutes.

“We’ve being doing around 15 per cent of our consultations face-to-face, but we will try to avoid bringing any other patients into the surgery on Tuesday to minimise footfall and risk.”

The surgery is one of the 54 out of the 55 in south Glasgow which are taking part in Covid vaccinations of the over-80s.

Many have yet to receive their first vaccine batches, but these are expected arrive within the next two weeks.

Dr Montgomery, who is also chair of the south Glasgow GP committee, said the divergence between Scotland and England is likely to leave the public confused, and added that there is “huge willingness” among GPs to take on a bigger role.

“There’s going to be a lot of expectation from the public that they’ll be going to their GP practice to be vaccinated, but as things stand that’s not the case.

“We’ve got no information yet on what will happen when we get to the 75 to 79-year-olds, for example.

“There’s an order in which folks are going to be done, but right now there isn’t any detail about how and where it’s going to be done.

"But GPs and their teams want to have greater involvement in vaccinating their own patients in their own premises, particularly those at high risk, and are pushing hard for this."

HeraldScotland: Dr John Montgomery, lead clinician at the David Elder Medical Practice in Govan, GlasgowDr John Montgomery, lead clinician at the David Elder Medical Practice in Govan, Glasgow

Dr Montgomery added: “A lot of us want to do more than the over-80s. In England it’s very much a GP-led vaccination programme but to my mind we should be involved in the shielded group. That’s an obvious one and that makes up about 4.5% of our list.

“And following on from that, the at-risk under-65s who we covered in the flu group.

“Once you’re getting down to under-50s and lower risk groups, sure you can use your football stadiums and your Louisa Jordans and get as many people as possible involved in administering it.

“But I think we need to be making plans now in Scotland, because England seems to be very clear about how it’s going to administer these programmes and, at the moment, we’re a wee bit behind the curve.”

READ MORE: Are we priorising the flu vaccine fairly - and why is Indonesia immunising its working age population first? 

In England, vaccinations of over-80s in the community - using the Pfizer vaccine - began in GP practices on December 14, before being extended to care home residents a week later.

In Scotland, care home vaccinations started earlier, on December 14 and “well over half” of residents have now been given their first dose.

Dr Montgomery stressed that greater involvement could be complicated by the other pressures facing GPs, who are already juggling work in out-of-hours clinics and community Covid assessment centres along with their existing workload of video, telephone, and in-person consultations.

“Demand for routine care has not fallen as it did in March,” said Dr Montgomery.

“So the worry is that practices may start to collapse with a combination of staff absences and rising demand. Which is when it comes back to why it’s so important to vaccinate the vaccinators.

“There is a ‘buddy system’ in place, so that if one practice caves due to staff shortages another can step in to deal with their patients, but the worry is that that has a domino effect if it has to be used.

“The same applies to staffing the Covid centres if demand increases there over the next few weeks.

“But even with all these pressures and out-of-hours, and GPs struggling to do their daytime job, they still want to do more Covid vaccinations.”

On Wednesday it emerged that GPs in London had been told to “stand down” from routine work over the next two weeks in order to “focus on urgent care” and free up time for vaccinations.

NHS England subsequently backtracked and told doctors to carry on with routine work, but by Friday the situation in the capital was being declared a major incident with one in 20 people infected in some areas and hospitals under “immense pressure”.

Not all health boards areas are delivering vaccinations in the same way in Scotland, however.

HeraldScotland: Dr Iain Kennedy, Inverness GP and secretary of the Highland Local Medical CommitteeDr Iain Kennedy, Inverness GP and secretary of the Highland Local Medical Committee

In the Highlands - where GPs were never supportive of the 2018 contract’s approach to immunisations - most doctors will be inoculating all over-50s and priority patients on their lists.

Dr Iain Kennedy, a GP in Inverness and secretary of the Highland Local Medical Committee (LMC), said their most recent survey found that over 90% of their members wanted to deliver the Covid vaccine to their patients, just as they did with the flu vaccine.

The region's GP-led drive is believed to be one of the reasons why Highland achieved one of the highest flu jag uptake rates in Scotland this year.

If an individual practice does not want to inoculate under-65s, the opportunity will be offered up to neighbouring practices first, before being offered to pharmacists and optometrists.

Practices close to hospitals, such as Raigmore in Inverness, Caithness General in Wick, and the Belford in Fort William, are more likely to receive batches of the Pfizer vaccine due to the logistical difficulties of storing and transporting it at -70°C.

Those further afield will receive the Oxford-AstraZeneca vaccine.

READ MORE: 'Real risk' some Pfizer vaccines will be wasted after U-turn on second dose, warns medic - as BMA calls for second appointments to be reinstated

Dr Kennedy said he had been given assurance by the BMA that any GP practices across Scotland which want a bigger role in the Covid rollout will be allowed to do so.

He said: “I’m hearing a mixed approach from GP colleagues across Scotland.

"There are some health board areas that are taking the same approach as us in Highland, there are other groups of GPs who are at the opposite end of the spectrum where they want to see the health board take complete ownership of the delivery, then there are GPs in between who are willing to contribute where they can.

“Some parts of the country are clearly feeling the pressure more than others.

“I can understand why things might be confusing to the public in Scotland, particularly given that GPs in England have been administering the vaccine for two or three weeks.

"Unfortunately I think this is one of the unintended consequences of the new GP contract in Scotland where centralising the vaccine in hospitals rather than like England's primary care networks has resulted in a slower start to the programme.”

In Edinburgh, Dr Iain Morrison is among the GPs who wants to have a bigger role.

Although he stresses he does support the GP contract's objective of delegating responsibility for vaccinations, in general, to health boards, he says the pandemic is a "unique situation".

HeraldScotland: Dr Iain Morrison, chair of Lothian LMCDr Iain Morrison, chair of Lothian LMC

Dr Morrison, who is chair of the Lothian LMC and a partner at Newbattle Medical Practice in Edinburgh, said: "We are vaccinating our frontline staff and the over-80s within practice. However, there is appetite to deliver more.

"We fully appreciate it’s not as simple as it being general practice only - under no circumstance do we want the delegated function - but we do want to help.

“There is concern that without general practice involvement the wider programme may not be as efficient as it could be.

“I would like to be involved in vaccinating anyone who is unable to attend one of the mass centres. There’s concern about the health inequalities of mass centres.

"I work in a very deprived area and our nearest mass centre currently is going be Queen Margaret University, which requires several trips on public transport which is counter-intuitive in a pandemic.

"If we have 120 sites within general practice in Lothian, that allows for a much more local distribution, which helps reduce health inequality.

“But we can’t do everything - we can’t continue doing all general medical services and the biggest vaccination programme of all time, so we do need the majority of vaccinations to be delivered centrally.”

Dr Morrison urged the public to be patient until vaccines become available.

He said: “Everybody is keen to get going, the willingness is there across the whole sector - but we’re a bit hamstrung by the bottleneck of supply.

“We are fielding a huge amount of calls regarding the vaccination programme, but the NHS will contact your when it’s time for your vaccination - please don’t contact us, in the nicest possible way.

"Because unlike the first lockdown, we’re not seeing any drop in demand for standard services.

"It is busier than ever. We had a record day on Tuesday for the amount of patient contacts in our practice, and only a fraction of that was Covid-related.”

READ MORE: Warning rollout of Covid jags to over-80s could be delayed by shortage of vaccinated GPs and primary care staff

Dr Lewis Morrison, chair of BMA Scotland and a consultant geriatrician in East Lothian, said he expected the bulk of vaccinations in his area to be delivered "in NHS Lothian facilities - not GP practices".

He added: “In England it will be GP-delivered; in Scotland it will be more a case that GPs will help where the geography and their availability to do so enables them, and secondly their premises.

“It may be that some GP localities are involved in vaccination, but the primary responsibility for delivering it lies with the health boards. "

A Scottish Government spokesman said: “GPs have a significant role to play in delivering the vaccine - and we thank GPs for their hard work as the over-80s community roll-out begins.

“We’re moving at pace to ensure that over-80s who - alongside care home residents - are highest on the priority list, get the vaccine by the end of this month.

“We will of course be discussing with GPs and other clinicians the next phases of community vaccine roll out as we work to getting all 2.7 million over-50s vaccinated by May.”