Caithness GP criticises 'outrageous' cost of NHS Highland vaccination programme
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A Caithness doctor has said it is "outrageous" that taxpayers could be left out of pocket by millions of pounds over the delivery of Covid and flu jabs in the Highlands.
Ewen Pearson declared he was "gobsmacked" that the price tag for the vaccination programme model put forward by NHS Highland was reported to be up to £9 million a year, whereas local GP practices were able to provide the service for just £1.5m.
Dr Pearson argued that GP practices have demonstrated they can achieve a higher uptake of vaccinations as well as doing the work at a fraction of the cost.
He was speaking after Highland MSP Fergus Ewing said he was continuing to press Scotland's health secretary Humza Yousaf on the issue.
Mr Ewing, the MSP for Inverness and Nairn and a former government minister, said this week: “The cost savings of using GPs will run to millions."
Dr Pearson, of the Pearson Practice in Wick, said: “I'd heard some stories about this discrepancy. We always knew it was going to be a worse service and we knew it was going to be more expensive, but I was absolutely gobsmacked when I found out the actual difference.
"I don't think the figures are up for debate, which is even more staggering. They just seem to be accepting that this is how it's going to be and I don't understand why there is no way back from it.
“They've still got clinics and they're still talking about drop-ins, but we were always finished in December.
“A colleague [in another part of the Highlands] told me about a morning clinic where there were two nurses and in the whole morning they gave one vaccine, which again is just ridiculous.
"If we had two nurses for four hours we probably would give 12 of each in an hour, so 24 an hour. You'd be talking about 100 vaccines for two nurses in four hours.
“The uptake is higher so more people get their vaccines. Local knowledge helps, so we know when people can't turn up and we can chase them up and we can remind them a lot easier.
"For older people who were maybe worried about scams and that sort of thing, it's the familiarity that helps.
“We know that general practice is the most cost-effective part of the NHS. The six-times discrepancy is just outrageous.
“They all seem to be very quiet – I don't know why the public health doctors aren't speaking out about this. I would love to hear their explanation but I don't think they have one.
“They really just need to hold their hands up and say it has been a shambles – they need to go back to what was working before.
"I'm sure we could all do it again if we were asked and if we were funded adequately to do it. With higher uptake and lower costs it's common sense, really.”
Mr Ewing questioned Mr Yousaf in the Scottish Parliament at the end of November, highlighting the cost of the NHS Highland model and calling for a vaccination system that is "community-based, led by GPs". The health secretary said at the time he would engage directly with NHS Highland.
Mr Ewing said this week: “I continue to press the cabinet secretary Humza Yousaf to permit Highland GPs to carry out vaccinations. I have no explanation from NHS Highland why they cannot support this and other flexibilities to the terms of the GP contract.
“The cost savings of using GPs will run to millions. But the patient safety arguments are as strong.
“Running a parallel separate service will inevitably lead to lower vaccination rates with greater risk to those not vaccinated.
“Travel problems will make it much more difficult for many to access vaccination services run centrally instead of at rural GP practices, particularly the elderly and those with no car.
“It seems therefore absurd that our GPs are being prevented from doing work they are keen to offer for their patients, and a service most patients want locally accessible and from their GP or their staff.”
A spokesperson for NHS Highland said: "The new GMS [General Medical Services] contract (2018), which is a national contract that is being implemented across Scotland, signalled a shift of vaccine activity out of general practice to NHS board delivered models under the Vaccination Transformation Programme.
"The transfer of vaccinations is a priority for all boards in Scotland to achieve in full by March 2023. It is also recognised that the national vaccination programme has extended beyond what GPs have traditionally delivered as part of their contract (e.g. Covid, extended influenza cohorts), therefore funding to NHS boards has increased as a result.
"GP workloads are stated by the British Medical Association as being higher than ever before – the 2018 contract and associated changes were put in place to reduce the workload and improve patient quality. We hope that any additional capacity released through not having to deliver vaccinations can be focused on the more complex end of health and care and managing this ever-increasing demand.
"In NHS Highland we are working to transfer all vaccines out of general practice on a phased basis in order to meet this target. Travel vaccinations transferred to community pharmacies from summer 2022.
"NHS Highland has taken responsibility for the winter vaccination programme with childhood vaccinations transferring in March 2023. NHS Highland will continue to provide vaccination opportunities to those eligible up to March 31 as per the national programme for vaccination delivery.
"NHS Highland has also achieved higher rates for Covid-19 vaccine (72.3 per cent) and flu vaccine (63.6 per cent) than the national averages in the 2022/23 winter vaccination campaign."
The Pearson Practice is one of two GP practices in Wick, both based at Wick Medical Centre. The other is Riverview.
GPs provided the service for £1.5 million a year. The NHS Highland model is up to £9 million a year.
Edited transcript from Scottish Parliament Portfolio Questions, November 30, 2022:
Fergus Ewing: "To ask the Scottish Government what action it can take to support a GP-led Covid-19 and flu vaccination programme in NHS Highland, in light of reports that it would cost several million pounds less than the model proposed by the NHS board."
Humza Yousaf: “The Scottish Government will continue to support NHS Highland to determine whatever delivery mechanisms it considers best for the winter programme and it has not, and will not, veto the use of primary care.
“I would expect NHS Highland to benefit from the experience of its GPs in designing vaccination services which are cost-effective and allow the greatest use of all funds and work towards the best experience possible for our patients.”
Mr Ewing: “GPs provided the service for £1.5 million a year. The NHS Highland model is up to £9 million a year. Will the Cabinet Secretary ask his officials to engage directly with the GP practice in Nairn and others representing GPs in the Highlands to devise a system of provision of vaccination services that is safest, that is most efficient, that is community-based, led by GPs, and which, on the evidence available, would be likely to save several million pounds for the taxpayer when compared to the health board proposals?"
Mr Yousaf: “I will ask my officials to engage directly. I will go one further and I will also engage directly with NHS Highland on the issues that the member has raised.
"He is right – these things have to be balanced. Of course, at a time of severe financial constraint, we should be looking to get the best value for money but also ensuring, of course, that people have the access that they need for vaccinations.
"The winter Covid and flu vaccination programme is nearing its end but certainly in advance of any potential future booster campaign I'll engage with NHS Highland."
