21 Jul 2021

'Red tape' keeping GPs from giving Covid-19 vaccine, doctors say

From Checkpoint, 5:41 pm on 21 July 2021

Too much red tape and risk-averse health authorities means family doctors have been effectively sidelined when it comes to giving Covid-19 vaccinations, the head of Aotearoa's largest general practice cooperative says.

At least 628,000 people are now fully vaccinated for Covid-19 in New Zealand. But ramping up the rollout has been reliant on large shipments of Pfizer's vaccine arriving on time.

ProCare represents more than 170 general practices around greater Auckland. Clinical director Dr Allan Moffitt told Checkpoint they are desperate to have more GPs vaccinating.

"We've been really pushing to open up GPs being able to vaccinate, it's actually what our patients are telling us, what they want as well.

"For ProCare, we've got 90 practices that are willing and able to vaccinate, but we've been held back by barriers from basically the DHB and the [Ministry of Health].

"We did manage to remove those barriers, so we're about to broaden the number of practices going live each week, but then we hit the vaccine supply issues. But now we are ready to go, so from the end of July we should be starting to really get increased numbers of practices around Auckland vaccinating."

Dr Moffitt said the main barrier was DHBs were "fixated" on setting up the large vaccination centres.

"They were setting up ad-hoc, new facilities, and that's a huge undertaking. They didn't have a team resource to look at the primary care side of it, it was only just one person.

"They were also incredibly risk averse around what needed to happen, and didn't appreciate that general practice vaccinates people every day of the week, and do so incredibly successfully and safely.

"And this vaccine wasn't all that different actually. Even in the early days when we had more constraints around cold chain and shelf life, it was still a very doable thing.

"But now it's got a lot easier to do because the shelf life was longer, and that really can be treated like any other vaccine.

"Our practice nurses are highly trained immunisers and are very familiar with the rules around that. There are some differences for this vaccine around drawing up and needles and so forth that is different [from other vaccines], but once you master that, it's not difficult."

'Operating procedures so bureaucratic most practices were put off'

Dr Moffitt said DHBs seemed to be treating general practices in the same way as super vaccine centres.

"They seem to be imposing a whole lot of rules as if they were setting up a super vaccine centre from scratch, using inexperienced staff, new graduates from nursing school that never vaccinated before, rather than treating general practices as already having processes in place.

"Operating procedures were just so bureaucratic and difficult, most practices were put off."

Currently ProCare has 11 general practices administering Covid-19 vaccines, Dr Moffitt said.

"We've got another three going live this week across Auckland metropolitan areas.

"We've been limited to 10 practices per week, and even though we have got 10 approved per week … we haven't got that number vaccinating because some still haven't met their requirements.

"DHBs control access to the delivery of the vaccine, so we have to go through that approval step before general practice can get access to it.

"There is quite a lot of additional training involved, because apart from the drawing up of the vaccine there's a new Covid-19 immunisation register process that people have to train and learn on. It all has to be loaded correctly, there's quite a lot of administrative burden attached to that."

Dr Moffitt wrote to Director-General of Health Dr Ashley Bloomfield in March, advocating for general practices to be involved in the rollout, which would have reached further than the current system.

"Basically the response was: 'We're going to enable DHBs to involve primary care but it's up to the DHBs.'

"We have been pushing very hard to say this should be the norm. If we look at the uptake across Māori and Pacific populations, it's actually way below equity. And I believe that if we had targeted the right practices earlier on, we'd be doing much better for that really high-risk population group, and the elderly who struggle to travel.

"Sometimes to get to the super vaccine centre, it might be two or three buses that people have to catch. And if you don't have transport, it's much easier to go down to your local doctors surgery and have the vaccine there."

For those who might have vaccine hesitancy, talking with someone they know and trust at their local GP clinic would help, he said.

There is now a new process for approving general practices to go live with administering the vaccine, Dr Moffitt said, which he hopes will mean easier to access vaccinations for more people soon.

Process 'streamlined' for more GPs to vaccinate Group 4

In a statement, the Northern Region Health Coordination Centre said: "General practices are an important part of our programme.

"Auckland has been playing a lead role in the rollout to general practice with 41 clinics now vaccinating their communities and another 78 currently progressing through the onboarding process.

"Not all GP clinics meet the current criteria. Some of that criteria includes: having a focus on equity and our most at-risk communities, being able to maintain business as usual while operating the Covid-19 vaccination service and having suitably trained staff."

It said it has streamlined the process to ensure more GPs can start vaccinating their communities as New Zealand progresses into Group 4.

Auckland doctor Nicholas Cooper told Checkpoint he has been through the training and completed the paperwork, but there is still no word on if and when his practice will get vaccine supplies.

"There's a set of tasks we had to undertake to be ready to administer the vaccines, including online courses. We've done all of that and we've been ticked off by the PHO that has some degree responsibility for us. So we've got the nod that we're fine to do the job, we just don't have the vaccine."

He said with the current system it would be best if vaccinations were done in primary care by GPs.

"Purely because they've got the infrastructure already setup, and the experience to do it."

In response the Northern Region Health Coordination Centre said it has "reached out" to Dr Cooper directly, to see if he would like his eligible patients vaccinated at its new Epsom vaccination centre, before it opens for public bookings next week.