Doctors differ over rollout of Covid-19 vaccine to over-85s in GP clinics

The decision to administer Covid-19 doses to over-85s in GP surgeries will not impede the rollout of the vaccine, according to the head of the Irish Medical Organisation’s GP committee Dr Denis McCauley.

The first over-85s received their vaccines in their local doctors’ surgeries on Monday, as the vaccination rollout moved into the community for the first time.

However, the use of GP surgeries prompted some criticism from doctors who claimed it would slow down the rate of vaccination. Suggestions for alternative sites included local halls and churches.

Monaghan GP Dr Illona Duffy said GP surgeries with large numbers of over-85s would run out of space given social-distancing restrictions in place and the fact that many over-85s would be accompanied by another person.

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This would affect other GP services during vaccinations and could result in GPs having to send patients to hospital emergency departments.

“It is a problem for practices with larger cohorts of patients,” she said.

Her clinic could have vaccinated more people, more quickly in a bigger space such as a church or public hall.

She urged the Health Service Executive to rethink the rollout to older people so that GPs could instead use the 37 new local vaccination centres which includes many local hotels.

“There seems to be no pathway for us to enter discussions and yet those spaces are already available in these hotels so why can’t we be allowed to use them,” she said.

Dublin GP Dr Andrew Jordan said GPs surgeries could run out of space very quickly and have to stop face-to-face consultations for other health services if they were not permitted to vaccinate in bigger locations such as local halls.

“If the HSE is able to give Covid vaccines in a tent in a car park at St Mary’s Hospital in the Phoenix Park, I cannot understand how we cannot give it in a much more clement environment like a hall,” he said.

The decision about the location for vaccination clinics was taken by a group comprising representatives of the HSE, Irish Medical Organisation and Irish College of GPs, Dr McCauley said.

It reasoned that GP surgeries were the safest place to start this phase of vaccine rollout due to the frailty of the patients involved and the fact that staff are not familiar yet with dealing with the two vaccines involved.

Insurance issues and security were also factors that led to the decision, according to Dr McCauley.

Vaccine supplies

GPs have about five days to use up their supplies of vaccine, he pointed out, leaving them the flexibility to timetable sessions in quieter periods of their working week.

Because supplies are restricted at present, Dr McCauley argues that having to administer vaccines in GP surgeries will not impede the rollout of the programme.

GPs successfully administered more than a million flu doses to their patients in their surgeries last autumn, in the middle of a Covid-19 surge, he pointed out.

Carol O’Dea, a GP practice manager in Edenmore, Dublin, said it was scheduled to get 140 vaccines and hoped to have four vaccinators working “flat out” on Friday.

The practice will have one doctor doing emergency calls and appointments and nursing home visits have been rearranged for another day.

“We originally hoped to do the entire clinic in the hall, which would be ideal as it is not being used because of Covid, and this would mean we could have maintained a lot more of our non-Covid work.”

“We are using the main clinic for vaccination and then over to the youth centre for observation. We are very lucky as the hall is literally a few steps away. We are just praying for good weather.”

In his own surgery in Co Donegal, Dr McCauley aims to give the vaccine to his over-85s in an afternoon, allocating 10 minutes for the jab and 15 minutes' observation time afterwards.

A practice with two vaccinators needs four seats, while one with five vaccinators needs 10.

“What GP surgery doesn’t have 10 seats to accommodate patients and allow them to socially distance for 15 minutes,” he asked.

Seventy per cent of GP practices, those with more than 200 patients aged 70 and over, will be supplied with vaccine. Smaller practices will group together with others in hubs.

Although the decision to carry out vaccinations in GP surgeries may be revisited when younger patients are being dealt with, Dr McCauley hopes that with time the fears of some of his colleagues will dissipate and they will come to regard the Covid-19 vaccination programme as a sort of “flu vaccine-plus” arrangement.