Vax campaign not going by the book

The big news this week was the Australian Department of Health’s call for expressions of interest from general practices to take part in phase 1b of the Covid vaccination program, which is due to begin in March. As the EOI has been digested over the week, some serious questions are being asked about the plan, which doesn’t appear to be fully fleshed out.

Putting aside whether it will be financially viable for any but the largest general practices that can guarantee a production line process to take part, questions remain about how to schedule patients for the different phases of the roll-out, the ability to adequately staff the clinics, and the site requirements that the department is specifying. We are now seeing pushback from GPs about the MBS funding model and concerns over patients that won’t be able to get their vaccine from their regular practice.

There are also questions about the national booking system that the department is promising. There is little detail in the EOI about this, so we sent them a few questions on Monday. Is the department seriously going to build a whole new system, which would take months, or is it going to do the smart thing and use one of the existing online booking systems like HotDoc, MyHealth1st, Healthsite or HealthEngine, with an interface to the booking system used by each practice if needs be? Healthdirect used HotDoc to quickly rustle up a booking system for the Covid respiratory clinics, albeit without the interface, so it can be done in a hurry using an off-the-shelf system.

From the response we received from the department today, we are not confident they are on the right track. “We are working through opportunities and design of the national booking system,” a DoH spokesperson told us. “Further advice will be provided as these designs progress, including through discussions across governments and the sector. The Department is unlikely to be able to provide further details at this stage but will continue to provide information as it becomes available.” We are hearing that none of the vendors has been contacted as yet.

You’d think this would have been sorted last year, given that we have a global pandemic on our hands with a vaccine the only way to control it long-term and a mass vaccination program essential, wouldn’t you? Questions also remain about who is going to handle recalls for the second dose, and there are questions too for the hospital-based hubs about whether they will need a booking system or how they will access the Australian Immunisation Register (AIR).

To the department’s credit we have the AIR in place, and people can access their history pretty easily through Medicare’s online services and the My Health Record. (Chamonix has jumped on this and added a Covid immunisation status section to its MyHR-linked Healthi app.) But surely the department knew that a mass vaccination effort would need to be done this year and formed part of its forward planning? We are not overly confident.

We are also wondering why the Australian Digital Health Agency (ADHA) doesn’t appear to be involved in any of the Covid planning or activity, outside of the five projects it funded last year through its grandly titled innovation challenge. Why hasn’t it been put in charge of the national booking solution, or anything else IT related?

Perhaps it speaks to the relevance of the agency itself. In last week’s blog, we asked for your views on what you thought ADHA’s role is or should be, and we got loads of answers. Our favourite responses to the question of what would you like to see the Australian Digital Health Agency (ADHA) achieve in 2021 were “something” – quite a few of you said that – and “get shit done instead of nothing”.

Some called for the agency to be disbanded completely, many said it needed to resolve the interoperability and messaging challenges that have so far defeated it, but the clear leader in volume of comments was “make My Health Record work”. It was notable that no one leapt to the defence of the agency, except for one critical comment about Pulse+IT’s “negativity” and another criticising our “shallow, ill-informed question”. Everyone else thought something needed to be done.

But like our view on the Department of Health’s ability to handle a national booking system properly, we are not confident that will happen.

So, to this week’s question:

Is Australia adequately prepared for the mass vaccination roll-out?

Vote here and feel free to leave your comments below.


+2 # Karen Booth 2021-01-30 09:06
Large numbers of practices have been excluded because they do not have RACGP accreditation, despite the fact they have been accredited by the state health depts to stock and give vaccines under the NIP.
Nurse practitioners services currently excluded despite despite the fact they have been accredited by the state health depts to stock and give vaccines under the NIP.
Payments going to individual GPs, would have been better to give flexible pool of fund$ to practices to to run nurse vax clinics with GP onsite & as needed
+1 # Kate McDonald 2021-01-30 15:20
I’m stunned by the seeming lack of involvement of nurses. The department has the ACN developing the education module, which hopefully shows they’re aware of the role of nurses, but apart from that there’s nothing.

I’m 48 years old and as far as I know, have never been administered a vaccine by a doctor. Always a nurse.
0 # Andrew Baird 2021-01-30 15:34
Hi Kate, you did not need to disclose your age! :-) I am not going to disclose my age.

I have received vaccines exclusively from GPs, but I think that's an unusual experience. At some GP Clinics, only GPs administer vaccines, at some, both Practice Nurses and GPs administer vaccines, and at some, only Practice Nurses administer vaccines. I have no idea how many GP Clinics are in each of those three categories. But your point is correct. Nurses do a lot of the vaccinating in General Practice. The Government's General Practice roll-out does enable Nurses to administer COVID-19 vaccine in general practice, provided they are trained and accredited (and they will be if they are doing vaccinations). So GP Clinics that involve Practice Nurses in vaccination will be able to continue to do so for the COVID-19 program

I do not think it is reasonable for nurses to set up standalone clinics outside of general practice - they would need to get accredited for standards, training, equipment, cold chain management, etc. And that won't happen overnight.

Any word on pharmacies getting involved??
+1 # Kate McDonald 2021-01-30 15:51
In New Zealand we got our childhood vaccines administered by Plunkett nurses. I think my mum still has the book. TB in primary school in Australia, rubella in high school, tetanus twice in urgent care but once in a general practice, still administered by a nurse under the supervision of a GP. Annual flu shots paid for by employers and administered by nurses ... I don’t think my experience is unusual. Granted that the phase 1b patients are the high risk ones and GPs must be the primary clinician, I still find it extraordinary that nurses and the nursing workforce are not front and centre. They’ll be doing most of the work.

The department says the GP respiratory centres and ACCHS will be involved in phase 1b but they don’t need to go through this EOI process. Pharmacies will come on board later in the year for the low risk groups like 48 year old unessentials like moi.

Karen Middleton in The Saturday Paper today says Accenture has been given the contract to build the national booking solution. This is not ideal.
+1 # Andrew Baird 2021-01-30 09:07
The EOI application form has 18 pages and 5000 words. Not a good user experience.

In Phase 1b, the Government aims to administer 15 million doses of the AstraZeneca vaccinate to 7.5 million people

The Government wants 1000 general practices to do this (does this include GP Respiratory Clinics? – not stated). That’s 15,000 doses per general practice. The Government does not state when 1b will be completed. So, let’s say, if this is to be completed by a general practice over 15 weeks, that’s 1000 per week, or 200 per day (providing a vaccination clinic on 5 days per week).

Non-accredited general practices are excluded from submitting EOI (this may be because non-accredited practices have not been assessed for compliance with immunisation requirements, eg appropriate fridges, and appropriate protocols?). The Government does not know how many general practices it is excluding as it does not know the number of non-accredited general practices in Australia (nobody knows).

The Government do not know the number of GPs that are in accredited practices. So, 1000 general practices = ?? how many GPs

In SEMPHN, so far, 150 of 487 general practices have submitted an EOI.

Implementing a COVID-19 Vaccine clinic will necessitate changes in a Clinic’s workflows and necessitate staff deployments/red eployments/recr uitments (including deployment/rede ployment of GPs – who may be diverted from a regular consulting session).

Clinics may need to provide COVID-19 Vaccine clinics after hours to minimise disruption to the Clinic’s usual activities.

Pre-vaccination counselling will add to vaccine consultation time.

Drawing up the vaccine from multi-dose vials adds to time and to risk.

Recall system for 2nd dose, and following up attendance for 2nd dose will take additional time.

Practices will need to all for time taken to undertake training (not remunerated).

Reporting requirements (AIR) may potentially add to time taken for the vaccine encounter, but hopefully Clinical Software will facilitate this.

There are logistical challenges around physical distancing and post-vaccinatio n observation (15 minutes on site), particularly if a Clinic is running its regular consulting sessions simultaneously.

A consulting room is required for the vaccination encounter (private, sound-proof)
Space requirements.

There are time and motion requirements so that patients do not pass one another when moving between waiting area and consulting room.

Defibrillator required (appropriate, but some accredited practices do not have one)

Requirement for a person to take role of concierge (to direct flow)

No information about National Booking System and its integration with Clinic’s appointment system.

Remuneration is too low for consultation time and for costs associated with Vaccine Clinic (changing consulting session schedules, diverting GPs from consulting sessions to Vaccine Clinics, employing/redep loying nurses and admin staff, structural and workflow changes (eg protected areas with physical distancing), workload). The money doesn’t just go into the GP’s pocket!

Benefit 2 x BBI1st dose 1 x BBI2nd dose Both*
Item 3 metro 17.75 13.00 30.75 6.50 24.25 65.00
Item 5000 metro 29.90 13.00 42.90 6.50 36.40 99.30
Item 3 rural 17.75 19.60 37. 35 9.80 27.55 74.90
Item 5000 rural 29.90 19.60 49.50 9.80 39.70 99.20

Item 3 Level A, normal hours
Item 5000 Level A, after-hours (8pm-8am M-F, 1pm Sat – 8am Mon)
BBI Bulk-billing incentive.
Both* Medicare benefits for 1st and 2nd doses, plus a $10 PIP
+1 # Andrew Baird 2021-01-30 12:13
Hi Karen,
Same here. Our practice isn't accredited with AGPAL etc, but we are accredited with Victorian DHHS, and our GPs give the all NIP vaccines and travel vaccines too (well, no travel vaccines at present, of course, and we're not a YF accredited clinic). So, not accredited, so we can't participate in Phase 1b of the COVID-19 vaccine roll-out. Frankly, we would not wish to participate in this, at least, not as it is presently structured.
We'll be busy giving influenza vaccination to everyone who gets displaced from Clinics that are giving COVID-19 vaccines!
Also agree++ with your comments about payments, PNs, NPs, and nurse-led clinics.
0 # Andrew Baird 2021-01-31 11:12
Greg Hunt has announced that the number of general practices in the Phase 1b roll-out has been increased from 1000 to 2000 'because a large number of general practices have expressed interest'
The announcement also stated that Pharmacies will be involved in the Phase 1b roll-out. Very interesting. So pharmacies get in ahead of non-acccredited general practices that are accredited for immunisation by State/Territory health departments. Does anyone have any more information about this?
0 # Andrew Baird 2021-01-31 11:20
15,000,000 doses of the AstraZeneca vaccine for Phase 1b.

Assuming that:
1. Only general practices will be administering this (including GP Respiratory Clinics and ACCHSs, but excluding pharmacies), and
2. 2000 general practices are recruited to the roll-out program,

Then that's 7,500 doses (3,750 people) per practice on average. The period for Phase 1b has not been stipulated, but let's say 8 weeks. That's 938 doses per week, or 188 doses per day (for vaccination clinic on 5 days per week).

Do general practices have the capacity for this?
0 # Andrew Baird 2021-01-31 14:40
Any idea what proportion of Pharmacies are accredited for vaccination? Is there a way of finding out if a Pharmacy is accredited for vaccination?

If Pharmacies that are accredited for vaccination are going to be recruited for the 1b roll-out, then why not also recruit the vaccination-acc redited general practices that are not accredited general practices?

Why are vaccination-acc redited Pharmacies being given priority over vaccination-acc redite general practices?

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