Dear All

Our Covid Response Team met yesterday and discussed the proposed roll out of AZ Vacination to groups 4a and 7.

This is not without its challenges, not least in identification of patients that are eligible in each group. Michael has sent around some excellent tips to help identify patients through our IT systems but there will still be difficulty in identifying all appropriate patients in these groups.

Key points

1. Practices have the choice as to whether to provide this service. However it is clearly in the best interest of everyone in Ireland to facilitate vaccination of all groups as soon as vaccines are available. To this end we would encourage all Centric Practices to participate.
2. HSE need to know by close of business (5pm) today an ESTIMATE of those patients in GROUP 4a only (labelled 5a on HSE website just to confuse).
3. Patients within these cohorts need to be identified whether practices chose to opt in or not. If not, the HSE are responsible for arranging to vaccinate these patients. Age range 18-64 years.
4. The doctor's discretion can be used in identifying patients as the criteria is open to interpretation.
5. The good news is that we will be receiving AZ vaccines so you have more time to plan clinics, or administer in smaller regular sessions as the AZ Vaccine has a Fridge life 6 months.
6. Vials come with 10 doses per vial which will as per other vaccines need to be given with 6hrs of breaking seal.
7. AZ vaccines come in batches of 100 so you need to round off your estimate upwards to the nearest 100  (if you have less than 100 patients you can use the remaining vaccines to vaccinate Gp 7 later)
8. There is also the option to administer these vaccines in another location, organised by the practice (not HSE) provided the space complies with the requirements detailed in IMO circular 31.3.21.
9. Anticipated delivery dates of AZ vaccines will commence from 12th April and alternate with mRNA delivery weeks.
10. (We will look at Group 7 in the next week and contact you regarding this group in due course)

If you have any queries or need further help please contact myself or your regional manager lead through your PM.

We are discussing the most efficient and best way to contact and register these patients for the vaccine in each practice and I will revert with advice early next week.
I am conscious that we minimise additional admin work whilst ensuring we identify all patients in each of the groups.

Thanks

Gavin

Dr Gavin Maguire

GP Clinical Operations Support

IMO CIRCULAR DATED 31.3.21

Dear Member

Further to the communication on Very High Risk and High Risk patients we wish to clarify a number of issues that have been raised by members.

Firstly, we wish to advise that the IMO has no role in determining the prioritisation cohorts, this is a matter for NIAC and Government.  Following the change in prioritisation in relation to Very High Risk (Cohort 4a) and High Risk Patients (Cohort 7) a request was made by Dr Colm Henry, Chief Clinical Officer, of the IMO to seek the cooperation of GPs to vaccinate this group of patients in the full recognition that GPs are best placed to identify the patients within their own practices and recognising the issues with systems within the acute sector.

We fully recognise the enormous efforts of GPs have made and continue to make in terms of delivery the programme to Over 70s and the impact this has had in terms of workload for GPs and their Practice Teams.

As indicated this is a huge ask of General Practice but it is NOT an obligation and there is no intention for commit General Practice as a body to this Programme. The IMO in seeking to represent the interests of its members, and allowing for the variations in practice capacity and ability to continue with the vaccination programme, ensured the programme is Opt In.

In terms of you assessing whether or not you are in a position to participate please note the following points of clarification:

If I do not sign up for Astra Zeneca vaccination for Cohort 4 and Cohort 7 what happens to these patients.

The focus for this stage is establishing the number of patients (in these cohorts) who may be affected where the GP is not in a position to engage with the programme.  At that stage it will be a matter for the HSE as to how those patients that such practices will identify will be vaccinated in line with NIAC prioritisation.

How do I sign up for AstraZeneca Vaccination?

GPs complete the cohort profile form for patients on their list in cohort 4a. The form is available herehttp://imo.newsweaver.com/memberadvisory/x0i5vtllkvgfyod79xdkvj?email=true&a=6&p=59069450&t=32096350 . This form is then returned to GPvaccines@hse.iemailto:GPvaccines@hse.ie .

If possible GPs should return the form by 5pm on Friday 2nd April.

Why is the timeframe to sign up so short?

One of the most significant issues for GPs in the early weeks of the Over 70s programme (which started as a 3 week programme) was the uncertainty around when the practice would receive vaccines and the associated imperative to use the vaccine within 120 hours – this led to a number of significant issues in dealing with patient requests and queries.

The objective of this programme (which is a 4 week roll out for Very High Risk) is to be in a position to advise GPs IN ADVANCE OF THE ROLL OUT what week (i.e 12/19/26 April or first week in May) they will receive their delivery so that they can advise patients when the practice will have a supply of the vaccine.  We had received a commitment from the HSE that the logistics would be worked on in the period between 2nd April and 7th April.

The deadline ONLY applies to an estimate of the number of patients in Cohort 4A.

What if I wish to vaccinate Cohort 4a but not Cohort 7?

The vaccine to be used in this Programme is Astra Zeneca which is distributed in packs of 100 doses – it would not be possible to ensure that each GP only received vaccine as per the exact allocation and in most cases, particularly given the number of Very High Risk patients per GP it is likely that you would need to move down to Cohort 7 in order to ensure no vaccine is wasted.  However in relation to the broader cohort 7 patients, when you are asked to identify the number of patients you can indicate at that point you can indicate your intention to withdraw from the programme on the proviso that you complete Dose 2s for your patients already vaccinated.

Are there medico-legal issues in terms of identifying patients?

No.  GPs are asked to use the best efforts, it is recognised and acknowledged that not all patients may be captured within this programme but will in all circumstances have the opportunity to register for a vaccination in one of the mass vaccination centres, once the programme progresses to the next stage.

When will I have clinical guidance to determine patient numbers in Cohort 7

Cohort 7 clinical guidelines will be issued early next week but as in line with Cohort 4a there will be a pragmatic approach in terms GP clinical judgement in relation to the application of the clinical guidelines.  In general terms conditions in Cohort 7 will be similar to cohort 4 but the clinical threshold will be lower.

Do I have to use the Astra Zeneca Vaccine within a certain timeframe?

Strict timelines do not apply. Given the objectives of the vaccine programme it is important that vaccines are administered as quickly as feasible but there is greater flexibility in terms of organising clinics.  From the time of delivery to the GP practice, the vaccine has a shelf life of 6 months (the vials should remain in their original boxes in the fridge until time of usage) , which provides you with greater flexibility in the scheduling of clinics. From the time of vial opening (first needle puncture) to administration, the product may be kept and used at temperatures up to 30°C for a single period of up to 6 hours. After this time period, the product must be discarded.COVID‐19 Vaccine AstraZeneca®  comes ready to use (no reconstitution), and each vial contains at least 10 doses.  One dose (0.5 mL) contains not less than 2.5 x 108 infectious units (Inf. U).  When low dead volume syringes and/or needles are used, the amount remaining in the vial may be sufficient for an additional dose(s). The National Immunisation Advisory Committee advises that if more than ten doses can be safely and accurately withdrawn from a vial they can be used as valid doses. There should be no pooling of excess vaccine volume from multiple vials.

Does Astra Zeneca clinics have to be administered in GP Practices or can GPs use facilities such as local halls for clinics?

GPs may choose to run Astra Zeneca vaccination clinics in halls or local centres where it is more practical.  As with the flu vaccination programme it will be the responsibility of the individual GP (or groups of GPs who come together) to ensure the non practice location:

·      Is suitable in terms of providing registration area, vaccination area and observation area

·      Is set up with appropriate facilities for refrigeration and emergency clinical intervention (i.e. severe reactions)

·      Has toilet facilities and hot and cold running water

·      Is covered for the running of vaccination centres in terms of public liability

Is the Operational guidance document still relevant?

The operating guidance document in it’s current format is relevant for the Over 70s Programme, however many of the basic elements will remain the same and it will be updated appropriately.  However, at this time it is the clinical guidance document for this programme which will be of most assistance in terms of identifying patients can be viewed herehttp://imo.newsweaver.com/memberadvisory/1250hle2l88fyod79xdkvj?email=true&a=6&p=59069450&t=32096350.

As always our Member Advisory Team are here to assist (email imo@imo.iemailto:imo@imo.ie or gpissues@imo.iemailto:gpissues@imo.ie) and details of IMO Webinar on Tuesday 6th April will issue tomorrow.

Yours sincerely

IMO Team

APOLOGIES for any confusion regarding AGE groups for Groups 4 and 7. This was due to a lack of clarity in HSE and IMO documents

See below:

Dear Doctor,

Further to our earlier communication, we write to clarify the age categories for Cohort 4 and Cohort 7.

Cohort 4- Patients with Very High-Risk Conditions applies to those patients aged 18-69 who meet the relevant clinical criteria.

Cohort 7-Patients with High-Risk Conditions apply to those patients aged 18-64 who meet the relevant clinical criteria.

Yours sincerely,

IMO Team

(NOTE: patients aged 65-69 years that are NOT VERY HIGH risk will be vaccinated through HSE Mass Vaccination Clinics)

From: Gavin Maguire
Sent: 02 April 2021 10:10
To: gpdiscussion@centricgpforum.com gpdiscussion@centricgpforum.com
Cc: QIC QIC@centrichealth.ie
Subject: AZ Vaccination Rollout - Information

Dear All

Our Covid Response Team met yesterday and discussed the proposed roll out of AZ Vacination to groups 4a and 7.

This is not without its challenges, not least in identification of patients that are eligible in each group. Michael has sent around some excellent tips to help identify patients through our IT systems but there will still be difficulty in identifying all appropriate patients in these groups.

Key points

1. Practices have the choice as to whether to provide this service. However it is clearly in the best interest of everyone in Ireland to facilitate vaccination of all groups as soon as vaccines are available. To this end we would encourage all Centric Practices to participate.
2. HSE need to know by close of business (5pm) today an ESTIMATE of those patients in GROUP 4a only (labelled 5a on HSE website just to confuse).
3. Patients within these cohorts need to be identified whether practices chose to opt in or not. If not, the HSE are responsible for arranging to vaccinate these patients. Age range 18-64 years.
4. The doctor's discretion can be used in identifying patients as the criteria is open to interpretation.
5. The good news is that we will be receiving AZ vaccines so you have more time to plan clinics, or administer in smaller regular sessions as the AZ Vaccine has a Fridge life 6 months.
6. Vials come with 10 doses per vial which will as per other vaccines need to be given with 6hrs of breaking seal.
7. AZ vaccines come in batches of 100 so you need to round off your estimate upwards to the nearest 100  (if you have less than 100 patients you can use the remaining vaccines to vaccinate Gp 7 later)
8. There is also the option to administer these vaccines in another location, organised by the practice (not HSE) provided the space complies with the requirements detailed in IMO circular 31.3.21.
9. Anticipated delivery dates of AZ vaccines will commence from 12th April and alternate with mRNA delivery weeks.
10. (We will look at Group 7 in the next week and contact you regarding this group in due course)

If you have any queries or need further help please contact myself or your regional manager lead through your PM.

We are discussing the most efficient and best way to contact and register these patients for the vaccine in each practice and I will revert with advice early next week.
I am conscious that we minimise additional admin work whilst ensuring we identify all patients in each of the groups.

Thanks

Gavin

Dr Gavin Maguire

GP Clinical Operations Support

IMO CIRCULAR DATED 31.3.21

Dear Member

Further to the communication on Very High Risk and High Risk patients we wish to clarify a number of issues that have been raised by members.

Firstly, we wish to advise that the IMO has no role in determining the prioritisation cohorts, this is a matter for NIAC and Government.  Following the change in prioritisation in relation to Very High Risk (Cohort 4a) and High Risk Patients (Cohort 7) a request was made by Dr Colm Henry, Chief Clinical Officer, of the IMO to seek the cooperation of GPs to vaccinate this group of patients in the full recognition that GPs are best placed to identify the patients within their own practices and recognising the issues with systems within the acute sector.

We fully recognise the enormous efforts of GPs have made and continue to make in terms of delivery the programme to Over 70s and the impact this has had in terms of workload for GPs and their Practice Teams.

As indicated this is a huge ask of General Practice but it is NOT an obligation and there is no intention for commit General Practice as a body to this Programme. The IMO in seeking to represent the interests of its members, and allowing for the variations in practice capacity and ability to continue with the vaccination programme, ensured the programme is Opt In.

In terms of you assessing whether or not you are in a position to participate please note the following points of clarification:

If I do not sign up for Astra Zeneca vaccination for Cohort 4 and Cohort 7 what happens to these patients.

The focus for this stage is establishing the number of patients (in these cohorts) who may be affected where the GP is not in a position to engage with the programme.  At that stage it will be a matter for the HSE as to how those patients that such practices will identify will be vaccinated in line with NIAC prioritisation.

How do I sign up for AstraZeneca Vaccination?

GPs complete the cohort profile form for patients on their list in cohort 4a. The form is available herehttp://imo.newsweaver.com/memberadvisory/x0i5vtllkvgfyod79xdkvj?email=true&a=6&p=59069450&t=32096350 . This form is then returned to GPvaccines@hse.iemailto:GPvaccines@hse.ie .

If possible GPs should return the form by 5pm on Friday 2nd April.

Why is the timeframe to sign up so short?

One of the most significant issues for GPs in the early weeks of the Over 70s programme (which started as a 3 week programme) was the uncertainty around when the practice would receive vaccines and the associated imperative to use the vaccine within 120 hours – this led to a number of significant issues in dealing with patient requests and queries.

The objective of this programme (which is a 4 week roll out for Very High Risk) is to be in a position to advise GPs IN ADVANCE OF THE ROLL OUT what week (i.e 12/19/26 April or first week in May) they will receive their delivery so that they can advise patients when the practice will have a supply of the vaccine.  We had received a commitment from the HSE that the logistics would be worked on in the period between 2nd April and 7th April.

The deadline ONLY applies to an estimate of the number of patients in Cohort 4A.

What if I wish to vaccinate Cohort 4a but not Cohort 7?

The vaccine to be used in this Programme is Astra Zeneca which is distributed in packs of 100 doses – it would not be possible to ensure that each GP only received vaccine as per the exact allocation and in most cases, particularly given the number of Very High Risk patients per GP it is likely that you would need to move down to Cohort 7 in order to ensure no vaccine is wasted.  However in relation to the broader cohort 7 patients, when you are asked to identify the number of patients you can indicate at that point you can indicate your intention to withdraw from the programme on the proviso that you complete Dose 2s for your patients already vaccinated.

Are there medico-legal issues in terms of identifying patients?

No.  GPs are asked to use the best efforts, it is recognised and acknowledged that not all patients may be captured within this programme but will in all circumstances have the opportunity to register for a vaccination in one of the mass vaccination centres, once the programme progresses to the next stage.

When will I have clinical guidance to determine patient numbers in Cohort 7

Cohort 7 clinical guidelines will be issued early next week but as in line with Cohort 4a there will be a pragmatic approach in terms GP clinical judgement in relation to the application of the clinical guidelines.  In general terms conditions in Cohort 7 will be similar to cohort 4 but the clinical threshold will be lower.

Do I have to use the Astra Zeneca Vaccine within a certain timeframe?

Strict timelines do not apply. Given the objectives of the vaccine programme it is important that vaccines are administered as quickly as feasible but there is greater flexibility in terms of organising clinics.  From the time of delivery to the GP practice, the vaccine has a shelf life of 6 months (the vials should remain in their original boxes in the fridge until time of usage) , which provides you with greater flexibility in the scheduling of clinics. From the time of vial opening (first needle puncture) to administration, the product may be kept and used at temperatures up to 30°C for a single period of up to 6 hours. After this time period, the product must be discarded.COVID‐19 Vaccine AstraZeneca®  comes ready to use (no reconstitution), and each vial contains at least 10 doses.  One dose (0.5 mL) contains not less than 2.5 x 108 infectious units (Inf. U).  When low dead volume syringes and/or needles are used, the amount remaining in the vial may be sufficient for an additional dose(s). The National Immunisation Advisory Committee advises that if more than ten doses can be safely and accurately withdrawn from a vial they can be used as valid doses. There should be no pooling of excess vaccine volume from multiple vials.

Does Astra Zeneca clinics have to be administered in GP Practices or can GPs use facilities such as local halls for clinics?

GPs may choose to run Astra Zeneca vaccination clinics in halls or local centres where it is more practical.  As with the flu vaccination programme it will be the responsibility of the individual GP (or groups of GPs who come together) to ensure the non practice location:

·      Is suitable in terms of providing registration area, vaccination area and observation area

·      Is set up with appropriate facilities for refrigeration and emergency clinical intervention (i.e. severe reactions)

·      Has toilet facilities and hot and cold running water

·      Is covered for the running of vaccination centres in terms of public liability

Is the Operational guidance document still relevant?

The operating guidance document in it’s current format is relevant for the Over 70s Programme, however many of the basic elements will remain the same and it will be updated appropriately.  However, at this time it is the clinical guidance document for this programme which will be of most assistance in terms of identifying patients can be viewed herehttp://imo.newsweaver.com/memberadvisory/1250hle2l88fyod79xdkvj?email=true&a=6&p=59069450&t=32096350.

As always our Member Advisory Team are here to assist (email imo@imo.iemailto:imo@imo.ie or gpissues@imo.iemailto:gpissues@imo.ie) and details of IMO Webinar on Tuesday 6th April will issue tomorrow.

Yours sincerely

IMO Team