General practice and COVID-19: the journey to get vaccination experts involved

As of July 2021, 94% of New Zealand’s population were enrolled with their local general practice. That’s just over 4.8 million people.¹ From newborns right through to the elderly and across the course of their lives these people are seeking out their general practitioner (GP) when they need to address a health concern.

When COVID-19 found its way into New Zealand 18 months ago, GPs and rural hospital doctors adapted. We quickly and efficiently changed our consultation methods to primarily phone and video-based in order to reduce the spread of the virus in the community and to continue care while keeping patients, and ourselves, safe.²

When talk about approved vaccines and worldwide vaccination rollouts started, we anticipated that our workforce would get the call to be involved in New Zealand’s response to COVID-19. After all, we are experts in vaccinations. General practices have been successfully rolling out continuous nationwide vaccination programmes for childhood immunisations and the flu for decades. During the first Level 4 lockdown in 2020 several practices successfully operated drive-through vaccination clinics for the flu vaccine. In fact, despite the issues with COVID-19 in the community, more flu vaccinations were administered in 2020 than in previous years.³

While the initial call about GP involvement in the vaccination rollout didn’t come straight away – for a variety of reasons – the College and the Ministry of Health were proactively working behind the scenes to address this and work towards a solution.

General practitioners watched on as a new vaccination programme was created, seemingly from scratch, with an expectation that a different model could deliver a large-scale vaccination programme. This has been the main source of our frustration and is why we pushed so hard to be involved in the rollout.⁴

Admittedly there were challenges from the outset and valid reasons for a cautious start to the rollout. There were supply issues. The journey even getting the vaccine into the country can only be described as a rollercoaster ride. The Government faced issues of confirming the vaccine’s arrival into the country and estimating the volume required when we were in the fortunate position of having little COVID-19 illness in the country. But we now have a reasonable supply of the Pfizer vaccine and a more streamlined process for acquiring more, with backup, to give everyone eligible a first dose.⁵ If we can keep this up it does look likely that the majority of New Zealanders who choose to be will be fully vaccinated by the end of the year.

Then there was the storage issue. This was another barrier that excluded most general practices from being able to administer the vaccine early on in the rollout. The original storage temperatures meant that practices did not have the necessary freezers required to store the vaccine. The change allowing the vaccine to be stored at a normal cold chain fridge temperature for up to 31 days⁶ meant it was easier to both transport and store at locations such as GP clinics and pharmacies.

We were pleased to see the Government addressing equity by making the vaccine free, fair and equitably distributed and involving Māori and Pacific providers in the rollout plan but the process for confirming frontline health professionals as eligible to vaccinate was originally fraught with red tape. Getting recognition of general practice capability to deliver vaccines required the College to produce a comparison of its Foundation Standard against the new Ministry of Health standard.

During this time the College fielded a significant number of queries from frustrated general practices who could not deliver the COVID-19 vaccine to patients. To add to the confusion and workload for practices, each of the 20 DHBs had their own administrative processes to signoff general practices and this varied across the country. While we acknowledge that there are extra administrative and procedural obligations for the COVID-19 vaccinations, especially around the COVID immunisation register (CIR), the failure to leverage the systems already in place within general practices meant there were unnecessary double-ups in processes that slowed down the rollout.

This was a frustrating time for us. As GPs, we are here to improve the health outcomes of our communities.

However, it feels like we have finally turned a corner.

In August, the District Health Boards accepted the College’s Foundation Standard certification into part of its eligibility process for practices wanting to administer the vaccine.⁷ This has made a significant difference and it is now easier for general practices to become involved in the vaccination rollout. Since August, over 150 practices have either started administering COVID-19 vaccinations or are confirmed to start vaccinating. The College put a lot of work into getting this over the line and we are pleased to now add this service to the already long list of services that are available to patients.

Where GPs and general practices play such an important role is in the access we have to our communities. We build strong relationships based on trust and compassion with whole whānau (family) groups and have in-depth knowledge of their healthcare, and we see our youngest patients grow up before our eyes. We know the best way to contact with them and perhaps most importantly, we know that a centralised one-size-fits all approach does not suit everybody in our books – so we know how to adapt to meet their needs.

This is an important point. A centralised one-size-fits all approach does not suit the whole of the health sector.

The vaccination rollout is a team effort. Teams across the health sector are continuing to work on the frontline and are coming up with innovative ways to safely administer the vaccines to their communities.

Earlier this year, the College surveyed its members to gauge the levels of involvement GPs wanted to have in the vaccination rollout. We wanted to hear directly from members if there were any concerns or if in fact they were wanting to get involved but coming up against too much bureaucracy.

Of the 656 responses received, 58% (380) said their practice would be willing to be involved in the vaccination rollout. Not surprisingly, the three top barriers to being involved were staff numbers, time, and space at the surgery.

Interestingly, if obstacles such as the ones above were removed, when asked how much of the enrolled population could their practices vaccinate, 47% (308) of respondents said ‘almost all’, 30% (197) said ‘high risk’ patients, and 21% (138) said ‘half of the enrolled population’.

Since this survey, the College has been repeating the message that GPs are the experts in vaccination⁸ and have used these data as a source of truth to show that as a profession we want to be involved and help to provide patients with their own individual protection against COVID-19.

The College has also been advocating the importance of being vaccinated and with the length of time between doses extended to six weeks,⁹ the College has been supporting calls for unvaccinated Māori and Pasifika to be prioritised to receive their first dose of the vaccine.¹⁰

With the Delta variant now in New Zealand and seeing how fast it can spread in the community, the worrying low rates of vaccination in Māori and Pasifika needs to be addressed because the data tell us that these groups of people have greater health needs, increased levels of comorbidities and are often more vulnerable to illness.

It is a fundamental equity issue to vaccinate these community groups because the effects of COVID-19 for them will be more damaging than for other groups.

Ensuring as many people as possible over the age of 12 years receive at least their first dose of the vaccine as soon as possible will go a long way in protecting our communities.

With this Delta outbreak, the impetus to vaccinate and the system changes that make it easier to bring general practices on board will hopefully keep the numbers of vaccinations rising. That is, after all, the goal we are all working towards.