Opinion former engagement
We continue to work with opinion formers to highlight the work of London’s general practice teams, and to elicit support from key stakeholders for unambiguous communication to the public by our national leaders. We think it is critical that patients and communities have a clear understanding and expectation of what services can be offered at any given time; covering immediate essential needs to prevent the harms we saw in the first wave with delayed presentations for serious illness and long term condition exacerbations, and helping to ensure that people continue to access other essential services such as childhood vaccinations.
To that end, LMC officers and Londonwide LMCs staff continue to meet and brief MPs and key stakeholders. Since the start of the year we have met with Labour Leader and Camden MP Sir Keir Starmer, Conservative MPs Bob Blackman and Stephen Hammond, and briefed all London MPs on key issues such as vaccine delivery and availability, system interface challenges, access and workload, and workforce planning. You can see a template of our February letter here.
We also work closely with the GLA and Mayor of London and are currently supporting a programme addressing vaccine hesitancy in specific London communities. If you would like to get involved and speak at a future event please drop us a line: info@lmc.org.uk.
Policy Engagement
The Secretary of State for Health recently released a new White Paper Integration and Innovation: working together to improve health and social care for all. Intended to “improve cooperation, reduce bureaucracy, strengthen accountability to Parliament” and “make the system work for those who work in the system”, the proposals are wide ranging and cover a lot of ground, from establishing Integrated Care Systems (ICSs) in law and giving them commissioning power over primary care, through to vesting Ministers with additional powers and introducing a new “Duty to collaborate”. The proposals need to be considered alongside other policy measures announced over the past 18 months to two years: see our responses to the recent ICS consultation, consultation on the ICS and standard contract, the CQC strategy consultation and previous digital first proposals.
We are liaising with the DHSC to make further representations on the proposals in the White Paper before the draft Bill is published. Please share your comments with us. There is also a live consultation on the Provider Selection Regime which sets out a new approach to procurement of services which would remove scrutiny and procurement rules. We will be submitting a response before the closing date of 7 April. Again, please feel free to share your comments with us.
London MPs debate Covid vaccination programme
On Tuesday 9 March Andy Slaughter MP (Labour, Hammersmith) introduced a hour and 30 minute debate around the vaccination programme in London, including supply, vaccine hesitancy and access. A full transcript of the debate is available here.
Mr Slaughter started the debate by praising the NHS in London, citing his own vaccination as an example of the professionalism of the process. He also mentioned a conversation that he had had with his “local director of Covid-19 response” and welcomed news of increasing supplies of the vaccine. He then raised a series of concerns about the vaccination programme in London, going on to:
- Highlight a lack of vaccine at some PCNs, with major centres not opening at all.
- Ask for confirmation that the Hammersmith Novatel, due to open on February 8, will open next week [week of 15 March].
- Call for Government support for the vaccine hesitancy campaign next week.
- Ask for data again and acknowledged that this may seem like a “slippery slope”. Several MPs have been asking for granular data to get a better understanding of how the programme is working in their constituencies
- Raise concern about vaccine supplies – he said that he thought London had been “left out” when the programme began, a position which was soon corrected before receding again (citing 600,000 doses per day in December/January compared to 200,000/400,000 per day this week).
- Talk about hospital hubs being in a privileged position in which they could order supplies when needed while the PCNs were more reliant on deliveries – leading to situations where five sites in Hammersmith did not receive any supplies last week
- Express great concern at the low uptake at the White City hub, in one of the most deprived parts of Hammersmith, where he said that “significant vaccination had been going on there for fewer than 10 days”.
Mr Slaughter also mentioned his unease at people being unable to access vaccination centres due to mobility issues and PCNs being scaled back to the extent that they would find it difficult to target those not yet vaccinated in cohorts 1 to 4. And cited vaccine hesitancy as the “most important point” and called for local solutions to go with national resources, including more data. He said:
“In my constituency—I feel the pattern is true across the rest of London—the more prosperous areas, the less ethnically diverse areas and the less deprived areas were already at 100% for the older cohort of the population. Poorer areas, such as those in Shepherd’s Bush, White City and West Kensington, were below 75%. That is a very significant difference. It is replicated across London, and north-west London is one of the most difficult areas. As of last Friday, it was the only integrated care system area in England that was below 80% for those over the age of 65. All the London ICSs are down at the bottom, but north-west London is slightly further down.”
He closed by saying that having trusted people, good access and people knowledgeable enough to answer the questions the people had was the key to addressing hesitancy – but that London boroughs like his needed more money (citing the lack of Community Champions money Hammersmith received).
Karen Buck MP (Labour, Westminster North) represents next-door Westminster North, a constituency that encompasses the deprived Church Street and Queen’s Park wards in the north and the affluent Abbey Road and Regent’s Park wards nearby. She also called for more data to understand the complexities of London demographics – which, in the case of Westminster North, included abject poverty on the one hand and wealthy absent landlords and an “emptying” central London on the other. Ms Buck also complained that she has not seen information provided to DPHs and questioned the variance between ONS figures and NIMS data.
Bob Blackman MP (Conservative, Harrow East) said that there were problems with reaching many diverse communities who were reluctant to get vaccinated. He also complained about supplies, saying that some of the Harrow centres will only receive half of their capacity. He wants a better plan for the supply of vaccines, stating:
“At the end of April, two of our mass vaccination centres will close, and there will be the potential for complete chaos when we come to the second doses, because everyone will be invited to attend one centre in Harrow to get their second dose. I predict that is going to be quite chaotic, so I would ask that we look at potentially keeping those centres open for a further period to ensure that every adult gets their opportunity for at least the first dose by the end of July, as per the plan that the Minister has.”
“Equally, allowing flexibility to GPs undertaking vaccinations at GP surgeries would help considerably. It would reach those harder-to-reach groups, because people trust their GPs in the way that they do not necessarily trust going to a large vaccination centre.”
Rupa Huq MP (Labour, Ealing Central and Action) expressed concern that there are wards of deprivation in Acton which she declared are a “vaccination black spot”.
Feryal Clark MP (Labour, Enfield North) also raised concerns about data, access, GP registration and hesitancy, saying that an 80 year-old Kurdish woman should not be expected to book a vaccine over the Internet and that here was a “digital divide” in her constituency in the area with only a 50% vaccine rate. She also raised concerns about those not registered with a GP:
“Finally, 16,000 people across Enfield—predominantly in the eastern part—are not registered with a GP. There is no clarity on how those constituents will access vaccines. I would be really grateful if the Minister set out the plan for people who are not registered with a GP.”
Catherine West (Labour, Hornsey and Wood Green) name checked Dr Peter Christian of Dukes Avenue practice and highlighted his concerns about vaccine hesitancy.
Rushanara Ali MP (Labour, Bethnal Green and Bow) expressed concerns about Ramadan and vulnerable congregation members not being vaccinated. She also called for vaccines to be available through GP practices, and said:
“What we need to do now is make sure that the vaccines are in the right places. The centralised hubs are, of course, useful and important, but it is also vital that we get vaccines to local GP surgeries. As I have said to the Minister time and again, it is vital that we get more vaccines to pharmacies and that pop-up clinics get up and running. The ones that we have are very good and very helpful, but the unpredictability of supply, the inability to plan and the lack of local flexibility are all leading to sub-optimal outcomes, when we could have better outcomes.
“So today I call on the Minister, once again, to get the vaccines to the local providers and to provide local authorities with additional support, so that they can do the chasing, as is the case in my local authority. What we have seen is that when GPs are responsible for getting vulnerable patients, including homebound patients, vaccinated in my borough, 95% of those patients have been vaccinated. So this is not rocket science; we can address the gaps.”
Fleur Anderson MP (Labour, Putney) raised the issue that a vaccination centre at Queen Mary’s Hospital has been built but not opened and there is not centre in Roehampton, which she said was “deprived”.
Siobhain MacDonagh MP (Labour, Mitcham and Morden) raised concerns about centres not being opened near her “wards of concern” but closer to Wimbledon instead.
Helen Hayes MP (Labour, Dulwich and West Norwood) expressed significant concerns about minority community vaccine hesitancy, and cited figures for Lambeth and Southwark of 80% of white residents over 65 having been vaccinated compared to below 45% of African and Caribbean residents.
Lyn Brown MP (Labour, West Ham) highlighted the challenges of vaccinating and keeping track of a mobile, rental, population. She also paid tribute to local GPs in their vaccination efforts.
Responding to the debate, Vaccine Minister Nadhim Zahawi MP:
Emphasised the success of the vaccination programme so far and expressed his concern about take-up within the BAME communities. He emphasised the Government’s plan to tackle hesitancy at the local level, in partnership and using trusted voices.
On vaccine supplies in London, he said that the supply deliveries will support the vaccination of cohorts 1 to 9 by mid-April. He said:
“The hon. Member (for Hammersmith) raised the issue of the Novotel opening next week. I can confirm that it will open next week as a vaccination centre. There are 200 sites across London now vaccinating. I know that some people have issues about travel, but I know also that Age UK, for example, and some other brilliant charities have come forward to offer free travel for the over-50s to get them to vaccination sites.
“The hon. Member for Westminster North (Ms Buck) raised a specific point about confusion between ONS data and NIMS data. I will just point out to her that, on occasion, there is double counting. ONS data is purely age based, and at-risk people or the workforce in care homes will be double counted in that data. The NIMS data is more accurate, but, for the sake of full transparency, the NHS has made both datasets available.
“My hon. Friend the Member for Harrow East (Bob Blackman) raised the specific issue of vaccine supply. I can reassure him that we are about to see a massive step change in vaccine supply to his constituency. Of course, we need to make sure that we do not make a mistake, as he quite rightly warned us, with second doses. I can assure him of that, and I will take another look at his point about the mass vax centre closures.”
Regarding unregistered patients, Mr Zahawi said:
“The hon. Member for Enfield North (Feryal Clark) talked about unregistered people. They can actually register at any GP practice, because we have amended the contracts to allow GPs to take on more people who are unregistered, including those who are undocumented, who have the ability to be vaccinated, because we want everyone to be protected.”
Andy Slaughter MP closed the debate by urging the Minister to see the good work going on in North West London and urging him “not to forget those left behind” in the race to vaccinate.