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PDA statement regarding pharmacist vaccination sessions in Glasgow and Greater Clyde

There have been reports of anomalies in the booking system for Covid-19 vaccination sessions in the Glasgow and Greater Clyde health board area, and allegations that some pharmacists may have used technology to secure multiple shifts ahead of others.

Mon 17th May 2021 The PDA

The context

The task of vaccinating the entire population of Scotland in a short time frame is difficult and the NHS has recognized that it therefore cannot solely rely upon NHS employees. Consequently, the government agreed that the Health Boards could supplement their cadre of vaccinators by relying on those health professionals who normally work in primary care, such as pharmacists, dentists and optometrists. The fee that the government decided to pay these additional vaccinators was £231 for a 3.5-hour session.

It is not in dispute that these additional healthcare professionals have significantly increased the capacity of the vaccination centres. A letter from the Chief Executive of Greater Glasgow Health Board has thanked all those who have helped to boost the capacity of the NHS in this vital task.

Rates of pay

There is a difference in the payments being made to NHS employees, principally nurses, versus the amount paid to the self-employed health professionals who are providing the extra capacity.

There are important differences in the way that the nurses as NHS employee’s and the pharmacists and others from primary care will work. Whilst the self-employed pharmacists will not only have engaged in specific training and endured Hepatitis B vaccinations as did their NHS colleagues, additionally, they would have had to have purchased their own specialist Covid-19 vaccination indemnity insurance. They would not have been provided with the benefit of NHS holiday pay, maternity or NHS pension benefits. Importantly, they would also have taken the additional risk of not being provided with any NHS sickness leave benefits in the event that they fell ill themselves because they had been infected by the Covid virus and could not work.

These are somewhat different circumstances faced by their NHS employed colleagues. However, while these factors explain why the NHS decided to pay what amounts to a higher hourly rate for each session, there is clearly a public concern as to the scale of the difference in rates. In principle, we believe that the nurses should be paid more for supporting the Covid-19 vaccination programme and that this is an issue for the NHS to urgently resolve.

Allegations of how contractors have applied to service these sessions.

The PDA are extremely concerned by suggestions that there may have been anomalies with public procurement processes for vaccination services managed by the Greater Glasgow and Clyde Health board.

There have been suggestions made that some pharmacists have used technology to apply to book vaccination sessions after they have been made available by the NHS. Although the precise allegations have not been made public, pharmacists working as self-employed individuals will often use technology to book their work for the months ahead as will many of their usual community pharmacy clients and locum agencies. In this way, shift patterns can be covered efficiently, giving those who need the cover certainty and peace of mind.

That pharmacists have supported the programme and booked up sessions in the ways described will not have in any way impacted upon the taxpayer. Patients will have had the benefit of having their vaccination centres operated largely at the capacity that the NHS had hoped for.

Allegations have also been made that some of these pharmacists have swapped their sessions with other pharmacist colleagues who filled them instead. Generally, in self-employed contracts, the ability of a self-employed contractor to substitute another suitably trained and qualified self-employed pharmacist into their existing bookings is an important principle of holding self-employed status; a requirement established by the Inland Revenue. In such circumstances, the person organising the substitution should make this apparent to the employer as soon as possible. These substitution requirements apply equally to the optometrists and the dentists.

Therefore, although allegations have been made that some individuals may have provided sessions booked for colleagues, it is not yet clear on what basis this occurred as it may be an entirely legitimate process. The PDA fully support transparency and fairness in public procurement and maintaining the standards of conduct expected of regulated health professionals and welcome a fair, fact-based investigation into the allegations. The public will expect that any allegations need to be properly investigated and explained.

Pharmacists treated differently to other healthcare professionals.

As healthcare professionals that have a long history of providing flu vaccinations to the public in community pharmacies, pharmacists are more accomplished vaccinators. In the Covid vaccination programme, pharmacists have provided support and training to both the optometrists and the dentists who have joined a vaccination programme for the first time. The issue however goes way beyond who should get paid what for administering vaccinations. Evidence coming in from across the whole of the UK has shown that a successful vaccination programme requires much more than just the administration of the vaccinations. Pharmacists, with their unique skill of being responsible for medicines have taken significant responsibility for the wider pharmaceutical care of patients and the management of the vials. There are several matters that must be attended to before even getting to the point where a vaccine is ready to administer.

These pharmaceutical care issues may include the management of the vials to ensure that their out of fridge time allowances are managed properly. Such a situation is complicated by the fact that each vaccine has different storage requirements and all need to be adhered to. Sequencing the use of the vials through the recording of batch numbers and releasing the correct vials for the correct vaccinating sessions. Ensuring that there is no swap over between the different vaccines that may now be in use within a vaccination centre. Moreover, there is the important job of taking charge of the vaccine risk management and patient safety agenda – disseminating safe practice information, based on examples of untoward incidents and lessons learned by pharmacists in other parts of the UK to other healthcare professionals. Indeed, pharmacists are not only distributing and displaying risk management posters in vaccination centres, but they are also supplying colour coded stickers to assist with the prevention of accidental swap overs and all at no cost to the NHS or the taxpayer. (Posters and stickers available via a download)

Despite these additional and important patient safety services delivered by pharmacists, it has emerged in recent weeks that the Scottish government has announced that pharmacists are now going to be treated differently to the optometrists and dentists.

The government has clarified that whilst individual optometrists and dentists are still invited to support the vaccination service on the £231 sessional rates that had been set by the NHS, the sessional rates for pharmacists can only be paid to pharmacy business owners and it is for those business owners to decide who if anyone, they wish to send to undertake the activity. Even if it happens to be the same pharmacists that covered the service previously, it is the pharmacy business owners who can then decide how much of the sessional fee they wish to pay them and how much they wish to keep for themselves.

Self-employed pharmacists have been told by the NHS that they can still book to support the vaccination service direct, but if they do so, then it has to be either on a voluntary basis for no pay, or for the same rates of pay that the nurses receive, but with all of the inherent costs and risks that they would have to bear themselves and none of the employee benefits such as holiday pay, maternity and pension benefits and sickness protection.

This is not only inexplicable, but it is grossly unfair. Why does the government not attach any value to the important patient safety role that pharmacists can deliver? What possible say should be given to often large multinational pharmacy owners about which self-employed pharmacist should help with the NHS Covid vaccination service or not? What is the benefit to the taxpayer of paying them the money?

When the PDA spoke to the government about this, it was told that it was because of a historical oversight where individual optometrists and dentists had been placed onto the NHS performers list but that pharmacists, for some reason had not.

The Chief Executive of the GGCHB wrote to the PDA recently and explained;

The Pharmacy [Owners] are uniquely placed to balance participation in the vaccination programme with ensuring patients have continued access to the essential pharmaceutical care services and their own business needs.”

The PDA is not aware of there being any pharmacist shortages in Scotland and so these explanations do not stand up to scrutiny.

This does not seem to be a position taken with optometrists and dentists and it would appear that the Scottish government have paid more attention to the business needs of pharmacy owners – many of whom are large multinational operators, than they have done to the legitimate business needs of the local Scottish self-employed pharmacists. They have also paid more attention to the act of administering the vaccination, than the important initial patient safety role upon which the vaccination programme is reliant upon.

It is hoped that the government can resolve these issues as soon as possible. It is a great shame that pharmacists experienced in delivering vaccinations and delivering additional patient safety benefits by managing the vaccines themselves and who often are supporting their other healthcare colleagues in how the vaccinations are delivered are being excluded from the programme by unfair treatment by the government and the perceived business needs of the pharmacy owners.

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