Pharmacies in England have been waiting to hear about the role they can play in plans to deliver the COVID-19 vaccine for months. The first murmurings of such a service surfaced in October, when the Medicines and Healthcare products Regulatory Agency (MHRA) changed the law to enable pharmacists to administer the COVID-19 vaccines as soon as safe options were found.

Then last month, NHS England and Improvement (NHSE&I) said pharmacies would be part of the rollout of a national COVID-19 vaccination service before the end of 2020, should a vaccine become available.

Just over a week later, the Pharmaceutical Services Negotiating Committee (PSNC) announced that the only pharmacies to deliver a vaccine would be those in areas requiring a greater provision of the service.

NHSE&I finally released documents detailing the “urgent” preparations for the role of pharmacies in the service last Friday, November 27. Pharmacies had just over a week until 4pm on December 6 to let NHSE&I know about their interest in being part of the service.

Following the news today (December 2) that the Pfizer/BionTech vaccine has been approved for use in the UK, how can pharmacy play a part in the programme?

Click on the bullet points below to jump to the relevant part of C+D’s guide to the contract:

How can pharmacies get involved in the COVID-19 vaccination programme?

Why will not all pharmacies be involved?

How can pharmacy professionals get involved in vaccine delivery outside pharmacy settings?

What do we know about how the vaccine will be delivered by pharmacies?

How can contractors deliver the vaccine outside their pharmacies?

What training is involved?

What funding will pharmacies receive for the COVID-19 vaccine?

What are the other logistics around pharmacies delivering the vaccine?

Pharmacy COVID-19 vaccine criteria

Selected pharmacy-led sites will need to comply with a list of requirements, which NHSE&I says it does not expect the majority of contractors’ sites will be able to meet.

These include:

• Fridge space to store 1,000 vaccines at once or plans to attain this space.
• Capacity to deliver 1,000 vaccines a week within their shelf life as well as new vaccine types as they become available.
• Space to store personal protective equipment (PPE), vaccine equipment and clinical waste.
• Socially distanced space for patients to be observed for 15 minutes after vaccination if they are driving.
• Ability to deliver the vaccine while maintaining other pharmaceutical services.
• Ability to administer the vaccine seven days a week from 8am-8pm including bank holidays.
• Providing security guards if needed.

Pharmacy contractors meeting these specifications should fill in a form, “Annex B – Pharmacy site designation process form” and submit it to their NHSE&I regional team by 4pm on December 6.

The NHSE&I regional team will then assess if it needs the pharmacy to reach its delivery goal and whether the site “provides equitable access for its local population”.

"All hands to the pump?"

NHSE&I expects to commission fewer community pharmacy sites than GP centres, it says. This is because it does not expect the majority of contractors’ sites are able to meet its requirements, such as delivering 1,000 vaccines a week. The commissioning body needs pharmacies to “continue their very important role” in providing flu vaccinations and other services.

However, NHSE&I also says: “Pharmacies are well placed to reach out to our diverse communities and avoid inequalities in access. This means community pharmacy will have an important role in a potential COVID-19 vaccination programme.

“Running a potential COVID-19 vaccination programme requires ‘all hands to the pump’”.

Local vaccine effort 

Pharmacy professionals do not have to rely on a local pharmacy having the capacity to deliver 1,000 COVID-19 vaccines a week in order to help the vaccine effort. They can sign up locally to join their NHS COVID-19 vaccine team in paid roles via the NHS Professionals website.

The salary for healthcare professionals taking part in this programme, including pharmacists, is £12.74 an hour, with the role estimated to last between three and six months.

Multi-dose vials 

The vaccines delivered by pharmacies will depend upon which ones the NHS recommends using. However, NHSE&I says contractors should assume vaccines will come in “multi-dose vials and will need drawing up”.

Contractors should assume patients will require two doses delivered 28 days apart. These should be delivered at the same site unless there are “exceptional circumstances”. Providers must contact patients twice who had one dose to book another appointment.

Patients need to wait at least seven days between receiving other vaccinations, such as those against flu, and COVID-19 vaccinations, NHSE&I says.

Additional requirements for pharmacy teams include monitoring the vaccine expiry times and the time the vaccines spend out of the fridge. 

The vaccines can be delivered by individuals who are not registered healthcare professionals as long as they are under the supervision of a registered healthcare professional.

The pharmacies record a patient’s vaccine history via NHS England’s National Immunisation Management Service.

A drive-through pharmacy vaccination? 

There are several ways that contractors can deliver vaccines outside their pharmacy, as designated sites do not have to be in a registered pharmacy.

These may include subcontracting with other providers, such as GP surgeries, which pharmacies can discuss with their Primary Care Network, NHSE&I says.

Pharmacy contractors could even deliver COVID-19 vaccines through a drive-through model as long as it is not the only option for patients in the area.

E-learning programme

Public Health England has published training material for the healthcare professionals, including pharmacy teams, on administering the COVID-19 vaccine.

These include an e-learning programme with an assessment. Additional modules specific to the different COVID-19 vaccines will be added to the platform when the other vaccines become available.

Read more on training in a C+D news story on the topic.

£25 fee for two vaccine doses

Participating pharmacies will be paid £12.58 per vaccination, so £25.16 total for two doses. The arrangements that were introduced earlier this year to support pharmacy contractors delivering the national flu service – such as a fund for “additional venue hire” – will be “extended to support the COVID vaccination programme”, according to NHSE&I.

PPE, vaccines and consumables will be provided to pharmacies for free, NHSE&I says. 

There will be no extra funding beyond the £12.58 fee for unsocial hours or overtime.

Vaccinating 'at-risk' patients

Pharmacies can vaccinate their own staff against COVID-19, NHSE&I says. PSNC said last month that community pharmacy teams would be among the second cohort in line to get vaccinated alongside other health and social care workers.

Community pharmacy will have an “important role” in administering vaccines to ‘at-risk’ patients and health and social care staff, NHSE&I says.

Pharmacies that have been accepted onto the vaccine procedure but want to withdraw will have to give 42 days of notice to allow for commissioning through another provider.

Two contractors can collaborate to deliver the vaccine while maintaining pharmaceutical services for an area. They can also apply to halt other services to prioritise the COVID-19 vaccination under new NHS regulations that were laid before parliament in October.

Pharmacies will be able to order the vaccines via a “strict system”, NHSE&I says, which will seek to ensure “the principle of equivalence” so contractors get “fair access” to supplies. The commissioner aims to give all sites at least 10 days’ notice of availability to ensure sites can be arranged, but this may not be possible with the Pfizer/BioNTech vaccine expecting to start rollout from next week.

Many of the logistics are awaiting confirmation including the priority of patient cohorts.