NHS England omits advice to apply clinical judgement re vaccine

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It has come to light that a letter from NHS England and NHS Improvement to all vaccination centres and GPs in the UK has omitted advice that health professionals can and should apply their clinical judgement when placing people in group 6.

Vaccination of people with underlying health conditions that put them at risk of serious illness from COVID-19 is now well under way in the UK. However many people with ME are being forced to battle with their GPs to be able to access the vaccine. For young people who are otherwise lowest on the vaccination priority lists this is a particularly egregious position to be put in.

Incongruously, carers of people with ME/CFS are being invited to receive the vaccine before the person they care for.

Some people with ME are having success sending a template letter to their GP. But we have now heard from many people, including those who have been housebound and bedbound for years, that their GP is refusing to prioritise them. Some report this is because the GP doesn’t know that they are able to prioritise people.

The green book, developed by the Joint Committee on Vaccination and Immunisation makes it clear that the examples of conditions that place someone into Group 6 are not exhaustive, and that clinical judgement should be applied. However in advice sent to all GPs, this key point was omitted.

#MEAction UK are calling on NHS England to rectify this immediately.

Read our letter to NHS England and Matt Hancock MP.

Dear Professor Powis and Mr Hancock,

It has come to light that there appears to be a discrepancy between the advice being supplied by the JCVI, based on the Green Book, and that sent by NHS England to Local Vaccination Sites, copied to CCGs, GPs and Regional leaders. 

In the Green Book (issued 12 Feb 2021), it advises, following the Group 6 Table on pages 10-12, that:

“The examples above are not exhaustive, and, within these groups, the prescriber should apply clinical judgment to take into account the risk of COVID-19 exacerbating any underlying disease that a patient may have, as well as the risk of serious illness from COVID-19 itself.” (top of page 12)

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/961287/Greenbook_chapter_14a_v7_12Feb2021.pdf 

However, this paragraph appears to have been omitted in the letter from NHS England sent to all Local Vaccination Sites and copied to CCG’s, GP’s and Regional leaders, 

https://www.england.nhs.uk/coronavirus/publication/vaccination-of-jcvi-cohorts-5-6-and-additional-funding-for-vaccination-in-residential-settings/

This wording in the Green Book is key, as it allows GPs and clinicians to add patients who may not have been picked up by the classifications in Group 6, but who may experience significant worsening of their existing illnesses if they were to be infected with Covid 19.

Infections can cause exacerbation of symptoms of relapse in patients with ME/CFS, many of whom are already living with considerable disability, as identified in section 1.6.4 of the new (draft) NICE clinical guideline on ME/CFS which will come into practice in April 2021:

https://www.nice.org.uk/guidance/gid-ng10091/documents/draft-guideline

The missing paragraph from the NHS letter is causing significant problems for people with ME/CFS, as GPs are not aware that they have the ability to add patients to the vaccination lists and are refusing to consider their cases. 

This situation also creates a contradiction where carers are being invited to receive their vaccination under group 6 before the person they care for; the person whose neurological health condition and quality of life would be severely impacted if they caught COVID-19 but who is not included under this NHS England advice to GPs and vaccine centres.

Please can you ensure that NHS England update their advice in their letter of 13th February to include this crucial provision and resend it to all Local Vaccination Sites, CCGs, GPs and Regional leaders as a matter of urgency. The practicalities of how GPs can exercise their clinical judgement to code patients appropriately such that they are added to the vaccine priority Group 6 should also be made clear.

Thank you for your urgent attention in this matter. If there is a more appropriate person to respond to this we would be very grateful if you could forward this on.

S. Louise Beaton,

On behalf of #MEAction UK

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