New report exposes challenges of ‘absurd’ vaccination scheme across Highland communities
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Analysis has exposed inefficiencies and challenges in the new health board-led delivery of vaccines across the Highlands.
The paper raises concerns over the potential impact of this new 'fragile' model on vaccine uptake and accessibility.
It follows concerns raised by GPs and groups across the region on the possible resurgence of childhood diseases such as measles as well as the costs of the new programme – which was formerly reported to be up to £9 million a year, whereas local GP practices were able to provide the service for around £1.5 million.
The report dated July 2023, which is understood to have been written by public health consultant Dr Jenny Wares and commissioned by NHS Highland, focuses on the vaccination transformation programme (VTP) and is based on data collected since March this year, when vaccination delivery was fully transferred from GP practices to the health board.
It states: "Whilst the aim is to build on the already successful vaccination programme across Scotland, and further increase vaccination uptake, concerns are held regarding the ability to effectively replicate and deliver what had been in place prior to the transfer to health board delivery within NHS Highland given our remote and rural geography.
"NHS Highland is experiencing significant challenges with respect to trying to deliver the VTP model as detailed within the data collated.
"Furthermore, the current model does not adequately incorporate the existing challenges posed by the local geography and demography and is likely to be less effective, efficient and sustainable than other models. With respect to sustainability, this relates to staffing but also to the environment."
The report highlights cases in which staff had to travel for more than five hours – notably for clinics in Sutherland – to deliver low volumes of vaccines, with some baby immunisation clinics deemed as 'simply not sustainable' and many surgeries requesting to continue vaccinating their own babies.
Staffing challenges were also found to have led to the cancellation of clinics, recognising an "ongoing need to cancel clinics secondary to an inability to staff them" – but also to wider delivery challenges, citing delays in the shingles and pneumococcal programme for 2022/2023 – which the report states won't be completed during the current season.
It raised concerns over the number of childhood vaccination clinic cancellations.
"Unlike the mass vaccination programmes, it is recognised that the childhood programme is inflexible with age-specific vaccinations and that the time-dependent childhood vaccines must be administered in a timely way as per the schedule. This compounds the delivery challenges noted as the impacts of a cancelled clinic can be much more significant."
The spring booster campaign was also reported to have been affected, with almost 600 appointments cancelled only in Inverness – following a scheduling issue – and a total of 1510 cancelled across the board.
Challenges were also found in the delivery of non-routine vaccinations such as rabies, tetanus and hepatitis B, reporting cases in which post-exposure prophylaxys were not delivered on time.
"Given the remote and rural challenges, this provision is challenging to deliver and has led to extensive travel times for patients or for staff as it is difficult to deliver an ad hoc outreach service on this basis for non-routine vaccinations. This approach is not patient centred and could lead to a decreased uptake of vaccinations if there are barriers to access. This then poses a potential health risk."
Calls for Highland GPs to be able to return to a practice delivery model have been voiced by GPs across the Highlands.
Inverness and Nairn SNP MSP Fergus Ewing said: "For considerable time I have argued that medical treatment in the Highlands should be provided by GPs locally where the GPs wish to do so. This is being prevented because of the GP contract which is widely regarded as driven by GPs in cities and the Central Belt. The health boards have power however to enable flexibility – flexibility that is essential for the Highlands – but so far they have refused to use these powers.
"It appears to me that the health board who have the power to order local flexible arrangements are succumbing to pressure from health officials in Edinburgh.
"The report, understood to be instructed by the health board themselves, is heavily critical of the attempts to create a parallel separate vaccination service."
He added that many constituents complained about the health board service saying they found it hard to access.
"It's inconvenient, it seems to be inefficient, and the board's own advisers are say it's not working," he continued. "This is an absurd situation but I shall continue to press the health board in Inverness and the government in Edinburgh to use some common sense and flexible measures for the Highlands – measures most certainly required."
Former Nairn GP Alastair Noble voiced his concerns in the past months over the impact of the new system on rural communities.
He said: "Having read this excellent paper from Dr Jenny Wares, who is properly doing her job as a public health doctor in raising the real concerns about what will happen when vaccination levels fall below the percentage needed to give us herd immunity, I can only repeat my question from the Courier hustings in Inverness to the now First Minister: Does he want to be the First Minister of Scotland who oversees the return of preventable children's infectious diseases in Highland?
"The answer from this paper is that is exactly what he will achieve. We need NHS Highland to very quickly negotiate and agree with all Highland practices the best solution for their own patients and locality.
"It is simply amazing that practices in Argyll and Bute are allowed to continue but we are told the Scottish Government is blocking practices also in the NHS Highland area – like Nairn – from getting vaccines.
"It is also interesting to note that NHS England is both paying the GPs to continue delivering the vaccines through the practice staff with local knowledge, it is even offering bonus payments to encourage full cover for this winter of the most vulnerable groups."
A spokesperson for NHS Highland said: "We recognise that there are still improvements that can be made in the design of our vaccination service to maximise the opportunities for people across Highland to receive their vaccination, and we are working hard to make those improvements.
"We are committed to delivering vaccinations as close to the local communities as possible."
