What do GPs need to increase weekend vaccinations?

Jolyon Attwooll

21/07/2021 5:22:55 PM

General practices are providing the lion’s share of COVID-19 vaccinations during the week. Two GPs discuss how things stand for out-of-hours clinics.

Graph of weekend COVID vaccinations in Australia
Primary care delivered more COVID-19 vaccine doses that state clinics until the weekend of 5 June, which followed a snap lockdown in Melbourne. (Source: Department of Health)

Dr Todd Cameron is one GP who offers COVID-19 vaccinations at his clinics on a Sunday – but is forthright in his views on why others may not.
‘I think people are knackered,’ he told newsGP.
The Melbourne practice owner, whose clinics have been administering around 300 vaccine doses a day, believes mixed messaging on the AstraZeneca in particular has created an extra burden many general practices have struggled to navigate.
‘The extra workload having to deal with what that has caused has been an absolute nightmare,’ he said.
‘If you talk to the front desk teams, our call volumes are at 30% above normal background levels.
‘We are delivering the hardest vaccine just because it requires the most front-end compliance and consent, whereas Pfizer is much easier because there is very little in the way of contraindications.’
Dr Cameron’s clinics started to offer the Pfizer vaccine this month, which he says has run successfully due to pent-up demand. However, he believes other factors are also hampering after-hours vaccination efforts, including staffing pressures with extra demand at mass vaccination clinics.
‘Most medical clinics are working with constrained staffing,’ he said.
‘They’re probably trying to fit [it] in the normal work week, rather than relying on overtime or – even worse – burning staff out.’
Like many other GPs, he also notes the lower payment for second doses, which have now come more into play, particularly with the older age-groups.
However, Dr Cameron views the weekends as an easier time for the vaccination clinic to run, notwithstanding the levels of fatigue – and he notes the supplementary MBS funding for out-of-hours vaccinations all day on Sunday (which run from an extra $12.20–12.30 extra per dose).
‘You want to use the space well. On weekends there is more parking [and] typically everything’s a bit easier,’ he said.
‘The point at which the clinic breaks even is [also] lower on weekends. My personal experience is these should be run outside of normal clinic hours.’
Primary care remains by far the main workhorse in the vaccination rollout during the week.
From Monday to Friday, general practices are collectively administering more than 90,000 doses daily more often than they are not, which is typically more than the combined doses administered in all the state and territory vaccination hubs.
However, it is a different story on weekends – at least recently.
Initially, primary care was the main driver for weekend vaccinations as the rollout began, according to data released by the Department of Health.
Dr Daniel Byrne, who runs an Adelaide general practice, says the vaccination supply during the first few weeks could not meet demand, including on Saturdays.
At that time receptionists, doctors and nurses were doing extra shifts, with the process up and running smoothly – until the first change in Australian Technical Advisory Group on Immunisation (ATAGI) advice in April when it recommended Pfizer be the preferred vaccine for under-50s.
‘We were doing a great job until the rug got pulled out from under our feet,’ he told newsGP.
‘Demand just drizzled away, our Saturday afternoons clinics were just empty. No one wants AstraZeneca, and general practices weren’t given Pfizer.’
As such, he disputes  any suggestion that general practices have not been pulling their weight after-hours.
‘I have been doing 15 hours a week extra, weekend after weekend after weekend,’ he said.
‘Why are we [doing this] on top of our normal hours? Altruism to our patients, for the greater good. These are the people that trust us. Nurses, doctors and receptionists have all been chipping in for a good cause.’
While he does not open the clinic for vaccinations on Sunday as he needs ‘one day off’, Dr Byrne believes the rollout can still be accelerated out of hours. He sums up the key in three words: ‘Pfizer, Pfizer, Pfizer’.
Dr Byrne believes having an alternative to AstraZeneca will be a major contributor to completing the task in older, more vulnerable age groups.
‘We’ve done the true believers. People have made their decisions, for whatever reason,’ he said.
‘The 30% of unvaccinated over 70-year-olds want Pfizer. I think we will be hitting [more than] 90% vaccination rate [once Pfizer is available].
‘It’s not hesitancy, it’s lack of Pfizer. Give us the Pfizer and you will see us vaccinating all hours again.’
GPs qualify for extra MBS payments if vaccination doses are administered outside of normal working hours.
The after-hours period comprises services offered on public holidays, on a Sunday, before 8am or after 1pm on a Saturday, and before 8am or after 8pm on any day apart from a Saturday, Sunday and public holidays.
There are four after-hours MBS items for GPs to assess a patient for COVID-19 vaccinations. These run from between $12.20–12.30 extra per dose compared to the equivalent MBS items during normal business hours.
Different rebates are available, depend on whether patients are in a metropolitan area (MMM 1) or rural/remote area (MMM 2–7).
The RACGP’s information page has more information about the COVID vaccine items, including descriptors and rebate details.
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after-hours AstraZeneca COVID-19 Pfizer vaccine rollout

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Dr Jane Alyson Aroha Wehipeihana   22/07/2021 7:07:09 AM

We could do a lot more if we could get more. Pretty basic really. 240 a week, we do in 1 day. That’s it for the week. We are unable to get anymore. I have called the Health Minister of QLD and Greg Hunt to try to get more. Nope. So what do they want us to do more when they won’t release more?

Dr Muhammad Hafizei Muhammad Nasir   22/07/2021 8:42:10 AM

Spot on Dr Byrne.

Dr Mark Daykin   23/07/2021 12:08:40 AM

Let's be clear- this is a public health issue. Not a General Practice issue. A public health issue. I'll happily be part of a solution and I have done many a weekend clinic, but let's not self-direct some perverse sense of guilt to our sector that we are not doing enough. Have no shame in wanting to be rested or see family and kids after 5 days a week of 'normal' work. The abject failure of procurement, messaging and planning at both federal and state level cannot be made up for by GP's burning themselves out or by losing their long term experienced reception, admin and nursing staff to low morale or abuse for what frankly amounts to cents in the dollar for a government happy to otherwise haemorrhage billions to other areas. Does anybody truly think Covid will go away soon? Pace yourselves!