Table 2 Typology of the key vaccination delivery models used in England for the SARS-COV-2 vaccine rollout, up to the end of October 2021
Models | Description | Positive features | Challenges |
|---|---|---|---|
Hospital hubs | • Block contracted by NHSE to serve priority groups, based on estimated utilisation | • Ability to maintain super cold storage for mRNA vaccines early in the programme • Effective reach into registered patient populations through modified call-recall | • Logistical difficulties in ensuring access for some priority groups, especially older, vulnerable patients |
Mass vaccination sites | • Block contracted by NHSE based on estimated utilisation • Located based on availability of appropriate sites using sites including conference centres, stadiums and others • Staffing from local service providers and trained surge capacity • Appointment booking through NBS | • Scale of vaccine administration possible • Local modifications to the basic model (using outreach) improved uptake among vulnerable groups | • Access issues for some cohorts due to e.g. cost of transport, reluctance to use public transport for those shielding • Poor appointment uptake as booking required digital access • Perceived risk of contracting COVID-19 on-site • Lower trust from patients than primary care models |
Primary care delivery models | • Local models grouping together a number of GP practices of varying sizes • Location based on existing premises within a PCN’s area • Contracted on fee-for-service basis • Multiple variations including hub-and-spoke approaches, ring-fencing specific clinic days within each practice, or nominating a single practice within a PCN to focus entirely on vaccination | • High uptake especially among vulnerable and ethnic minority groups - capitalising on trust and established relationships • Less prescriptive approach to service design permitted flexibility to develop services better tailored to local needs, but also to local capacity | • Sidelining of regular clinical care contributed to withdrawal of some PCNs from later phases of the program • Slow path to approval for delivery of Pfizer vaccines in the community • Large variations in capacity across the country contributed to variations in service delivery approach |
Pharmacies | • Selected in discussion with PCNs based on identified geographical gaps in provision • Contracted through regional pharmacy commissioning teams on fee-for-service basis • Appointment booking through NBS | • High uptake given geographical footprint, long opening hours, community links and presence of staff with relevant language skills | • Participation in the programme limited by target minimum vaccination rate of 1000 doses per week, shortages of staff, space and cold chain capacity • Initial inability to pre-book or re-book patients through NBS made appointment management challenging |
Roving and outreach models | • Tailored delivery, mostly developed as partnerships between PCNs and local public health teams, but delivered by PCN staff • Varied outreach models including fixed, temporary sites (e.g. supermarkets) and mobile approaches | • Ability to target specific communities or vulnerable groups for which access was limited or uptake low • Community engagement seen as effective | • Cost-effectiveness unclear – best used as highly targeted service delivery approaches |