The next phase of the NHS England & Improvement Covid-19 vaccination programme is getting underway with the Patient Group Direction that provides the legal mechanism for administering the vaccine to patients coming into effect today (December 14).

Practices in more than 100 parts of the country are taking delivery of the vaccine, with the majority starting vaccinations for those aged 80 and over tomorrow. Patients will be contacted and invited for vaccination.

The roll-out is being co-ordinated through primary care networks with more practices and community pharmacies in other parts of England joining on a phased basis during December and in the coming months, says NHSE&I.

Standard operating procedures have been drawn up that apply to all providers contracted to provide local vaccination services in community settings, including community pharmacies, GP practices, non-NHS sites, care homes, and patients’ own homes

Other SOPs explain how incidents and enquiries should be escalated and addressed, and the audit and governance processes.

A letter from the NHS England chief pharmaceutical officer Dr Keith Ridge to CCG lead pharmacists and chief officers highlights the fragile nature of the vaccine and cautions that some GPs might not be used to dealing with such medicines.

The vaccine is inherently “fragile” and must be handled carefully, the letter says. “The key component is mRNA which is a delicate substance. The mRNA is encased in microscopic lipid nanoparticles both to protect it and to help it get into cells. But the nanoparticles are delicate and this is why the vaccine is frozen so that they do not degrade, including when being transported.

“Similarly, if the thawed vial is shaken rather than gently inverted during preparation, the lipid nanoparticles may again degrade, or release the mRNA which is destroyed. Once the vaccine is diluted, it is not yet clear how much movement the vaccine can withstand and so that is why the vaccine must not be transported after dilution.”

Vaccination information from other organisations such as the MHRA, Public Health England and the Specialist Pharmacy Service, which has been published in the past couple of weeks, is listed on the NHS England website.