A leading GP says all adults must receive a vaccine for Covid-19 as a network of Medway doctors marked issuing their 50,000th jab this week.

Dr Satvinder Lall, clinical director for the Medway South Primary Care Network (PCN), is helping to lead the vaccine roll out covering 130,000 patients in Rochester, Strood, Chatham, Walderslade and Lordswood.

Dr Satvinder Lall reflects on delivering 50,000 vaccines in Medway and says they're ready to step up the pace

Risks of blood clots among younger patients receiving the AstraZeneca jab has raised concerns about people getting the jab.

But Dr Lall says the scientific evidence shows benefits to individuals and the effects of vaccines on wider communities far outweigh the risks.

"We've all had a horrible year and the vaccine is the light at the end of the tunnel," she said.

"Infection rates have dropped dramatically and that's partly due to lockdown but the roll out of the vaccine means we've protected our most vulnerable.

"It's a rapidly evolving process and it's really important younger people do step forward to have the vaccine.

"I understand the concerns of risks and benefits but actually if we want to get out of this pandemic then our adult population has to be vaccinated.

"If you aren't – yes the younger population might not get unwell – you can infect someone else and we don't know yet how long immunity lasts then there's a risk of spreading it to someone you might love.

"I'm not trying to emotionally blackmail but it's important to realise that we ourselves might not feel unwell or be too unwell from Covid but there's an impact on others around you."

She added this could also be around the longer term implications of long Covid which even patients developing mild initial symptoms or illness could then experience severe and more serious longer term impacts such as memory loss and respiratory problems.

"We have patients that we've referred to Long Covid clinics that have been off for the last year and they're young patients – in their 30s and 40s.

"So I would strongly encourage if you have concerns speak to your healthcare professional – not necessarily a GP but a practice nurse. Everyone is well versed in managing it.

"I show a graphic with patients giving you the risks of getting compared to the risks of taking the contraceptive pill and smoking and the risk is negligible.

"The risk of getting Covid and having severe effects in the under 30s versus the risk of clots increases – so it becomes a level playing field.

"At that point the AstraZeneca vaccine isn't appropriate so if you had concerns I would talk you through that.

"With anyone in the over 30s coming in for AstraZeneca we'd talk about that and make sure there's no other risk factors predisposing them to a risk of a clot. However the JCVI have recommended to use an alternative in the under 30s.

"Each case is individual and there are things we take into consideration.

"It's not just a case of you're 30 and off you go and that's where the consent process comes in and if they're not suitable we will turn them away and rebook them in for another jab.

"It's having those conversations and it's better to have the conversation than be worried and not come in and have the vaccine at all."

The vaccine programme for Medway South, Rochester and Strood PCNs started in January and this week issued its 50,000th jab.

It runs from two sites – Rochester Healthy Living Centre and Lordswood Healthy Living Centre – and has so far issued 14,000 second jabs to the most vulnerable patients.

"It's exciting and although that's a mix of first and second doses it feels like we're making a dent," Dr Lall said. "It's hard work but it's worth it.

"I say this to the teams every day: we're making history and people will look back and wonder what did they do in Medway and Swale.

"We couldn't do it without the support of our volunteers and our staff and particularly Dr Peter Gilbert, who's set up this whole thing up and the logistics.

"We've had hiccups along the way but we're in a really good place overall.

"I did the daily pep talk and mentioned we're at the 50,000 mark and everyone gave a big woop of joy – clinicians and volunteers.

"So when we put it into context, the hard work has paid off and I don't think people expected to deliver 50,000 by this stage."

Dr Lall said the PCN had delivered first vaccines to 95% of its most vulnerable residents in the first nine cohorts with the programme now inviting those aged 44 and above.

She added in this week alone they were expecting to deliver 3,000 vaccines from one site and would be continuing throughout the Bank Holiday weekend due to the expiry dates and shelf-life of the vaccines.

"The next steps are happening and they're happening quite rapidly," Dr Lall added.

"We have the capacity to deliver as quickly as we can and we are delivering. It's a bit of a slog but we're getting through 600 to 800 people each day so it's been phenomenal."

GP networks across the county are employing different "models" to suit local needs and demands, Dr Lall said.

She explained in Rochester, Strood and Medway South, teams were focussed on maintaining GP provision without needing to refer too much staffing resource to the vaccine programme.

Dr Lall added this meant the daily capacity in her area would be slightly lower as a result compared to other primary care networks which are vaccinating upwards of 1,000 people per day.

"Given the set up we probably could deliver a lot more but it would mean then pulling people out of practice," she said.

"The next steps are happening and they're happening quite rapidly..."

"We know access to general practice and primary care is a challenge anyway and more so with Covid.

"If we draw more resource out it's going to be difficult because patients have other illnesses we need to manage so we need to get the balance right.

"As GPs we're well placed to deliver this because we run mass flu vaccinations and was always only done at practice level.

"The issues for us [with Covid vaccines] has been around observation times because of allergy, side-effects or immediate problems and social distancing so we can't have as many people.

"With a flu clinic you're literally jabbing one a minute but in these we can't go as quick.

"The other challenge was the weather in January with all the doors open.

"But patients have been amazing and patient patients and had loads of cards and letters which has been good for staff morale."

Maintaining morale has been among the greatest difficulties and supply of the vaccine doses is key to how staff are feeling during the programme, Dr Lall said.

"It has been vaccine dependent and I think that's where morale ebbs. You can have a great rota and then there's no vaccine for the next few days.

"That's great for practices because they've got that access back in practice but it feels a bit like we're getting going and lose the momentum.

"Looking ahead we've got established delivery dates and doses so we're in a better place to plan that better in the last two weeks."

Dr Lall says the ambition for the PCN is to hit the government target to vaccinate all adults by the end of July before that date.

But she warned this will be critically dependant on the flow of vaccines being delivered to GP sites and the mass hubs, such as the one at the Pentagon Centre in Chatham.

The under 30s will only be offered Pfizer and Moderna jabs following scientific advice about the extremely rare side-effects of blood clots caused by the AstraZeneca vaccine.

"We're not quite sure what the supply chain looks like at this stage [for Moderna and Pfizer]," Dr Lall said.

"There was an announcement that we've acquired millions more Pfizer but the challenge is supply chains.

"We're ready so give us the vaccine and we'll put it in arms," Dr Lall said.

"We've then got to think about second dose and roll into the possibility of boosters and there's no guidance on that yet.

"We're taking it one week at a time at the moment."

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