Operational guidance for adults (16-64 yrs) with a Severe Mental Illness and Intellectual Disability

• On 24 February 2021, the JCVI advised the government to invite all people on the GP Learning Disability Register for COVID-19 vaccination
• The advice of the JCVI remains that adults with severe and profound learning disabilities, and those with learning disabilities in long-stay nursing and residential care settings, should be offered the vaccine in priority group 6 (people with Down’s syndrome are included in group 4). Adults with less severe learning disabilities are not currently prioritised.
  
• However, as GP systems do not always capture the severity of someone’s disability, this means that some adults who are more severely affected by learning disabilities may not be invited for vaccination alongside people with other long-term health conditions.
  
• GPs can use GP Learning Disability Registers and SNOMED codes (which describe the impact of learning disability although there is variation in how these are applied) to help identify this group. 
  
• NHSE/I recognise that there may still be people who are not on these registers and the NHS needs to make an extra effort to put this right. GPs should use clinical discretion to ensure the right people who meet the severe and profound learning disability definition are on the register. 
  
• Alongside this, the NHS is asking key stakeholders and voluntary and third sector partners to encourage people who have a severe and profound learning disability to come forward to their local GP. Their GP should then assess the individual and, if appropriate, add them to the list to be vaccinated. 
• When organising their COVID-19 vaccination, NHSE/I also advise GPs to use this important opportunity to offer people with a learning disability their annual health check and to book them in for their flu vaccine, so the NHS makes every contact count for this important group of people.

• The JCVI also determined that those with schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment are within cohort 6.
• NHSE/I is encouraging GPs to take a similar approach to that being proposed for those with a learning disability, working in partnership with secondary care mental health services and VCS partners to ensure appropriate outreach mechanisms are in place.

You can read the latest information about clinically extremely vulnerable groups on the NHS England website. 

This includes an update to the shielded patient list following a new, data-driven risk assessment, called the COVID-19 Population Risk Assessment. This has been developed to help identify people who may be at high risk from COVID-19.

It has been used at a national level to help identify an additional group of patients with specific multiple risk factors which, combined, may put them at similar risk to those who are clinically extremely vulnerable to severe outcomes. 

People within this group will be prioritised for vaccination in cohort six, if not already offered, and are eligible for further support.

• Eligible adult carers will be contacted via the National Booking System to receive an invitation to book vaccination through Vaccination Centres, Community Pharmacy vaccination centres or Hospital Hubs, once a list compiled by NHSE/I in conjunction with Local Authorities has been produced. 
• Local systems may choose to flex these arrangements based on the needs of their populations and local vaccination centres should be prepared to administer the vaccination to eligible adult carers who choose to receive the vaccination, and are coded as such on the GP system.
• NHSE/I recognise the difficulties in identifying people in this group. They are asking the third sector to help them identify people through public campaigns, with an ‘ask’ that eligible unpaid carers contact their local authority to make themselves known so they can be prioritised for vaccination through the National Booking Service.
• Local vaccination centres should also prioritise invitations to carers aged 16 and 17 flagged within their systems to align with their known allocations of Pfizer/BioNTech vaccine. The Pfizer/BioNTech vaccine is the only currently authorised vaccine under Regulation 174 which can be used for individuals aged 16 and 17.

As part of cohort 6, all adults over 16 years of age who are inpatients in Mental Health, Learning Disability and Autism settings are eligible for the COVID-19 vaccine from the week commencing 15 February 2021.

Some patients might have already been offered the vaccine in earlier cohorts, either because of their age (65 years+) or because they have an underlying health condition that makes them clinically extremely vulnerable. 

In most areas, patients should be able to access the vaccine directly from their inpatient service provider (including the independent sector). 

• The Green Book Chapter 14a states: “Younger adults in long-stay nursing and residential care settings: Many younger adults in residential care settings will be eligible for vaccination because they fall into one of the clinical risk groups (for example learning disabilities). Given the likely high risk of exposure in these settings, where a high proportion of the population would be considered eligible, vaccination of the whole resident population is recommended.” 
• The proposed definition for inclusion of such settings is “a closed community with substantial facilities shared between multiple people, and where most residents receive the kind of personal care that is CQC regulated (rather than help with cooking, cleaning and shopping)”. This would include CQC registered care homes (excluding older people’s care homes who were included in Cohort 1) and those identified as part of the Mental Health Services Dataset (MHSDS) as well as Learning Disability settings sites which are not in the MHSDS and Special residential colleges and supported living. 
• Shared student accommodation, detained estates (including prisons and immigration removal centres) are excluded within this definition. The COVID-19 Vaccination Programme is addressing vaccination within detained estates separately in conjunction with Health and Justice teams. 
• Local systems and regions are best placed to map and assure in-reach to the majority of settings of multiple occupancy through their delivery model mix of providers and should continue to advance their plans for delivery to these settings including the immediate mapping of such settings if this has not already commenced. Further guidance in the form of a mobilisation support pack including; considerations in advance of a visit to such settings; the consenting process and support to prepare for vaccination for homes, residents and families, will be issued week commencing 15/02/21 on how to support vaccinations in settings of multiple occupancy.
• In such cases from 15 February onwards, a PCN grouping or community pharmacy contractor will be able to claim an additional supplement of £10 for each vaccination administered to eligible residents and staff in these settings, on top of the £12.58 Item of Service fee.