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Flu, one hell of a season!

24 March 2011

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By Cathryn Bateman

In theory, the flu season covers a relatively short time; but in reality, related issues seem to go on and on. What’s more, although the season is technically now over, pre-season training – ie, preparation – for this autumn’s flu season has already begun.

Despite speculation that the administration of flu vaccines may be whisked away from primary care in the future, we have already placed our order vaccine order for 2011. This was primarily to secure the best delivery dates, but also to enable us to plan our operational processes for the coming year, as during the autumn the flu campaign will dictate these.

As a large urban practice, our practice population contains a large elderly cohort, which means the flu season has a huge impact upon our workload. We have found that if we don’t plan for it at the earliest possible point, the impact of the flu campaign has a knock-on effect upon other clinical areas. Our Quality and Outcomes Framework (QOF) achievement, for example, will suffer: in order to maximise the flu campaign we will have to compromise other services to contain the programme within the small window of time.

On reflection, our campaign this year went very well, despite unfounded allegations from the media accusing general practice of not ordering enough vaccines and turning away eligible patients. I appreciate this was in December, but only in an ideal world would our campaign be finished by Christmas and we would get a pat on the back for a job well done.

Our campaign began in earnest on 24 September last year, following a couple of operational meetings and a planning meeting. Upon receipt of the vaccine, it’s all systems go: stocking up fridges, logging batch numbers and ensuring macros and computer templates are fully functional.

Our practice offers flu vaccinations opportunistically and, of course, during chronic disease clinics. We arrange home visits for patients unable to attend the surgery, but the bulk of the work is done during flu week – or rather flu weeks to be exact.
All leave is banned during flu week (hence the need for the early planning meetings), as it really must be all hands on deck. The nurses do the bulk of the work, but are supported by doctors and the entire administration team. Everyone in the practice plays their part: if they are not administering vaccines they are making appointments, arranging home visits, sorting the finances, and so on.

Many of the patients are familiar with the routine, and some will even telephone the practice in August to find out when flu week is this year! We send a letter of invitation to up-and-coming 65-year-olds to inform them of their eligibility, but advertising to other patients is usually done via the local press and local information booklets (the free ones that get pushed through your door).

This approach has worked well for us over the past few years. Coupled with posters within the practice and internet bulletins, the message has got through – or at least some of it has. Despite our assurances to patients that there is enough vaccine for all, many will continue to queue around the block to be the first one through the door.

I have to say our service is good. It’s not gold standard, nor do we aim to be, but it’s generally efficient and profitable (unless you overload your fridge, of course, and contaminate the vaccines, triggering an insurance excess fee – sadly, we have done that before) and the patients like it.

Indeed, the appreciative comments on a service well managed and administered can be heard throughout the organisation and indeed the town, so why would the Department of Health (DH) be looking at other providers for the service? Perhaps other providers may do it cheaper, though our fee has not been set by us – we sign up to provide the service and accept the administration fee being offered. Perhaps alternative providers will be more polished, with state-of-the-art accommodation?

What they won’t have is the patient base and access to it. I accept that they may be able to get a list of names, but they won’t have the charm and influence of a familiar professional to encourage the patient to partake. I am overjoyed that for the first time this year we have achieved the 75% vaccine uptake rate required by the DH to be given to patients over the age of 65.

Despite taking some casualties along the way (staff were sometimes pulled away from their routine work to make sure we hit that target), the achievement of the uptake rate target is recognition of the work that all our staff have put in and their professional credibility. Definitely a team approach to a team game.