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by Awil Mohamoud
18 December 2020

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Covid vaccination programme: ‘This has been the most stressful time in my 16 years as a practice manager’

The Covid vaccination programme kicked off in general practice this week, with around 100 GP sites receiving vaccine stock on Monday, and more deliveries taking place over the past few days.

According to data collected by the Government from hospitals and GP-led sites, more than 137,000 people in the UK received the first dose of the Pfizer/BioNTech Covid-19 between 8 and 15 December, with 108,000 of those vaccinated in England. 

Most of the vaccines have been administered to the over 80s, care home workers and NHS staff, the Government said. 

As practices reached the end of their first week of clinics, Management in Practice spoke to two practice managers about planning and delivering the Covid vaccination programme.

Robyn Clark, practice manager, Kingswood Health Centre, Bristol

Ms Clark’s practice is the designated site for Covid vaccinations in her PCN, and as one of the first wave locations, administered vaccines to patients this Wednesday and Thursday. 

She told Management in Practice that delivering the clinics has required a ‘mammoth effort’ from the PCN workforce. The practice has had 15 vaccinators on each of its two daily shifts, 15 administrators supporting them by logging information into the clinical system, and a number of others on duties, including marshalling the building and managing the car park – which the local authority helped with.

The past few days have been very busy, especially as they had so much to plan in very little time, she added, but was pleased to report that the first clinic was a success.

‘The staff just got on with it really well, and they’ve all been quite pleased with how it was run and happy to see patients who were happy to see them,’ she said.

‘They [patients] have managed to come in, get a vaccination, sit down for 15 minutes, and feel like they’ve actually come back to their surgery again, which is really nice.’

She added that the patient turnout was ‘fantastic’, with only a few Did Not Attends (DNAs), and the practice distributed remaining vaccines to staff where it could not rebook those individuals.  

Planning

Ms Clark commented that planning the Covid vaccination programme was ‘the first time the four practices in our PCN have done something truly collaborative, as there’s been a lot of cross organisational working’.

This has included the practice managers working together to create a supporting workforce for the clinic, arrange vaccinators, and coordinate patient booking – which all the practices were doing using the same clinical system. 

‘Trying to book 975 patients into one appointment book for the two days was a bit of a challenge, and quite a lot of buffering was going on with the system, as too many people were trying to book in at the same time,’ she said.

Delivery

The nature of the Pfizer vaccine – transported at -70C and delivered in batches of 975 doses – means it must be administered within three and a half days – which Ms Clark said made things more challenging. 

‘If it was like a flu clinic then there would be a lot less pressure, and we’d be able to do it at a pace that we felt more comfortable with,’ she said. 

Updated vaccine guidance published last week also means GPs must observe patients for at least 15 minutes following their injection with the Pfizer Covid vaccine, to observe for anaphylaxis.

Following this news, the practice had to change plans for a one-day vaccination clinic, and move to two days instead, as this measure limited capacity, Ms Clark said.

‘Without the 15-minute wait, we could move patients through the building, like we would for a normal flu clinic, and we would have done all 975 on the same day. So, we had to stand up an entire second day of vaccinating, with all the technical support and logistics that it entails.’

Hours and workforce

NHS England previously said that practices could be expected to provide an 8am to 8pm service every day, if vaccine supplies allow, and administer ‘a minimum of 975 vaccinations’ every week. 

Ms Clark said the first patients arrived through the practice door at 8:30am and the final ones were out by 5:30pm, meaning they were able to keep the first clinic within normal surgery opening hours.

Delivering the vaccination programme did, however, mean that the practice had to stand down routine business on two separate days.

‘As a lead site, we had to tell our patients that we were running an emergency service over those two days while we were vaccinating, so we had a team of GPs and advanced practitioners who were triaging phone calls in another part of the building,’ Ms Clark said.

‘We also had another GP who was based at a neighbouring surgery for any patients who needed to be seen face-to-face.’

She added that the practice managed to limit its routine service on this occasion, and will be able to again in January, but has already spoken to its clinical commissioning group (CCG) to say ‘it isn’t a sustainable model in the long run’.

Jo Wadey, practice manager, St Lawrence Surgery, Worthing

Ms Wadey’s practice is also a designated site for Covid vaccinations within her area, and expects to begin delivering vaccines on 11 January – something she and her PCN colleagues have been planning diligently for. 

‘From a practice manager point of view, it has probably been the busiest and most stressful time in my 16 years. It is literally taking up all of my time, [partly] because the guidance changes all of the time,’ she said.

‘But it’s also really exciting to think that we could actually start to vaccinate our community.’

Ms Wadey visited a wave one site in the area and said it was ‘overwhelming to see just how grateful the patients were to have their vaccine’.  

‘That gives us the enthusiasm and inspiration really to carry on and get it sorted.’

Fast moving 

Things have been made more difficult by constantly changing guidance, Ms Wadey added, as well as the intricacies of the Pfizer vaccine. 

‘We do flu clinics every year – and it’s really easy; we know what we’re doing. But this is much more complicated because of the Pfizer vaccine and having to get rid of 975 doses in such a short space of time,’ she said.

‘You’re having to put the patients in every six minutes to get through in the three and a half days. And in order to do that, you’ve got to be fast, or you’ve got to make sure that you’ve got a [free] waiting room if you get behind.’

She added that her PCN has also been working ‘really closely together’ with other PCNs across Worthing, ‘to just try and help each other and get us organised for it’. 

NHS England recently announced that GP Covid vaccinations are set to be rolled out more widely to care homes in England from next week – something Ms Wadey said the PCN is also keeping in mind.

Workload

Planning for the Covid vaccination programme has required lots of work, Ms Wadey said, including ensuring that the PCN has enough staff available for when the programme starts and that they’ve all had their vaccination and anaphylaxis training.

‘We’ve had to try and work out the patient flow. We’re starting with the over 80s, so we’re having to ensure that we have seating for them, but with social distancing it’s quite a challenge. You need to have enough marshals to take the patients from the car park into the waiting area,’ she said.

‘The whole logistics around drawing up the vaccine and giving the vaccine needs to be thought through very carefully because it’s very fragile, and you’re not allowed to travel with it.’

The practices decided to use their local GP federation to deal with booking patients and have given them the contact details of those eligible for the vaccine.

Ms Wadey told Management in Practice that they have also had to think about other smaller details, such as notifying the highways and police due to expected traffic build-up, dealing with wasted vials if some patients do not turn up, and making sure they have gathered a list of staff phone numbers to offer them any surplus vaccines.

‘In summary, massively busy, massively stressful, but it will be amazing once we can actually start to deliver these to our elderly population. It will make such a difference to them,’ she added.


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