General practice enters this winter’s flu vaccination season with more to contend with than any other year.
The Government has pledged to vaccinate more than 30 million people in England – double last year’s number – following the decision to extend eligibility for the free jab to more schoolchildren and shielded patients and their households, as well as 50-64 year-olds ‘later in the season’. Wales and Northern Ireland have adopted a similar approach, while Scotland has included household members of those shielding, social care workers and people aged over 55.
This takes place around the corner from a possible second wave of Covid-19 infections, and as normal winter pressures pick up and routine services return to near-normal levels.
The Government has also yet to provide details on various issues affecting how practices will operate this winter such as the number of top-up vaccines they can expect from the central stockpile, or what other support and funding will be available.
Practice managers and their teams, who plan for the flu season well in advance each year, have had to adapt and improvise in recent weeks and months to meet this unprecedented challenge and to ensure the safety of their patients and staff.
We spoke to three practice managers about what this period has looked like for them and how their practice is preparing for the programme.
Ann Stewart, practice manager at St Gabriel’s Medical Centre, Prestwich
The Covid-19 pandemic has added ‘a massive layer of complexity’ to preparing for the flu vaccination programme this year, Ms Stewart says, as practices have had to plan for measures including social distancing and regular cleaning to keep patients and staff safe.
‘It has taken far longer than it would have done in normal years,’ she says.
Ms Stewart, along with the office manager and nurses, has carried out process mapping on a wall and planned ‘all of the steps [they] need to do, scrutinising each one to see what may have been missed, to get the new system as tight as possible’.
On the plus side, this situation has offered ‘a good opportunity to think outside the box and do things a bit differently’, she adds, with her practice introducing a drive-through clinic in its car park.
The practice opted for a drive-through, as well as a walk-in option, due to having a high number of shielding patients, and anticipating that some could be too anxious to visit the practice building for a vaccination, Ms Stewart says.
This could also mean being able to see more people, as time would be saved on cleaning rooms between patients, she adds.
The local area has also, historically, had a low uptake for the two to three-year-old age bracket, and so the practice hopes giving parents another convenient option will help improve that.
‘We are quite excited about our drive-in opportunity and who knows where that may lead. If it works, it is something that we may increase and spread further. We could use it for mass vaccinations against Covid, potentially, next year.’
The British Medical Association (BMA), in July, called for more to be done to encourage higher vaccination uptake, following research that showed childhood vaccinations have declined 20% since lockdown in March, amid a ‘concerning fall’ in recent years.
Flu vaccine stock
Last year, 15 million patients got a flu vaccination in England despite a target of 25 million. This year, the eligible cohort has been expanded and that target increased, causing uncertainties around whether practices will have enough supply, particularly for the 50-64 age group later on.
‘As with every practice, we would have ordered our flu vaccines based on historic uptake and usage and, of course, we all have to place our orders a year in advance. No one anticipated Covid, so I suppose it could go either way,’ Ms Stewart says.
‘Covid could make patients very aware, meaning people come in this year, despite never having done so, or actually it could mean they do not come at all. We’re hoping that what we worked out based on last year’s uptake will suffice.’
Jane Dawes, managing partner at Blackmore Vale Partnership, Dorset
Ms Dawes’ practice, which has four sites, would in normal years run flu vaccination clinics at two of its largest locations. However, with a patient list of 27,000 patients, it determined that for safety, this would not be feasible this winter. The practice has instead booked the local airfield, which was offered for free, and has acquired marquees to hold a drive-through clinic. This space will also be used to do shingles and pneumococcal vaccinations for children.
The practice also considered the fact that both of those practice sites are located at the edge of small rural towns and lack the parking infrastructure needed to run an efficient service that doesn’t have people waiting around – possibly increasing exposure to other patients and staff, Ms Dawes says.
Flu bus services
Deciding to hold the clinic at the airfield has presented its own accessibility issues, which the practice has put in steps to address, Ms Dawes says.
‘We have quite an elderly population and lots of them are really isolated, so we are working with local minibus providers who do school runs to offer buses for those who don’t have access to a car, which is quite a few people.
‘The bus will be socially distanced and they will all wear a mask. They will be driven to the airfield and a clinician will get on the bus and vaccinate the patients.’
The bus, which will do roughly two trips a day, will travel to different villages, and will pick people up from areas that have limited access to public transport, Ms Dawes adds.
The practice has also arranged a ‘flu bus’ with another company to travel around villages to vaccinate patients who, for whatever reason, do not make the two-week flu clinic at the airfield.
Doing the vaccination via a drive-through also helps the practice reduce the amount of PPE used, Ms Dawes explains.
‘We’re a big practice and still seeing a lot of patients, so we’re getting through a lot of PPE,’ she says.
‘The supplies by NHS England have been intermittent, so we get some from there and try and source our own. We put regular orders in roughly twice a week and collect what we can when the CCG has a delivery.’
In July, MPs called on the Government to deliver a plan to ensure sufficient PPE provision and claimed it was not treating the matter with ‘sufficient urgency’ amid a potential second wave of Covid.
Ms Dawes’ practice has also been holding informal Facebook Live sessions with patients to answer questions and explain reasons for changes to this year’s flu programme. The team, which usually includes a GP, a nurse and the practice manager, answer other questions including about the vaccine itself and why it’s important to take, particularly this year.
It started doing these group video meetings either weekly or fortnightly at the start of Covid to talk about the virus and address concerns, Ms Dawes says.
‘We’ve had lots of patients and it has been really great PR. It’s very helpful because it breaks down the barrier between clinicians and patients, and they absolutely love it. Apart from your time, it costs nothing,’ she comments.
Emma Jacobs, practice manager at the Walnut Tree Health Centre, Milton Keynes
The flu clinic at Ms Jacobs’ practice this winter will be a complete contrast to other years, where this has typically been a social occasion, with patients gathering in the waiting room with tea and biscuits and raising money for charity.
The practice has decided to hold flu vaccinations within the practice, as it determined this would be more suitable for its patients.
‘Certainly, where we are, doing it on-site should not be an issue,’ Ms Jacobs says.
‘We’ve got a relatively small patient catchment area, geographically, and therefore most people will be able to arrive on foot, and if they can’t, we have a lot of car parking space around us.’
Patients will check-in with admin staff in an outside gazebo and will be split into two separate queues – under and over 65s, before going inside for their vaccination. Afterwards, they will be asked to follow the one-way system out of the practice, and there will be a one-minute gap for cleaning before the next patient goes in. The practice plans to run the clinic twice, each time on a Saturday.
The practice will likely be stretched to capacity this year, Ms Jacobs says, particularly due to needing more time to clean between patients and also having to do routine catch-up work, such as diabetes and respiratory checks, on top of the flu vaccination programme.
‘What we really need to focus on is getting as many people in on those Saturdays, because even though we have a larger nursing team than ever before, they are running out of capacity.’
Running additional clinics on normal working days would be unworkable, due to restraints on how many people can be in the building at any one time and because of the staffing that would be required, Ms Jacobs explains.
‘We try to be quite organic, so if having a bespoke clinic on another Saturday would work well, then we will do that,’ she adds.
‘But normally, by the end of October or middle of November, the bulk of flu vaccinations are done, and then you’re just targeting harder to reach patients – those who maybe haven’t responded to the invitations.’
The practice does a run chart each year for flu vaccination uptake, and gradually adapts its promotion technique to reach as many people as possible, Ms Jacobs says. It starts with simple communication methods, such as sending letters and text messages, followed by healthcare assistants making phone calls to those who have not booked by a certain point.
The service specification for this year’s flu programme says that the 50-64 cohort will become eligible for the jab in November and December ‘subject to vaccine supply’ – this will be formally announced later in the season, with each year group to be considered separately.
Last month, NHS England admitted that practices across the country have had patients in this age bracket trying to book vaccinations since the announcement in July and some GPs have also expressed concerns that patients could get angry if the offer of a free jab is not ultimately met.
Ms Jacobs says that she wants to make sure the most vulnerable patients [in that cohort] get the jab first.
During the early stages of the pandemic, the practice increased its flu vaccine order by 10%, anticipating greater demand this year, and then again ordered around 500 more as it emerged that the cohort would be expanded to include 50 to 64-year-olds. At the time, there was no confirmation of a centrally held stock, so the practice was taking a financial risk, Ms Jacobs says.
She adds that while her practice can guarantee vaccine for all other groups in the cohort, there might not be enough for every person who presents within the 50-64 age range, and there are still questions around where the practice can source additional vaccines if required later on.
‘This is going to be massive and we’ve got to get it right,’ she says. ‘I think it’s something that we will hopefully look back on and be really proud of.’