This article has been provided and sponsored by Quality Compliance Systems.
Author: Alison Lowerson, GP policy lead, QCS
In March, Dr Clare Jones announced that she had chosen not to be vaccinated against Covid-19. In a written statement, Jones, who is a partner at the Wargrave House Surgery in Herefordshire, said at the time, ‘…is the Government really suggesting that because I exert my choice not to have the Covid vaccine my wealth of medical experience is going to be lost just because I choose to exercise my free will and conscience?’ [i]
Dr Jones’s decision not to be immunised, however, drew criticism from Patient Concern, while the Daily Mail quoted a GMC spokesperson as saying, ‘Doctors should be immunised against common serious communicable diseases unless medically contraindicated’. [ii]
While I don’t wish to comment too much on this story, as any practice manager knows, every member of nursing staff working in a GP practice currently has the right to decline a vaccine. Secondly, it’s important to note that a GP electing not to be immunised against Covid is extremely rare. At the beginning of March, for example, the NHS confirmed that nine out of 10 staff had been immunised against Covid-19.
That said, in England at least, the NHS’s Chief People Officer, Prerana Issar, conceded in March that there were still ‘staff who have declined the first dose of the vaccine’.[iii] It is impossible to know to what extent the temporary suspension on the AstraZeneca vaccine in a host of European nations due to extremely rare blood clotting side effects, will impact on vaccine take-up in this country. However, ensuring that people continue taking the vaccine requires a soft approach with clear, reliable and updated messaging at its very core. This is in stark contrast to the ‘no jab, no job’ policy, which the Government is currently considering applying to the care sector, after some care workers turned down the offer of a jab.
How to use policies to tackle vaccine hesitancy?
At QCS, the leading provider of content, guidance and policies for health and care sectors, we have documented how GP practices can address the issue of vaccine hesitancy. We’ve created bespoke policies, published articles and have produced podcasts and webinars on the subject. But, most crucially, we haven’t just focused on Covid. Instead, our policies and procedures cover all the vaccine programmes.
With this in mind, we’ve created a Staff Immunisations Policy and Procedure and risk assessment vaccine checklist for staff immunisations. The policy not only enables GP practices to regularly update staff vaccination status, but if there are gaps in a staff member’s immunisation record, the QCS risk assessment, makes it easy for practice managers to spot them. Practice Managers can then discuss the level of direct contact that team members have with patients and the procedures staff might be carrying out that could put them or their patients at unnecessary risk. After carrying out a detailed risk assessment, it might be that minor changes are made to that person’s job description, or if they don’t wish to be immunised against Covid or flu, depending on the risk factors, it might be that they are temporarily reassigned to work remotely.
There are also small sections of the population who want the vaccine, but aren’t able to be immunised due to a history of allergies and other health issues. The WHO had previously advised that pregnant women – or those breast feeding – should not be inoculated against Covid. But the UK Government has just announced that – with minor caveats – should now be offered a Covid vaccine.[iv]
But, before any risk assessments take place, from a best practice perspective, GPs should hold one-to-one meetings with staff who are unsure whether or not to be immunised. These meetings, which are usually led by nurses, should be informal and light-touch and explore the reason why the team member or a patient might be reluctant to be vaccinated. Implementing best practice is vital too. I’ll be discussing vaccine hesitancy and how to protect vulnerable groups in much greater detail with my colleague, Tracy Green, in the podcast that accompanies this article.
But in the next few months, it is likely that GPs will face far greater challenges than overcoming vaccine hesitancy amongst staff. With the majority of all Covid jabs in the UK currently carried out by GPs, the question many practice managers are asking is where are they going to find time, the resources and the money to finish the current Covid vaccination programme? What about giving their patients booster jabs – which may be required annually? And, if this wasn’t challenging enough, there are childhood vaccinations and the annual flu-immunisation campaign to consider too.
Take seasonal flu vaccinations, for example. There was some uncertainty regarding the number of different age groups who will be offered jabs, (particularly the cohort of patients aged over 50), and the number of immunisations needed. Low immunity to flu is another unknown. This year and last, for instance, due to a combination of shielding, self-isolating and a compliant public observing infection prevention and control (IPC) regulations, rates of flu dramatically decreased. But with Covid restrictions set to be lifted significantly in the next few weeks and months, nobody is quite sure how severe this year’s flu will be, and whether the number of doses ordered will be sufficient.
Flu: we need better reporting systems
Another challenge for GP surgeries is reporting flu. If patients have mild flu that doesn’t require them to visit their GP or local hospital, it is unlikely that they will inform their surgery once they have recovered. Perhaps, going forward, Public Health England needs to introduce better national influenza reporting systems similar to Covid reporting systems. If implemented, these would give a much more accurate picture of how other respiratory diseases, might impact on the population. Again, we’ll be talking more about this subject in our podcast.
Whatever the solution, the government needs to bear in mind that vaccination programmes cost money and use up valuable resources, which the majority of GPs simply won’t have due to contractual delivery pressures. The question is, who will help GP surgeries to continue the vaccine drive? An emergency taskforce – including the military – has been providing support during the pandemic, but how long can it be sustained?
Secondly, GPs surgeries across the country will need to re-evaluate their resources to deliver services, as the CQC still expects them to maintain safe levels of care and to deliver the services that their contracts require. Therefore, this means if a GP practice has decided to vaccinate cohorts 10, 11 and 12, practice managers and GP partners need to have a clear idea as to who will deliver the additional services and how they will be funded. To help them assess the correct staffing levels required on a day-to-day basis, QCS has produced a Staff Rota and Staff Availability Policy, with a rota template that can be reviewed and adjusted when required.
IPC policies and procedures should not be forgotten
Finally, as all practice managers know, formulating robust IPC policies – and constantly updating them – is the most effective tool that GP surgeries have in their toolbox to safeguard patients and staff from infection and disease.
Most recently, Chile – which currently sits third in the Covid-19 vaccination table – has discovered that vaccinations alone cannot be considered the ultimate panacea. The Chilean government made the mistake of relaxing social distancing and, shielding restrictions and despite the vaccine drive, it is now back in lockdown. [v]
Coupled with the vaccination programmes, a rigorous but flexible IPC policy is the key to fully opening up GP services and running them without disruption – which is a CQC requirement. At QCS, the GP team is constantly updating and creating new IPC polices and guides, as well as sharing best practice learning with surgeries. We have also created the QCS Covid Tracking tool, which can inform patients, staff and visitors based on their recent movements, whether they can or cannot enter their GP practice. Not only does it record if they have visited the practice in the last 21 days, it also records the result of their last lateral flow test.
This, and other measures that I have discussed show the clear value of incorporating up-to-date vaccination policies and procedures in GP practices. If you wish to find out more about how vaccine protocols can add value, why not contact QCS’s compliance advisors on 0333-405-3333 or email [email protected]? Or for more coverage on this debate, please tune into our podcast.
[i] Hereford Times
By James Thomas
Date: 6, March, 2020
[ii] Daily Mail
By Andy Dolan
02, March, 2021
[iii] Cambridgeshire Live
By Neil Shaw
15, March, 2021
By Sam Meredith
21, April, 2021