Dr Hilary Fox, clinical director of Rutland Health Primary Care Network (PCN) and member of the NHS Confederation’s PCN clinical director reference group, discusses the challenges of delivering the Covid vaccination programme
People pin their hopes on the Covid vaccination programme to allow them to visit friends and family, reopen businesses and regain wellbeing. It is beholden on all of us to make it work without jeopardising primary care, already fatigued by rapid changes and frontline management of patients’ needs and expectations.
The involvement of PCNs is an obvious step, which would have been easier if we had been included at an earlier stage. But agility and working under pressure is a key strength of general practice, and the promise of a solution to the crisis does galvanise action.
The plans for mass vaccinations were fairly well developed in our system, and in Rutland we have built on those plans, utilising the relationships that have been developed with local partners by our fledgling PCN.
Forming the best team to oversee the delivery is essential to the success of the programme. We identified leads for CQC, clinical and infection prevention and control, staffing, finance, site and IT, and the team visited the proposed site, walked through and modified the planned process, using experience gained over years of flu vaccination delivery at rates of over 900 per day including clinical grade cleaning, secure storage of vaccine, backed by a continuity plan for fridge failure, and the pinch points for patient flow.
We are fortunate to have already established a single PCN clinical system for our practices for ARRS staff to use when working across the four practices, so that all the patient records are available on one site.
Fatigue and extra hours
Recognising that working off site is new to us, we rely on the expertise of system partners, complemented by our practices’ experience. We need volunteers to help us manage the site and depend on the links with our progressive unitary authority, Healthwatch, voluntary organisations and patient groups.
Workforce is our biggest challenge. We aim to maintain primary care but our people are wearied by changes to their work patterns, lack of the informal social contact at work that promotes resilience and additional workload caused by Covid itself and the backlog.
Despite fatigue, people have come forward to work extra hours – including local retired clinicians. Using a single site means extra hours and additional staff, which represent additional costs. Delivery within the financial framework will be essential to maintain routine primary care.
The back-office work that supports the programme should also not be underestimated. Managing the rota of clinicians, admin staff, and volunteers needs dedicated resource. A key challenge will be booking patients into appointments, providing information and responding to questions. Appointment booking and patient communications for the flu programme normally starts weeks ahead.
Urgent need for patient-facing information
We urgently need the publication of the national patient facing information, because our communications programme needs to start well before the delivery of the vaccine itself.
We will be asking our partners in Healthwatch, patient groups and the local authority to help us with patient communications, and using text messaging – realising the benefit of the work of our social prescribing team early in the pandemic in recording telephone numbers and identifying people who need written information. We also plan to record a video for our websites, which walks patients through the process at the unfamiliar site.
The local Covid vaccination programme has been made possible by NHS England relaxing the rules to allow us to design something that can work for us. We aim for high volume, intense delivery of vaccinations – opening at the weekend by exception only to keep primary care functioning, maintain staff morale, improve infection prevention and control, and enable us to deliver the programme within the funding.
There are many unknowns. The greatest of these is the uncertainty surrounding vaccine delivery – we need to have a reliable system for receiving the vaccine in order to plan rotas and book appointments. Will people trust the vaccine? How will the public receive the NHS England cohorting – will those in the later stages of the programme accept this?
While PCNs are well placed to deliver the programme – using trusted local clinicians to improve uptake – the enhanced service cannot be delivered without the support of the whole system. PCNs need to be supported to be agile, flexible and responsive to local need, and systems need to work to achieve the fragile balance between guidance, support and direction – which differs for each PCN.
The connections that have been established since the inception of PCNs are going to be key to making this run smoothly.