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GPs buried under trusts' workload dump

Use flu jab campaign to earn CHD points

Dr Tim Gietzen's practice is planning its flu clinic already – he explains the organisation involved and why he feels it's worth it

If you are the sort of person who writes an indignant letter to The Daily Telegraph if there are Easter eggs in the shops in December, don't read on. We're planning our flu clinic already.

What we hope to do is to combine the flu clinic with a catch-up clinic for CHD, asthma etc and cover the cost of extra nursing time with a Pneumovax blitz. The premise is simple. All of our CHD, asthma, diabetes and COPD patients should have a flu jab, as should most of our hypertensives. If we specifically invite them for a check-up and a flu jab we can fill a lot of gaps. If they refuse, or don't turn up that's their first yellow card. One more refusal and they can be excluded from the target.

One of our receptionists is happy to work evenings, from the beginning of September she is going to sit down with a telephone and a computer and phone every person over 65 or on the relevant disease register. This is a break from normal practice; usually we let the patient book an appointment but this way we can record that they've been invited. With the screen in front of her she can note the fact that they've been invited and start to fill in some of the blanks, like smoking and the use of aspirin.

She can also make an individual hit-list for each patient – needs Pneumovax, blood pressure and cholesterol check, that sort of thing. We are banking on the fact that most people will be up to date on most things. If they're not we will have to draft in more help, but better that than missing out on the points.

It sounds daunting but with a little planning it shouldn't be too difficult. Our first step is to ensure we have the right staff doing the right jobs. The way we see it, a receptionist, a nurse and a health care associate ought to

be able to see three patients every

10 minutes.

On the day of the clinic the receptionist will book them in, hand them a leaflet on contraindications and side-effects of the flu jab and a preprinted form highlighting missing nGMS information. She directs them to the health care associate who, if necessary, can check blood pressure, ask about smoking status and take blood.

Even if every other person needs some sort of intervention then this will still allow nearly seven minutes per patient, which should mean she can see 18 patients per hour. Once she's finished recording her information she can pass them, complete with the form, on to the nurse.

She can give the flu and Pneumovax and, if indicated, check peak flow

and offer smoking cessation advice. The completed form can then go

back to the receptionist for data entry.

Clearly this is not the same as a full asthma check or a full CHD check but it will fill in nicely in areas such as recording smoking status or checking blood pressure. There won't be time to deal with any abnormality which is revealed so other members of the health care team will need to be braced for an influx of patients with elevated blood pressure.

Reception staff will need to be vigilant at spreading follow-up appointments so that the entire surgery doesn't grind to a halt.

Tim Gietzen is a GP in Eastbourne, Sussex

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