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Dr Geetha Chandrasekaran clinical director, North Halifax PCN, West Yorkshire, shares her thoughts on delivering the Covid booster and flu vaccinations
If you are confused when you finish reading this blog don’t worry – I think that sums up the delivery of this autumn booster.
I got a phone call on Saturday the 30 September at around 11am from our very stressed Covid vaccination programme (CVP) lead, asking if we were vaccinating today and if so could we make sure we weren’t using the XBB 1.5 vaccine.
It was only ‘legally’ ok to use from the 2 October. So even if we had the stock, had done the training and given assurance and it was the vaccine which may protect better than previous vaccines, due to the recent strains, we weren’t allowed to administer it for another 48 hrs. After which, miraculously, the legal stance would change, the old vaccine had to be quarantined and discarded and the XBB 1.5 vaccine would come into play.
And so, the nightmare of delivering this programme continues. As a PCN with some clinics planned closer to patients in practices, we had decided that we would take part in the campaign this autumn/winter as we are quite used to co-administering with flu and felt the benefits of this delivery model for patients.
Our enthusiasm started to wane rapidly as various messages filtered through almost daily. Changes to start dates, a reduction in the Item of Service (IoS) fee, some indication that recording vaccines on systems would be different, and even more disruptively, interference with our tried and tested methods and timings of the annual flu vaccination programme.
We were told we couldn’t start even flu till October (the contract stated different) despite the fact we had already set up and booked flu vaccine clinics. We were also told we could only co-administer flu with Covid.
Fortunately, there was a lot of noise – rightly so – from people on the ground and finally the voices were heard, and some changes were made. Not only could we start flu vaccines as planned we had to bring forward the CVP and the IoS fee was increased within a narrow timeframe.
The ordering system which we had just mastered had an overhaul too. As if the Future NHS site wasn’t hard enough to navigate, we now had to use a dashboard, delivery would follow data on stock and booked clinics although there was no clear communication on how this would be possible.
General practice is struggling with workforce capacity and increasing demand. We are trying to make sure we provide the best possible care for our patients. PCNs have provided additional workforce and services and taken away some of the administration burden of this programme. In general practice we are resilient and as PCN in our area of West Yorkshire, we are strong, so we took up the challenge and continue to deliver the programme despite the barriers.
Clinically, I understand incidence/surge and need for acceleration/postponement if indicated by a robust evidence base. But it must also take into consideration the people on the ground who deliver the programme and the capability to do so without breaking themselves or the system. Decisions made did not seem to really follow any of these parameters and the CVP team at NHS England lack insight into the practical delivery of the programme.
Programmes, such as this, set without adequate consultation and with changing goalposts, do little to build confidence in our teams or among the population and we cannot work on goodwill for much longer. Although, in our ‘place’ of Calderdale, all PCNs have signed up and started to deliver the CVP.
This is despite the inadequate funding, differences for PCNs versus other providers and constant changes which do not bode well for future programmes.
Unfortunately, all this red tape and bureaucracy does is demoralise teams and subsequently disadvantage the populations we serve, especially in areas like ours with high deprivation, struggling families with cost-of-living pressures, unemployment, high prevalence of long-term conditions where delivery and care closer to home is paramount to their engagement and wellbeing.
It has the potential to be an effective vaccination programme if streamlined with good planning and process so I dream and hope that next year is different and believe that it can only get better.
Dr Geetha Chandrasekaran is a GP partner at Plane Trees Group Practice, clinical director of North Halifax PCN in West Yorkshire and on the Pulse PCN editorial advisory board.