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Running the Covid vaccine and booster programme became a transforming mission for Central Middlesbrough PCN, which adapted swiftly to the demands – especially, working with the community to ensure hard-to-reach patients were not missed
The challenges faced in the pandemic by our PCN are not unique. We had to evolve fast to deliver the vaccination programme alongside our general practice duties. I believe the trust we’ve built up in these times is essential to the way we work.
Covid vaccine programme
The vaccine programme became my personal ikigai – a Japanese word for purpose, motivation, reason for living. Many of us lost loved ones and colleagues to Covid and the vaccination programme gave us a positive way to fight back. I felt that all the years of my leadership journey were coming to fruition with this vaccination programme.
We started the service in January 2021. We chose a small practice with a list of 2,000 patients to be the designated vaccination hub – it has a large parking area and its sister practice was able to absorb the patient footfall. We set up temporary cabins at the front and back of the building to create a one-way system, check-in and observation area.
We consulted with patients and commissioners and nominated a receptionist to field queries. Our patients were very understanding.
Setting up the vaccination hub also gave us experience in working with the local authority and businesses. We had to ensure adequate street lighting, road gritting, police and street warden patrols. This was a real taste of working beyond the realms of general practice.
There was also the work of setting up for vaccination. We assembled a team of 30-40 vaccinators who would rotate through the hub. Our pharmacists and pharmacy technician, recruited through the additional roles reimbursement scheme (ARRS), were also trained by the clinical lead at the PCN to become vaccinators.
We also became a vaccination training hub for the local fire services, who then worked in mass vaccination centres and other PCNs.
We linked with local sixth form schools and our site became a hub for work experience. These young adults will be our future workforce and we feel proud that we have played a role in shaping their life experiences.
We also recruited around 30 volunteers who have continued to support us through the programme. While this created additional work with a contract, a lead practice and an induction, they formed an integral part of our team and felt aligned to our PCN.
After the first round of first doses we created ‘Covid vaccine warrior’ badges and certificates for all our staff and volunteers.
As the vaccination programme progressed, we released the hub site for some days of the week for normal running of the host practice.
When the announcement was made on 12 December to accelerate the booster programme, we were not surprised. However, we were fatigued by the increased general practice workload alongside the work of delivering vaccination clinics. And we were finding it was tough to keep up with the ever-changing guidelines on testing, isolating and PPE.
Two practices in our PCN opted out of the booster programme because of workforce issues, but the remaining practices absorbed the work.
By this time our ARRS appointments were well established. Our physiotherapist and mental health practitioner were able to support in direct patient care. Our pharmacist and technician managed the vaccination hub and also helped vaccinate. The care co-ordinators multitasked between admin roles at the vaccination site, marshalling, booking patients and also supporting housebound and care home vaccinations.
We’ve been working on shifting sands with Covid for the past year. At first, when we met with NHS England and the CCG, it seemed it might be necessary to cancel holiday leave in practices, but we managed to find a solution that improved capacity for vaccination and did not affect the much awaited Christmas and New Year break. We got authorisation from the CCG to open a practice for extra hours from 6pm to 9pm and opened extra clinics for the first week of January for those who preferred not to be vaccinated in the holidays.
We’d already been quite agile and set up more than 25 pop-up vaccination clinics for hard-to-reach areas.
Our first pop-up vaccination site was at a mosque and was sparked by vaccine hesitancy in the local BAME group. With support from local religious leaders and other community leaders, we vaccinated 185 people with their first dose in May 2021. This attracted a lot of media attention and was recognised in November with a local award. We won for the public health teams’ Covid champions – a mixture of lay and council workers who help with community outreach by myth-busting and distributing leaflets.
There are significant areas of deprivation in our community. Car ownership is low, which makes it hard for some people to get to vaccination sites. We took vaccines to charity shops in these areas and were encouraged by the uptake.
Walking through the mall, I noticed many shop units were empty, so we worked with the council who talked to landlords about using them for pop-up clinics. We have now done two pop-up clinics in the heart of the centre and have another planned for the Valentine’s Day weekend.
Our next project is vaccinating the homeless, working with charities and public health.
We hope that the relationships we have built during the vaccination programme will go further. For example, in the BAME community we have poor uptake of cervical smears and learning disability health checks. We also suspect that people in this community do not readily seek help for family members who are developing dementia. They see it as part of ageing and become carers without seeking advice and support. We are doing research to assess whether this is just our perception or if it is a reality and if so we’ll seek a way to support the carers and the patients.
We have appointed a multilingual care co-ordinator who understands the culture. I feel this will help us develop better connections with the community.
As a PCN we have delivered approximately 45,000 vaccines, including first, second and booster. We delivered at a scale that was unprecedented and was certainly needed.
We now need to look at the sustainability of the vaccine programme. The vaccination site needs to return to full-time general practice duties so patient care is not affected.
I think it would be a shame to lose all the work we’ve done by only having mass vaccination sites. These do not work for everyone – for those without a car, the vulnerable, the elderly, those in care homes.
There should continue to be a range of options and the vaccine should also be brought into practices and administered like the flu jab.
And there is, of course, the other PCN work we want to focus on.
People in the North East don’t get the benefits they are entitled to so we are working with a benefits adviser to address this as poverty leads to poor health. Working with our neighbouring PCN and local authority, we are setting up a project to put a benefits adviser in our practices on a few days a week.
We also now have much better links with public health at the council so we are hoping to build on that by working jointly to address health inequalities as part of the DES for the PCN. We have a joint working group with two other PCNs in our area and the local authority, and have identified our key priorities. With an overarching theme of addressing poverty, we will be looking to address mental health and alcohol-related problems.
We have challenges with estates, which are woefully inadequate to take on the additional roles. I don’t feel new staff are well suited to remote working. Unless premises are created where PCN staff can work together, the sense of belonging will be missing.
We struggle to secure the resources to handhold, to welcome and integrate these new members. While the reimbursement of the salary takes away the financial strain, it does not always cover the finances involved in recruiting, managing and the usual HR processes.
We have employed a PCN manager but there is no extra funding directed to the PCN to support this financially. Lack of adequate administration support will burden practice managers and this needs to be addressed.
We also want to focus on leadership development to establish a model of distributed leadership.
The vaccine programme has really shown how important the PCN structure is and how vital it is that we work beyond our practices – so we hope to build on that to tackle the other health issues in primary care in our area.
Clinical director Dr Vaishali Nanda
Practice The Discovery Practice
PCN Central Middlesbrough
Location Middlesbrough, North Yorkshire
Number of practices in PCN 7
Number of patients in PCN 50,000
PCN hires (ARRS employed)
Recruiting (ARRS roles still to fill)