How to give 940 Covid Vaccines in one day – a PCN story.

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Covid-19 is a disease that has affected us all. Whether you have been ill with it or not, whether you have known someone who has had it, or not, whether any of your loved ones have died or not, you will have been affected. Perhaps by having to work from home, maybe being unable to work, some of us will have had children trying to study from home rather than school, and we’ve all been impacted by lockdowns, shops and restaurants being shut and more.

This is the context and background for us all at the moment. The prospect of a vaccine to help protect us and move us towards the possibility of a return to normal at some point in the future is very appealing.

As GPs when we heard that we might be able to be part of the solution and administer covid-19 vaccine to our patients we were keen to hear more. As we learned more about the very specific requirements of the first vaccine to be approved, however, it seemed as though this was not a vaccine that we would be able to deliver from our General Practice sites. Storage at -70 degrees, a shelf life of 5 days once defrosted, packed in boxes of 975 doses in multi-dose vials that need diluting and then drawing up with 5 doses per vial, warnings that the vials cannot be moved around or jostled heavily. All of these things make this a tricky vaccine to deliver. Add to this the need to maintain social distancing and include a 15 minute post-vaccination observation period and you have a challenging scenario.

Winsford is a town of around 35,000 people in Cheshire. There are 5 GP practices operating out of 3 premises. We are Winsford Primary Care Network.

Late in the afternoon of Thursday 3rd December Primary Care Networks  (PCNs) were asked if they could sign up to deliver a box of vaccines (975 doses) delivered on Monday 14th December in 3½ days. This is how we achieved that.

  • We wanted to do it

This might seem trite, but I think it’s really important. There are lots of things that make this a challenging vaccination programme, but you can overcome them. If you don’t really want to do it you can find many reasons to say no. It kind of boils down to whether you choose to be a ‘Yes, if…’ person or a ‘No, because…’ person. For this we were certainly in the ‘Yes, if…’ camp. That is not to say that we approached it blindly, nor is it to suggest that those PCN sites that decided not to sign up for wave 1 were wrong to approach it in the way they did. How you approach it though does matter and does make a difference to how you will feel about it as well.

  • We all agreed

This vaccination programme needs to be done with groups of practices working together. Individual practices cannot say yes on their own. We have good communication channels between our practices with a WhatsApp group and regular on-line meetings. We quickly discussed and quickly decided we were all in. The ability to rapidly check things out with a ‘steering group’ made a big difference.

  • We prepared

We read all the information and joined all the webinars. We asked questions and pressed for replies. We made sure all the health care professionals scheduled to vaccinate had access to the information they needed whether that be Standard Operating Procedures or eLearning modules. We made sure all staff were aware of what was happening and were prepared for questions from patients. We also talked to neighbouring PCNs to find out what their plans were and shared any learning. This is a key point – share, share, share.

  • We asked for volunteers

We asked for staff to volunteer to work through this list of over 80s ringing them to invite them, we asked for staff to volunteer to work on their days off. We asked for the community to help. Winsford has a Town Park, and the Friends of Winsford Town Park (https://fowtp.co.uk/) have been incredible in their support of the town, this year during the pandemic in particular. They provided marshals for our car park, sourced a marque for us to use to manage the 15 minute observation period, and staffed the marquee as well. Huge thanks to them all – we could not have done this without them.

  • We sorted the logistics

Many conversations ironing this all out:

  • Each practice invited its own patients and emphasised the importance of attending their appointment AS WELL AS an appointment 3 weeks later. They were encouraged not to arrive early to avoid queues and bottle-necks.
    • A one-way system through the building using the main entrance, 4 queues with the waiting room and then into the corridor of one of the practices where we used all of their rooms.
    • Additional admin staff greeting people at the entrance, guiding them into the appropriate queue and bringing them into the correct vaccination room.
    • Each practice did its own patients, although as we got into a rhythm we started to vaccinate patients from other practices if this were feasible to keep the flow going.
    • 10 consultation rooms in use, some housing 2 health care professionals administering the vaccine, some housing 1. Every room had an a admin person for data input.
    • In each room one of the HCPs would consent the patient and ask all the relevant questions while the other would be drawing up the vaccine and would then give the vaccine.
      • One practice had run a search for all on anti-coagulants and highlighted them in order to facilitate the consenting process for them.
    • Data entry onto Pinnacle done by the admin staff in the room – we were worried about this but it was fine. We had either EMIS running as well to pull off the NHS number and/or a printed list of patients. You can find patients on Pinnacle using DoB, Name, Postcode, but NHS number and DoB is quicker. The paper list is a useful back up in case of the IT going down. Pinnacle did go down for a while for us, but we were able to record on paper and add to Pinnacle once up and running again. You need to be familiar with Pinnacle so check it out, but it worked well.
      • Don’t forget when vaccinating staff to add them to Pinnacle – they might not know their NHS number but you can look them up.
      • We used EMIS or the paper check list to keep track of any DNAs. We could then quickly fill using a patient reserve list to ensure every dose was utilised.
    • An exit onto the staff car park where we had a marquee with 45 socially distanced chairs for people to wait their 15 mins. The marquee was within shouting distance of the HCPs inside.
    • Each practice decided for itself how many patients to invite each hour. We had 3 every 5 minutes per station. This worked for us.
    • I cannot emphasise enough the strength of letting each practice adjust their process within their consulting rooms – we all did things slightly differently and this worked really well. General Practice is very good at being flexible and adapting given the freedom to do so.
  • We used CCG comms and did our own

We emailed our local newspaper with details of what we were up to, and they wrote an article giving patients a heads up about everything. We also worked with our CCG comms team and ended up with ITV news and a lovely story relating to our first patient to get the vaccine in our centre. Don’t underestimate how good this made everyone feel. There was a real buzz around seeing staff on TV!

(https://www.itv.com/news/granada/2020-12-15/gp-practices-across-the-north-west-begin-the-covid-19-vaccine-rollout  …

https://youtu.be/IbUsJK3PSf4

https://www.winsfordguardian.co.uk/news/18945170.first-winsford-covid-vaccine-goes-man-84-desperately-missing-wife/)

Above all, I think we would say that anyone looking to deliver the Covid vaccination programme from a GP setting should feel confident that it is achievable. By working together it’s amazing what you can achieve. We worked together to agree all of the above. We worked together by one practice giving up all of its consultation rooms for this, and working from a couple rooms in a neighbouring practice. We all put the same message on our phones warning patients what we were doing and asking them to be considerate – they responded by only really presenting with urgent things on the day. We kept smiling, we remained positive, we learned from the day and we will be even more prepared next time.

Did anything go wrong? Not really. Our main issue was our carpark which was not big enough with a poor entrance and it turned into a ‘pinch point’ as people tried to drive in. This was exacerbated by the staff car park being out of action because of the marquee. Parking is worth thinking carefully about. The other issue was that people wanted to stay for longer than 15 minutes in order to chat! As someone said to me today ‘everyone loves a vaccination clinic’…

I am incredibly proud to be part of Team Winsford. We did well and believe that we have served our patient well with this endeavour. All the 940 patients vaccinated on day 1 already have their appointments for 3 weeks’ time – they have the same appointment time with the same clinician as they did first time around!

When January comes – we will be ready.

Dr Jonathan is GP at Swanlow Surgery in Cheshire, part of Winsford Primary Care Network.

Follow Jonathan on Twitter @DrJonGriffiths

*Those with an attention to detail will have noted that we still have 35 vaccines to give. I am writing this on the evening of day 1, but after giving 940 today, sorting the remaining 35 will be a piece of cake…

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