Layer 1

GP view: How will socially distanced flu jabs work in pharmacies?

The idea of a long queue of patients ready to get their flu vaccination now seems alien”

The need for social distancing could make delivering flu vaccinations difficult for both pharmacies and GPs, says Dr Toni Hazell

I sometimes feel that my life is mapped out by the passing of the seasons – another Christmas passes, my kids get a year older, and of course, the annual ritual of the flu vaccination season.

At my GP surgery, we start planning in spring and usually vaccinate over 600 patients on a single Saturday morning in September, mopping up the rest opportunistically over the next few months.

But everything has changed now. The waiting room, usually home to more than 30 people on a normal day, now holds four socially distanced chairs for those patients who need to be seen face-to-face. With the advent of video technology, we can safely manage many more patients remotely than was possible before. The idea of a long, snaking queue of patients with their sleeves rolled up ready to get their flu vaccination now seems alien.

So how are we going to get this done? My paper copy of a national newspaper is doubling as a mouse mat while I write this, and I’m looking at a headline: “Flu jabs for half of the population.” That may be a slight exaggeration, but apparently we will be vaccinating all of the over-50s and the families of those who were in the shielding group, as well as all of the usual at-risk patients.

We don’t yet know when a vaccination against COVID-19 will become available or whether that will be given in primary care.

The Royal College of General Practitioners (RCGP) published a useful document in July that considers some of the issues when delivering vaccinations during the COVID-19 outbreak – the main one being the need for social distancing.

The RCGP points out that it usually takes us one to three minutes to deliver a flu vaccination, but in current circumstances this time may double, requiring a significantly increased number of people delivering the vaccinations.

Some GPs operate out of large, purpose-built premises with multiple entrances and exits and may be able to cope with large numbers of socially distanced patients, but for many this will be impossible.

Seeing vaccinations happening in schools – for adults, not just children – church halls or council facilities may become commonplace, and the RCGP is even suggesting that a drive-through flu vaccination clinic may work in some areas.

There are obvious possible safety issues if a patient has an anaphylactic response to a vaccination while in their car, particularly if they are the driver. As always, we have to make sure that no-one is left behind. How will any new arrangements work for those who find it difficult to access healthcare because they have learning difficulties, are functionally illiterate, not on the internet, don’t have a mobile or a car or don’t speak English? And of course, those who are housebound will need to have the usual arrangements made.

Flu vaccinations have been offered by pharmacies for years. The pharmacy service may become more important, although of course you are constrained by the same issues of personal protective equipment (PPE) and social distancing as GPs. As well as this, some pharmacies operate from small premises, with consulting rooms that make social distancing difficult.

This year will certainly be interesting for flu vaccination, and it remains to be seen whether any changes will be a one-off or will end up being permanent.

Toni Hazell is a GP based in a practice in London

6 Comments

Adam Hall, Community pharmacist

I don't understand how it is that GPs (but, in reality, nurses) can give a flu vaccine and send the patient on their way without any hanging about yet we have to observe them for 10 minutes. Is it so that GPs can process more flu vaccinations in any one session, and also to restrict our "through put"? Just asking

Matthew Edwards, Community pharmacist

Appointments every 10 minutes, prepopulation of pharmoutcomes via the preconsult app and a one way system around the shop. Screen in the consultation room to protect everyone and still using appropriate PPE.  This is a simple effective service that can be done safely and with ease if you apply yourself.

Kevin Western, Community pharmacist

Why should it be an issue? We generally do them as patients walk in, and as long as patient flow isnt exceptional, it isnt a problem. I was amused by our local surgery who sent all their patients a letter last year pointing out that if they had their vaccinmes at the surgery, it would be done in a properly professional environment unlike other flu service offerings...this year they are doing it in their properly professional car park...

Leon The Apothecary, Student

Those kinds of disingenious letters described are wholely unprofessional. 

Getting Shorter, Community pharmacist

The surgery we are next to started their Saturday jab clinics last week. Definitely not as busy in the carpark as previous years. I asked one of the nurses how they are managing it... they have 5 waiting spots, 5 rooms with 5 jabbers, and someone on the door to enforce one-out-one-in. When I asked about patients waiting afterwards in case of anaphylaxis, I got a shrug, which is slightly worrying...

Meanwhile, we're planning to allow 30 minutes per jab, for paperwork, extra washing, cleaning etc and the wait afterwards as we can only really cope with one person at a time while running the rest of the business. However, we are still waiting for the PGDs to be published - the LHB are currently "working towards" having them ready for 21st Sept... they've only had the best part of 6 months knowing this would likely be the most important flu vaccination season ever to get it sorted, poor dears.

 

I have a cunning plan for mass vaccination. We've just built all those big field hospitals that are currently standing empty - surely we could staff them with many lines to process large numbers of people. Clinical staff only needed to scan paperwork that throws up queries, actually give the jabs and react to analphylaxis (all the emergency gear should be on hand already) - the ins and outs, giving over and checking the paperwork, keeping an eye on the waiting rooms both ends, etc, can all be done by pretty much anyone.

Leon The Apothecary, Student

Flu Vaccination Season always appears to be a surprise every year, and I do not understand why.

Job of the week

Pre-registration Pharmacists 2021
London (South), London (Greater)
Competitive package