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