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Are vaccinations going to change during the pandemic?

Are vaccinations going to change during the pandemic?

Flu season is fast approaching, and the NHS is bracing itself for the usual strain winter ailments place on its services each year. But with the prospect of a second wave of COVID-19 coinciding with these pressures, the government is implementing plans to try to prevent the health service from being stretched to breaking point.

As part of these plans, mass vaccination programmes, including flu, will undergo a complete overhaul. Health leaders have been tasked with finding new ways of delivering vaccinations while also protecting vulnerable patients from coronavirus.

Primary care has historically shouldered the responsibility for delivering mass vaccinations locally; not just routine childhood immunisations and the seasonal flu jab, but also large-scale emergency programmes to limit the spread of infectious diseases - like smallpox in the 1960s and swine flu in 2010.

These programmes have been largely successful, with seasonal flu vaccine rates in the over-65s consistently among the highest in Europe.

This year, however, brings extraordinary challenges. COVID-19 risk and infection rates are again rising in many parts of the country, and according to a British Medical Association survey, the majority (86%) of doctors in England expect a second coronavirus peak in the next six months - if you live in the north of England, you'd be forgiven for thinking we're already right in the middle of it.

In order to protect the most clinically vulnerable people, and to help limit the impact of seasonal flu on top of the possible coronavirus wave, the government has expanded its flu jab programme for 2020-21. Free NHS vaccinations will be offered to up to 30 million people - double the usual number.

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Support to manage vaccine demand

While GP practices and community pharmacies will be expected to deliver the majority of these, they won't be able to tackle this exceptionally high demand without help.

Dr Tehseen Kahn, a GP in Stamford Hill in London, points out that different parts of the health service will have to work together to make sure as many people as possible can access immunisations.

"There is a real effort to try to join up different providers and services, with the emphasis on collaboration rather than competition," he says. "So, a patient might be invited to have their vaccine in an outpatient setting - such as a clinic or routine appointment where previously they wouldn't have had it."

Making contact count

He adds that although a lot of outpatient appointments are still being conducted remotely, some face-to-face contact will always be needed. For example, A&E departments will still be open to people who meet criteria for in-person urgent care, and clinicians there could potentially offer vaccines to eligible patients during their visit.

Furthermore, people with certain long-term conditions need ongoing hospital treatment. Dialysis patients, for instance, typically attend hospital several times a week for their dialysis, which could provide an opportunity for them to receive their flu jab, meaning they don't have to make a separate visit to their GP or other healthcare professional.

"Encompassing the expansion of the vaccination programme is the whole ethos of 'make every contact count'," explains Dr Kahn. "That means that wherever a doctor or healthcare professional sees a patient - wherever there is a contact - you take the opportunity to immunise them."

All hands on deck

Managers at Dr Khan's GP practice have broadened that approach to maximise contact between patients and admin staff, too, by training receptionists to administer flu jabs.

When a patient books in to the surgery and the system flags that they are eligible to be vaccinated, reception staff can broach the subject with them, offer the vaccination there and then, and take the patient aside into a separate area or room to administer it.

Importantly, receptionists are only able to immunise patients when they're fully trained to do so safely and competently. "In our practice's area there has been a focus on both theoretical and practical training. Receptionists shadow a healthcare professional and practise their clinical skills on a non-human model to master the technique," Dr Khan says.

"Then, they are supervised by a nurse to deliver the vaccine. The training is comprehensive and accredited, and the receptionist has to be signed off by an experienced clinician to confirm they're safe to vaccinate."

So, patients can be assured that, although it might seem unusual to have a receptionist giving immunisations, it's completely safe. An added benefit is that they don't have to sit around in the surgery's waiting area, all the while risking exposure to COVID-19.

Remote vaccines

With more staff on hand to give flu jabs to patients at GP practices, it frees up clinicians to potentially support mass vaccination efforts away from the surgery. This year's programme could see plans set in motion at local level to deliver vaccinations in other community settings, like larger health centres, schools, sports centres, and local authority buildings such as council-owned gyms - and they will need to be manned by clinicians.

Moreover, doctors and nurses in some areas might have to make home visits to patients who were previously shielding - and might have to shield again if a second coronavirus wave hits - to minimise infection risk, and to housebound patients who can't get to their practice.

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Drive-through vaccinations

A novel way of vaccinating people without them having to enter a high-risk environment, like a GP surgery, is a drive-through service. Staff at The Project Surgery in Newham, East London, are offering drive-through flu jabs this year after successfully trialling the system to deliver childhood immunisations during lockdown.

Practice nurse Shabnam Khushi explains that children's vaccination rates had been falling before the pandemic, but the risk of catching coronavirus made parents and carers even more reluctant to attend appointments.

"As soon as COVID-19 hit, we had high numbers of parents not wanting to turn up, despite our efforts to encourage them," she says. "When we told them about the drive-through service many were quite apprehensive at first, but once we talked them through it and they had tried it, they were really happy."

When parents book in to have their child vaccinated, one of the nursing staff holds a telephone consultation and provides all the information about the vaccine, any potential side effects, and instructions for attending the drive-through clinic, which is run from the practice's car park.

Car park immunisation

On arrival for their appointment, the parent calls through to the practice from their vehicle. Shabnam talks them through the procedure again to make sure they are happy and to answer any questions, then draws up the vaccine immediately before going out to the car park.

When they approach the vehicle, the parent exposes the child's thigh so Shabnam can administer the immunisation through the passenger door or window.

As Shabnam explains, safety is a priority, and precautions are taken to minimise contact and cross-contamination. "My healthcare assistant is with me and carries everything I need to the car, and we both wear full PPE," she says. "We send a text alert to parents before their appointment asking them to wear a face covering."

The decision to offer drive-through flu vaccinations, which would work in much the same way, was easy because feedback from parents who used drive-through childhood immunisations was so positive.

"As a GP practice we're quite high risk for COVID-19, so many people prefer the safety of not being so exposed," Shabnam says.

"They appreciate the fact that we would go out of our way to accommodate their safety, as well as our own. It's minimal contact, and for many people it's a real life-changer."

Local plans

How the expanded flu vaccination programme will be rolled out in your area will depend on many factors. If you are eligible for a free NHS flu jab, your GP practice will get in touch with you with information about what plans are in place, and how and when to book your slot.

You can find out whether you're eligible for a free NHS flu vaccine or a private vaccine through your pharmacist by using the Patient flu eligibility checker.

Whatever options are available to you, Dr Khan's message is clear: don't be put off having your flu jab. "We know there is a lot of misinformation out there about vaccinations. But they are very safe, rigorously checked and tested over years of research.

"It's also about being a good citizen. The benefit of being vaccinated isn't just for you - it's for that child who's on chemotherapy for example, who doesn't have a functioning immune system and who is reliant on herd immunity and their community around them to protect them.

"It's a selfless act that you are gifting to someone else who cannot be vaccinated."

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The information on this page is peer reviewed by qualified clinicians.

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