The COVID-19 vaccine - a perspective from Dr Abbie Brooks
A perspective from Dr Abbie Brooks, GP from Priory Medical Group who has worked at a few of the vaccination hub clinics.
The launch of the vaccination programme had a rocky start because the initial plan locally was based upon running a drive through clinic like the successful flu jab hub. However, it soon became clear there was a potential safety issue due to the need to observe patients for 15 minutes post-vaccination. It was frustrating for everyone at the beginning as we invited patients and then had to postpone due to delivery issues but it was the right thing to do, to take time to prepare for this huge undertaking. Fortunately, deliveries are now getting more consistent and I was so excited to see the sign directing people to the clinic at the central vaccination hub on Tuesday 22nd December.
I had done all my e-learning courses and read as much about the Pfizer vaccine as possible but I still felt nervous and apprehensive the evening before my first shift. There were a lot of ‘what ifs’ – what if the reconstitution of the vaccine is complicated? What if the weather is terrible? What it the staff due to attend need to self isolate? Etc etc…
On the day itself, I arrived just before 8am to find a raft of local staff, both clinical and non-clinical, keen to get going vaccinating our vulnerable 80+years population. After introductions and an induction my PMG colleague, Dr Theresa Rutter, got her hands on one of the first vials of the vaccine. Patiently drawing up the saline and reconstituting the Pfizer vaccine, she brought in her first patient and the journey of vaccinating our vulnerable patients officially begun.
Locally we have a central hub, it is a large heated marquee based in an old park and ride car park. It has been the site of the flu vaccination drive-through service so we knew it was an ideal location for this large scale covid-19 vaccination programme. The hub is run by Nimbuscare, which work on behalf of the practices of York and so patients are invited from an array of local practices to attend these clinics.
Patients can arrive by car and are advised to stay in their vehicle until they are escorted to the vaccination marquee where there is a small, socially distanced queue. Patients give their details to the booking in team and then it is a case of waiting in the queue until there is an available pod. There are 10 pods set up at the site, each with two members of staff assigned to each; one giving the vaccine and one entering information in to the clinical computer system. Pinnacle is a nationwide system that keeps a record of all the patients that have received their vaccine. These records are then shared with your own GP practice.
You will be asked a few questions; firstly your full name and date of birth and then a few clinical questions to ensure it is safe for you to receive the vaccine. There has been some discussion around whether you need to bring your NHS number with you; no you don’t need to as we can usually find you on our systems with name and DOB. However, if you have your NHS number handy it makes the search a little quicker. We then make sure you are happy to go ahead, talk through what to expect after the vaccination (all in the leaflet you are given too). Next, we give you your injection. In general, we give the injection in the muscle at the top of your arm. Finally, you are passed a card with your details on and asked to wait in the observation area for 15 minutes.
I have attended a few vaccination clinics now, and they have all been so good for the soul. I work as a GP in a large practice and these past 10 months have been the hardest and busiest I have ever known. Knowing that every vaccine I give could make a difference to that individual and family’s life is just the best feeling. The more vaccines we give, the closer we are to being able to see and hug our loved ones. Seeing and talking to patients in the 80+ age category, many of which haven’t been out since March, is such a privilege. We keep the site covid secure and ensure the safety of the patients attending. It was great to work on 9th January when we were also able to start using the AstraZenica vaccine, every week the programme grows, we learn more and are able to protect more people.
The difficult storage requirements of these vaccines makes bringing them to patients quite complex. It would be great to run it just like a flu clinic, day in day out, but it doesn’t work like that unfortunately. We know it can be a challenge to travel to the central site, but due to the specific logistics required for these vaccines, the central hub is the most effective way of offering the vaccine to the most amount of patients. There are still challenges ahead, we find out at quite short notice (48-72hours) when a batch of vaccines will be delivered and this means contacting patients at short notice. We are very grateful for your patience as we know it can feel a rush or a little haphazard at times.
There is a ”priority list” which advises us which vulnerable groups should get the vaccine first. There has been a phenomenal effort across York to get care home residents and staff vaccinated as the highest risk group. Nikki Kanani (Medical Director of Primary Care at NHS England) recently said:
“For every 20 vaccines that we give in a care home, one life is saved.”
Practices across York have been doing their very best to invite patients aged 80+ and we are aware asking people to use an online booking system can bring challenges. We are also phoning patients in this group that have not yet been vaccinated and there is still a large number to protect. Please rest assured that no one will be forgotten. Currently, vaccinating housebound patients is something we cannot offer due to the inability to travel with the vaccines but we hope to offer this option in due course.
Health and social care workers are also a priority, and many have been vaccinated in the last two weeks. We will continue to offer appointments and, going forwards, there will be a hub dedicated to this group. Protecting those that have frequent contact with patients is key to reducing spread of the virus. I was vaccinated on my birthday, just before Christmas, it was the best present I could have ever received. I had a sore arm for a few days but was otherwise well.
This vaccination programme is a huge project but one that those working in primary care are up for. As a clinician I feel lucky that I get to be a small cog in this very large and complex machine. Working in these clinics is such a positive thing. I love working with colleagues from different practices across York and it is amazing to see so many people giving up their spare time to sign up for extra shifts.
As much as we cannot see the visible smile behind the masks, it is clear that each and every patient that comes through the vaccination hub is delighted to be there, getting the opportunity to protect themselves and their community from the virus that has seen our way of living altered for the last year. The team effort across the board, those behind the scenes, working on the ground to volunteers, clinicians, admin staff and more has been immense. York should be incredibly proud of what is happening at Moor Lane park and ride this year.
Some patients who were vaccinated in December were given a date for their second dose after 3 weeks. These appointments have been postponed to 8-12 weeks following the first dose due to a change in national public health guidance. This is to ensure that as many people as possible, on a population level, can be protected from this virus. These patients will be contacted directly to reschedule their second appointment.
"Please be patient with your practices, there is still much work to be done and we are doing our very best to get through the lists of patients as quickly as we can. You will be contacted when it is your turn."
Covid-19 cases continue to be at very high levels, having a real impact on our local hospitals. There are very sick patients in our ICUs and medical wards and this may impact on your clinic appointments or scheduled routine surgeries. It is important, that even if you have had the vaccine, that you continue to adhere to public health guidance on social distancing and mixing with others. Stay home, save lives, protect the NHS.
NHSuk: Covid-19 vaccination
JCVI prioritisation: Advice from the Joint Committee on Vaccination and Immunisation on the groups that should be prioritised for vaccination