The college's guidance focuses on delivering mass vaccinations while COVID-19 is still in circulation. Most practices will be looking at this while thinking about the flu campaign this year, but the RCGP says the guidance is intended to be generic and applicable to 'various potential vaccines which may need to be delivered to a large population in a short time frame'.
Should a COVID-19 vaccine become available in the immediate future, therefore, the guidance could also prove a useful tool for general practice to deliver a campaign targeting coronavirus.
Due to COVID-19, enhanced infection prevention and control will likely be needed when delivering any vaccination campaign and larger spaces may be needed to maintain social distancing, the guidance says. This means that the normal venues used for the flu campaign such as GP surgeries and pharmacies may not be appropriate.
The RCGP suggests that the actual vaccination process may take between 4 and 6 minutes, depending on the PPE requirements, which compares with a 'normal throughput' of between 1-3 minutes for seasonal flu. It says that unless the number of staff administering the vaccine is increased there will be 'significant implications for the time taken to vaccinate a population'.
Detailed planning will be essential, the guidance says, adding that this should be 'undertaken well in advance of the likely date of roll-out, to allow time for any challenges to be identified and mitigated'.
Planning should cover a pre-agreed area and it may be more efficient for several providers to deliver the campaign, pooling resources and working in conjunction with other stakeholders.
Clear structures and lines of accountability will be necessary and a single clinical lead should be appointed to take control of planning and delivery and ensuring patient safety, the guidance recommends. Co-ordination will be particularly important if a COVID-19 vaccine becomes available and multiple providers, possibly including NHS trusts and schools, are also delivering the vaccination campaign.
The guidance sets out a list of practical issues that GPs and their teams will need to consider when planning delivery of the campaign covering governance and leadership, the programme scale, vaccine stock and prioritisation of particular patient groups. Staffing issues and record keeping will also need to be addressed early in the process.
Where to run the campaign
The guidance provides model layouts for how to deliver rapid throughput of vaccinations while maintaining social distancing. Practices will need to consider building design, accessibility and numbers needing vaccinating when deciding where to conduct vaccinations.
Indoor and outdoor queuing could be considered, however the guidance warns that if the weather is bad practices may want to consider a 'fast track' process for vulnerable patients.
The guidance suggests that by working together practices may be able to make use of alternative settings such as community centres, schools or more modern practice buildings.
Drive through flu clinics could be useful, but they will need 'large spaces and well-developed traffic management' if they are to be successful, the guidance says. It also highlights that bad weather could be a problem for staff and the set up may make patients feel less able to ask questions.
Patients could also potentially be taken ill while in their car after receiving the jab, so in order to manage this risk practices may need to ask patients to wait on site post vaccination.
Other things to consider
GPs will also need to consider:
- Equipment required
- Layout requirements for large-scale vaccination, including flow of patients, queuing space, fast-track process for vulnerable patients, toilet facilities and secure equipment storage.
- PPE requirements for staff and patients
- Cleaning requirements and disposal of clinical waste
- Risk assessments
- Equalities impact assessment
- Patient assessment and record keeping
- Cold chain requirements
- Patient information leaflets
- How to deal with potentially unwell patients - those who attend when they are unwell and those who become unwell post-vaccination.
- How the campaign will deal with hard-to-reach groups, those who require a home visit and any patients who need specific access arrangements.
- The overall patient journey - the guidance provides an example of how this could work.
Communication with patients
Practices will also need to communicate with patients in advance of their attendance for immunisation. The guidance recommends this covers:
- Details of the vaccine they are attending for
- Location and setting
- What PPE they are required to wear
- When to arrive
- What paperwork to bring
- To attend alone if possible
- Not to attend if they feel unwell.