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How to prepare for an unprecedented seasonal flu programme?
The article was first published in Management In Practice
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QCS’s Alison Lowerson reveals the compliance steps that every GP surgery should consider implementing this summer.
When the UK went into Covid-19 lockdown in March, the flu season was all but over, but this autumn health workers are facing the nightmare scenario of having to deal with both viruses at the same time.
The UK Government has reacted quickly by launching, what it termed, ‘the most comprehensive flu programme in UK history’. In doing so, it announced that it would offer influenza vaccinations to 30 million people this winter.
The expanded programme will be available to people aged between 50 and 64, households of those who are shielding and children in their first year of secondary school.
On the ground preparations
What is less clear, is how a programme of such unprecedented magnitude will actually be delivered on the ground. At Quality Compliance Systems, a major provider of content and compliance tools for the GPs, care sector and dentists, we speak to practice managers regularly. Many have told us that a lack of government advice has thrown up a raft of unanswered questions, which could create a number of unforeseen compliance challenges.
Take the ‘known unknowns’, for example. First, with the vaccination programme spanning a number of age cohorts, many have doubts as to whether the Government’s projection of 30 million vaccinations is accurate, and if so, to what extent is it achievable? In an era of Covid, where social distancing must be also factored in, many want greater details regarding the equipment and infrastructure requirements for such an initiative. Others are deeply concerned about PPE. What are the PPE requirements? Will there be enough of it available to primary care, and what enhanced standards of infection prevention control do practice managers need to be aware of? In addition to PPE queries, if vaccination stocks are low, many are asking which cohorts they should prioritise and how will they access extra stock if their own supply, ordered pre-Covid, runs out?
And then there are the ‘unknown knowns’. Can a programme of widescale immunisation be conducted in GP car parks? If so, are temporary structures suitable and what are the compliance steps that surgeries need to be aware of?
It may also be that for a programme so large GPs need to consider utilising local amenities too. What are the policy implications of doing so? What extra measures need to be taken around infection prevention and control? If nurses have to work offsite, as looks possible, how do surgeries ensure that they are adequately resourced to operate a surgery and to meet the challenge of vaccinating thousands of patients in their local communities?
Government and CCGs have been to slow to produce guidance
Some of these issues have been touched on in a report issued by the Royal College of General Practitioners , but the guidance was largely generic and in my opinion doesn’t cover everything. Clinical Commissioning Groups (CCGs) have also been contacting practices asking how they can support them, but to many GPs this is purely a reporting exercise, the aim being to gather information to provide NHS England with a clearer picture on how practices are laying the groundwork to cope with winter flu.
Public Heath England published long-awaited additional guidance on 4August – including an update on the national flu immunisation programme 2020 to 2021. The hope is that the new guidance will give GP practices added impetus to put a flu vaccination strategy in place.
We, at QCS, recommend that GP practices take swift action now. So, what should they do?
The first step is to begin work on forming an action plan. QCS has created a helpful checklist, which is based on five policies and procedures including Action Planning, Infection Control and Decontamination, Staff Immunisations, Cold Chain and Annual Holiday. It is free to access and can be downloaded here.
Forming a robust and resilient strategy that embraces collaboration
What should an action plan cover? First, each practice needs to ensure that it has enough vaccines. At the same time, practice managers should think about PPE, infection control and decontamination. In addition to increasing Covid PPE stocks, practice managers should order PPE for the flu programme. Essentially, that’s disposable gloves, aprons and fluid resistant masks, which protect the eye and face.
As part of their flu action plan, practices should also consider what consumables they will need. They should start ordering disinfectant wipes and hand sanitiser, now, as most of these items don’t have an expiry date. Finally, they should re-visit their Clinical Waste Disposal Policy to ensure they have adequate storage for any excess clinical waste.
The second step is to ensure that there are the right number of staff in place during the winter months to cope with the extra demands that the flu season will bring. Therefore, practices should make sure, if possible, that staff take their leave in less busy periods of the year.
Third, when prepping for large challenges, the best practices embrace collaboration and reach out to local surgeries to pool vaccines and staff resources. QCS recommends to begin liaising with neighbouring surgeries to put a ‘staff collaboration’ programme in place. Working as a PCN is a great way to strengthen relationships and reach a larger patient population group. To minimise transmission, for instance, practice managers could look to place staff in bubbles so they have close contact with each other and nobody else. This is particularly important if flu programmes take place in the local community and require staff from different surgeries to work together.
Setting up mobile flu clinics: the challenges
Practice managers should think quickly and carefully about the best venues to stage their flu vaccination programme. It might be that the combination of the surgery and the car park is simply not big enough to accommodate such a large number of people. If this is the case, practice managers need to liaise with local authorities and parish councils to seek permission to use parks, village halls, town halls and public car parks.
Consider the potential costs of running a flu programme in a time of Covid. First, they should work out as best they can, how many minutes to allocate to each appointment, bearing in mind that it’s also necessary to factor in any potential recovery time and cleaning down. This should help calculate the number of hours that clinical staff need to be on-site to administer injections. If overtime is required, how will it be paid for? Do staff have adequate transport to get to and from the temporary clinic? If the vaccinations take place in a remote location, do staff have access to adequate toilet and hand washing facilities? And are there additional IT support frameworks in place, which are robust enough to work outside of the surgery?
Working collaboratively with councils at an early stage to iron out the many logistical challenges such as managing traffic flow, parking and erecting signage at flu clinics is equally important. Practice managers who consider local amenities to be the best option, need to think about power supply. Will they have access to a constant supply of electricity and are there emergency generators available if there is a power cut? In wrestling with these challenges, practice managers might also consider contacting their local military base (if there is one close by) for help and support. The UK military has decades of experience in providing the necessary logistics for field hospitals and has played a key role staffing Covid-19-test centres. With enough notice, a military base might be willing to send specially trained personnel and equipment to aid the flu vaccination campaign.
Seeking outside help
Thinking outside of the box too, external organisations such as aid agencies, who administer immunisations in remote third world locations, could provide advice on cold chain protocol. In addition, QCS has produced a Cold Chain policy and procedure. The guidance, which is only available to QCS customers, contains best practice advice about how to keep vaccinations at the correct temperature when taking vaccines outside of the practice.
Whatever action practice managers decide to take, it’s essential they tackle the ‘known knowns’ and ‘unknown knowns’ now, as leaving preparedness plans until the late summer, would not only be unwise, but it could put local communities at risk too.
You can also download our Flu Planning Toolkit for free here
You can also listen to your very own GP podcast here. This week, our Head of Primary Care, Tracy Green and Alison talked about the 2020 Seasonal Flu Programme
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