This is the second blog by Dr Ammara Hughes on Primary Care Leadership and COVID vaccination. Read the first blog here.
Saturday 19 December
Second Pfizer delivery awaited. It had been a long week with the anticipation and then successful delivery of the first 975 vaccines culminating on Friday. We had accepted the challenge of a further 975, with the delivery arriving today. The national guidance for number of doses per vial had changed this morning, to allow 6 doses per vial, so now we had 1170 doses available.
This left us with a bit of a quandary. We knew there was time pressure. 3.5 days to be precise. But the team had been working flat out over the last week with 14 hour days and needed a break. The steer from NHSE to reduce routine work where possible and focus on COVID vaccine efforts allowed us a bit of breathing space at practice level, so we could juggle the hub rota.
On Thursday 17 December, we decided today would be a day off. I came in to receive the delivery at 8am, which arrived promptly, allowing me some downtime. We would do a clinic on Sunday utilising all six practice clinical rooms, as opposed to four in the week. Our team were adaptable and responded to changes at short notice. (I realised that my local bakery produces the best doughnuts anywhere. And a promise of said doughnut led to a quickly filled vaccine hub rota!)
Sunday 20 December
Raj had given me the day off, and Farzad, my co-CD, was supervising GP.
Beth and Eddie, our programme and project managers, had set up an appointment booking system with a bit.ly link, one we had used for our flu hubs.
When we set up the flu link, we didn’t need to set a timeframe. We had plenty of vaccine with a long shelf life. The patients were naturally spreading across the week regardless of the number of slots we put on. We had live data of hot spots and could flex our staff accordingly.
For the COVID vaccine, we had 3.5 days. We modelled the rota on the assumption of an even volume of people each day. We had been calling patients to book them in as we hadn’t had time to send out comms and promote the service. Wastage was a real concern.
Sunday proved unpopular with patients , so we had to push more appointments to Monday and Tuesday. The clock was ticking. Some frantic phone calls to adjust the rota. There were three of us sharing the supervisory responsibility across the week. All of us were needed over the next couple of days to vaccinate, not just supervise.
I had the same sense of anxiety I felt at my last big birthday (40th in case you wondered!)
Will people turn up? Will we fill the rooms? Will we be throwing things away? Have we over ordered? Are we about to spectacularly face plant?
Monday 21 December
We had contacted our over 80s population for whom we had a phone number or weren’t housebound. Many wanted to discuss with family or were preparing for Christmas and didn’t want to come in just now. It was increasingly looking like accepting the second box of vaccines so close to Christmas was an error of judgement. Winter solstice wasn’t being kind.
Urgent action required. We didn’t have anyone as a benchmark to turn to, as we were one of only 100 or so sites vaccinating nationally.
The other priority group were care homes and their staff. We were already working with our community nursing colleagues on a model for care homes to be implemented next week, immediately after Christmas, and this required our workforce to be deployed in a different way. It was a traditionally quiet period so our practice and community nursing teams could focus entirely on care homes between Christmas and New Year.
Who else could we vaccinate? It would be a travesty to have any doses wasted. Frontline healthcare staff were the next priority group, and there wasn’t as yet, any clear steer on when and how this group could access a vaccine locally. Seemed a no brainer really. We have vaccines. Let’s offer them to our colleagues locally. A long shot perhaps, but we might get to 1170.
The remaining appointments went faster than Glastonbury tickets. Within minutes, there was nothing on the system. Turned out, the booking link went viral amongst healthcare staff across London.
Tuesday 22 December
Over 500 appointments to get through. We needed more rooms. My flexible practice team flexed even further and hot desked from admin areas, so we could increase vaccinating capacity.
Today also saw an unwelcome headline in a national newspaper stating we were turning away frontline staff from a London hospital. (Sometimes, you have to take these things on the chin, and recognise the best of intentions aren’t always perceived as such. We learn and move on.)
Our courtyard became a speakeasy (without the alcohol sadly!) for frontline NHS staff, mostly from critical care and ITU, who used their 15 minutes observation time to have a break from full PPE and embrace a brief moment of social normality.
We were utterly exhausted by the end of the day, both physically and mentally. Much for us to reflect on over the long bank holiday, particularly around sustainability.
“Peace on Earth, Goodwill to men”, is what Henry Wadsworth Longfellow wrote in his famous poem “Christmas Bells”.
As history repeatedly tells us, goodwill can only get you so far.
Acknowledgements
Thanks to Beth Nelson and Eddie Davidson, who cancelled Christmas and New Year plans, stayed late and arrived early to support the admin side of the hub.
Dr Ammara Hughes
Dr Ammara Hughes MBBS MRCGP (2004) is a GP partner at Bloomsbury Surgery, Central London, and co-Clinical Director, Central Camden PCN and a member of the NHS Confederation PCN network. She qualified as a doctor from Charing Cross and Westminster Medical School in 1996. She spent 8 years in hospital medicine in London, before becoming a GP in 2004. She has been in leadership in the NHS since 2007. She was an elected Governing Body GP member of Camden Clinical Commissioning Group from 2011-2017, serving two terms. Since then, she has undertaken provider lead roles. She was Vice Chair of Camden Health Evolution from 2017-2019, stepping down to take on the role of Clinical Director of Central Camden Primary Care Network.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.