Happy New Year! The debacle of second doses by Ammara Hughes

This is the fourth blog by Dr Ammara Hughes on Primary Care Leadership and COVID vaccination. Read the first, second, and third blogs in the series.

30 December 2020

A much needed long bank holiday this Christmas. Not as happy as it should have been for many. A second wave of COVID was in full swing, and rather than the usual hustle and bustle, this Christmas was a quiet affair, with national restrictions and a full lockdown looming. Return to work on Tuesday 29 December was a welcome break from the monotony.

Our vaccine hub brought some cheer in the doom and gloom. We had successfully delivered Pfizer vaccines to staff and residents of three care homes, in collaboration with our community nursing colleagues. By close of play tomorrow, it would be five care homes. Almost the entire borough.

We had also completed two “pizza boxes” (over 2000 Pfizer vaccines) before Christmas and were looking forward to a New Year break, before we started again on 5 January with second doses on that cohort.

All these patients had been pre booked for the second dose three weeks from the first one.  The cohorts were the over 80s, and frontline healthcare workers from our local hospitals. A cold snap was forecast, pre-empting us to get heaters for the gazebo. We had increased the marshals and admin team to ensure no elderly people queued outside in the bitter cold. They would also keep a close eye on patients as they undertook their 15 minute observation in the gazebo. Many of these people were local volunteers, who responded to Facebook invitations to help out. The NHS volunteer site had some convoluted process which led to nowhere.

Today also marked the long anticipated announcement that AstraZeneca’s COVID vaccine was approved for use in the UK. It really was looking like a Happy New Year ahead.

Then came the Chief Medical Officer’s bombshell at the Coronavirus briefing. We were to administer all Pfizer second doses at 12 weeks, with immediate effect. This was accompanied by an instruction to all vaccination sites, to cancel second doses and rebook those slots with patients for first doses.

I shouted a fair few expletives at the computer screen. If only we could go to the pub right now and let this news sink in. We had to settle for a rant over MS Teams. The upshot of our discussion was, drink wine tonight and worry about it tomorrow morning.

New Years Eve 2020

Daily call with all local vaccination sites.  Commissioners choosing their words carefully. They were just the messengers after all, but the decision was not up for negotiation. There were tears on today’s call, and certainly not ones of joy.

Effectively, what we were told to do, was call 2000 patients to cancel their second dose appointments, and call another 2000 patients to book into those slots for first doses. Of those we needed to cancel, we had no further date to offer them, as there were no delivery schedules that far ahead.  The second week of “second” (now first) dose delivery schedules were in doubt and unconfirmed. Patients booked in for that week would have to be cancelled regardless.

To sweeten this bitter pill, we were being offered £1000 in admin support for the cancelling and rebooking task. 25p per call I guess. Premium rate one might say. What was there to complain about?

A fair bit actually. Processes that had worked so well, in terms of our patient flow and follow up, were being turned on their head. We could only foresee chaos and a lot of upset people.

Today was Thursday. We were due to vaccinate again on Tuesday. The only working day between now and then, was Monday. The admin team had to get this done in one day, as they would be needed on the shop floor once we started vaccinating.

Yes. I repeat. One. Day. Or 24 hours. Even Jack Bauer (AKA Kiefer Sutherland) would struggle with this one. Couldn’t see script writers going for it.

“4000 calls you say?”

“Yes.”

“In 24 hours?”

“Well, maybe half that. Let’s do 2000.”

“Ok do the math!” (American script writer obviously)

“Erm…”

“Let me spell it out! There are 1440 minutes in 24 hours. So to make 2000 calls, you need to dial the number, tell the person, after you’ve exchanged some warm hellos, their appointment is cancelled, and wait for the fallout. Then you need to call someone else, and book them an appointment. You think that’s plausible in under a minute?! Get the hell out of my office!”

“How about 650 calls in 24 hours? As the whole 2000 would need to be done over three days.”

“Hmmmm. Gives you 2 minutes each. So no coffee or bathroom breaks. Edgy. I like it! But wait, three days in a row? The whole 24 hours? Crazy idea! No one can do that!”

“Ok. Shall we stick to the original script then?”

“Not as many fireworks, but keeps us in the running for a sequel.”

Don’t know about you, but I’ve never been a fan of fireworks.

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.

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