This is the fifth blog by Dr Ammara Hughes on Primary Care Leadership and COVID vaccination. Read the first, second, third, and fourth blogs in the series.
Pop-ups. The de rigeur of this millennium. You know you’ve made it if you have a farmer’s market or street market within a mile radius of you. We can’t get enough of them. And quite rightly so. Local art, fresh produce, showcasing seasonal bests, giving the mass production lines for huge supermarket chains a run for their money, and creating a sense of community.
GP led COVID vaccination sites share some of those traits. Davids amongst the Goliaths. Small independents rising to new challenges, without the infrastructure or funding afforded to acute Trusts.
One thing General Practice is abundantly rich with, however, is a strong sense of community. We know our populations, sometimes looking after several generations of the same family. Sharing in their joys and dark times. Seeing new babies arrive, while others depart for pastures new.
AZ arrival
Astra Zeneca (AZ) was finally given the go ahead in the UK on 30 December 2020. We were well into our Pfizer vaccination programme by then, with further deliveries scheduled just after New Year. These had to be used up within a few days.
The beauty of AZ was its stability. We could store the multi-dose vials for many months at normal fridge temperatures, and it could be moved more easily. We could finally vaccinate our housebound patients, as one vial of AZ could be moved door to door in a cool box. Each vial could vaccinate up to 11 people. Once a vial was opened, all 11 doses had to be given within 6 hours, due to no preservative in the vials.
This wasn’t a problem, given we were working across a primary care network (PCN) of practices, so had many housebound patients to vaccinate.
The other freedom we now had, was the ability to use a pop-up site.
Our existing pop-ups were very much no frills. A couple of portacabins set up to support the flu campaign, but the model designed with the impending COVID vaccine programme in mind. They had the advantage of taking our service to the heart of the communities who needed them.
Our central call and recall system gave us exact numbers and locations of patients needing vaccination. We were acutely aware of many vulnerable patients who couldn’t travel to the main vaccine hub for Pfizer, but we could now take AZ to them.
The Living Centre
As we entered 2021 and more vaccines were delivered, there were increasing media reports of vaccine hesitancy.
Our PCN has a long tradition of its own hesitancy. A hesitancy of crossing the Euston Road. For those who know London, you will be acutely aware of how busy this major London arterial route is. Even at the time of its 18th century inception, residents were opposed to the effect it would have on their homes and the air quality. Those debates continue to this day. The sheer success of this route has led to huge amounts of traffic, making it hard for residents to easily cross the road. Even with massive regeneration, the North-South Euston Road divide remains.
Some of our most deprived residents are North of the Euston Road in a part of the borough called Somers Town. Although a stone’s throw away from the main Bloomsbury Surgery vaccine hub on the South side, we weren’t seeing many residents from the Somers Town neighbourhood.
The area has seen some of the greatest investment in recent times, including the development of a beautiful community space, The St Pancras and Somers Town Living Centre.
Time for a pop-up! We had forged relationships with The Living Centre during flu season, using a room there on a regular basis. It was popular with residents and we had seen high flu vaccine uptake.
Delivery of the COVID vaccine was slightly different though. Even with Astra Zeneca, we had to be careful compared to other vaccines. We could transport vials to a pop-up site, but they could not be transported back to the hub for further storage. They had to be used on the same day and within six hours of a vial being opened.
We needed to undergo a quality assurance process at the pop-up site, exactly as we had done at the main practice hub.
It was a straightforward quality assurance visit. The overall clinical responsibility and oversight of the pop-up remained with Dr Farzad Entikabi and I as Clinical Directors. AZ comes pre-diluted and there is no need to observe patients for 15 minutes after vaccination, making the delivery model much easier in terms of workforce and space.
Due to the short distance from the main practice hub to the Living Centre, transport of the vaccine and other equipment on the day of a vaccine clinic was easy. (Well, I haven’t personally done it, but Raj Gill, our workforce lead and physician associate partner, makes it look easy!)
Successful local ventures
Many of our GP colleagues have arranged vaccine pop-ups in different community sites, such as places of worship and homeless hostels. Patients are trusting of these places and far from vaccine hesitancy, we are seeing strong vaccine uptake.
In our case, it seems fitting that aside from approximately 1500 vaccines delivered to date from our pop-up in Somers Town, the area hosts its own street market three times a week. It’s fair to say, we’ve made it.
Acknowledgements
Thanks to Jodie Allen and her team at St Pancras and Somers Town Living Centre, whose ongoing support to the COVID vaccine programme has made our pop-up a success. And to Janice Dick, our PCN care co-ordinator, for all her efforts with call and recall, ensuring our appointments are filled.
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.