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How to ... Set up pandemic flu jab clinics

Daniel Brookbank explains how his Eastbourne practice is organising patient vaccinations.

Good organisation is key to delivering a successful pandemic flu vaccination programme
Good organisation is key to delivering a successful pandemic flu vaccination programme

The DoH has at last published the directed enhanced service (DES) for pandemic flu vaccination, and by now all practices should have received a copy, either directly from the DoH or from your primary care organisation's flu lead.

GP practices need to be well organised if they are to vaccinate all patients in priority groups for H1N1 protection in the next few weeks. There is not a deadline as such although the DoH's hope is that all these patients will have received their jabs by mid-December.

In the DES
The DES lays out what is required to carry out a pandemic flu campaign, who to give the vaccine to, what needs to be recorded, which members of staff can carry out the vaccination, and what the payment is.

In our PCT we are required to sign an enhanced services contractor form to confirm that we meet the criteria for providing the service, including all the necessary training, staffing and so forth are in place.

Priority groups

There are four priority groups:

Group 1 - Patients aged six months or over and up to 65 years who fall into one of the following clinical at risk categories:

  • Chronic respiratory disease.
  • Asthmatics.
  • Chronic heart disease.
  • Chronic renal disease.
  • Chronic liver disease.
  • Chronic neurological disease.
  • Diabetes.
  • Immuno-compromised.

Group - 2 Women who are pregnant.

Group 3 - People who have household contact with patients who are immuno-compromised.

Group 4 - Patients who are 65 and over fall into one of the clinical 'at risk' groups in priority group 1.

In our practice this equates to about 2,000 patients. The DES requires that these patients are vaccinated in priority group order, starting with group 1 and working down the list.

We have also decided to offer the vaccination to all our staff. If a pandemic hits it will be important to keep the surgery running and we cannot do that if all the staff are off with swine flu.

Vaccine dosage
In most cases the dosage will be one single vaccination. However, there are a few patients who will require a second shot. All adults and children over 10 years old who have an impaired immune system will receive a second shot three weeks after the first.

Children six months or older and up to 10 years will receive half a dose initially and the second half dose three weeks later.

Calling in patients
There are quite a few ways to do this. In this surgery we have printed lists of all the 'at risk' categories, available from our QOF figures and general searches on our computer system. We are then telephoning the patients and inviting them in.

Some surgeries have decided to write to every patient to inform them and ask them to ring for an appointment. Yet more are putting a message on their answer phones telling patients that they can book a vaccination. The important thing here to instil a sense of urgency: if the pandemic is going to hit it is far better to have carried out as many vaccinations as possible.

Things to be wary of
  • Make sure you have second doses available for those patients who require two vaccinations.
  • The first priority group are all under 65 - very difficult to get hold of during the day.
  • Ensure that you only vaccinate the priority patients in group order (starting with group 1) as you might not be able to claim if you do not.
  • Be aware that if you choose to vaccinate anyone not in the priority groups you will not be able to claim for them.
  • Think carefully if you are going to do one vaccination a minute: your waiting room will be very full.

Running clinics
It is possible to run these as quickly as your seasonal flu clinics at one patient per minute, but it is important to bear in mind that the vaccine will need drawing up and with every tenth one, mixing. At my practice we decided to have two GPs doing the clinic, one drawing up and recording and one injecting. Our first clinic ran to time with a maximum wait of about seven minutes.

Your practice might prefer to vaccinate a patient every two minutes. You might also like to have an administrative member of staff doing the recording. Our clinic ran from 7am in the morning to midday and during that time, we vaccinated 300 people. With a further clinic of 180 the following week and opportunistic vaccinations in between we will have used up our initial 500 allocation very quickly.

Regarding your housebound patients, your PCO should have asked you for a list as it is arranging for these patients' vaccinations.

Payment
The DES pays £5.25 for every vaccination and this includes all your housebound patients. We have been given a form to fill in asking for every patient's NHS number and the priority group they fall into. It is a straightforward task that our computer will be able to sort out.

OUR PRACTICE

Seaside Medical Centre

  • 12,200 patients in Eastbourne, East Sussex.
  • Six partners.
  • 2,000 patients in the pandemic flu 'at risk' categories.
  • 500 vaccines delivered on 3 November.
  • Two clinics booked by 6 November.
  • Patients telephoned for vaccination.

 

 

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