Ash Vora, Managing Director, Substrakt Health
Includes key seasonal influenza DES specification updates for 2020/21
This year in the UK, more than 30 million people will be eligible for a flu vaccination, making it the most comprehensive flu programme ever. To put this into perspective, last year in the UK, around 15.3m vaccinations were administered to eligible groups.
Fears that a challenging flu season could place unsustainable pressure on the NHS if it came alongside a second wave of coronavirus, led to NHS England amending and re-publishing the Influenza and Pneumococcal Immunisation Directed Enhanced Service (DES) specification, which now details additional groups of patients to be vaccinated this year as part of an expanded programme.
The groups of patients eligible for a flu vaccination for the 2020/21 programme are:
- Those aged 65 and over on 31 March 2021
- Pregnant women
- Patients aged six months to 64 years (excluding patients aged two and three on 31 August 2020) defined as at-risk in annex B20
- Locum GPs
- Health and social care staff
- Household contacts of an individual on the Shielded Patient List
- Household contacts of immunocompromised individuals living in long-stay residential or nursing homes or other long-stay health or social care facilities
Patient safety in the midst of a pandemic
This poses a huge workload for GP practices in the midst of the COVID-19 pandemic, and inevitably challenges in keeping patients and practice staff safe during vaccination appointments. Measures taken to safeguard patients need to be persuasive enough to ensure that those most ‘at risk’ feel confident they are safe enough to attend.
The Royal College of General Practitioner’s (RCGP) Logistical Guide for General Practice ‘Delivering Mass Vaccinations During COVID-19’, highlights a specific set of challenges to achieving high volume through-put for vaccinations. Amongst the challenges – which include enhanced standards of infection prevention and control, larger spaces needed to maintain safe social distancing, and the use of personal protective equipment – is the increased time necessary for immunisers to prepare for each patient, which means additional time will be required for each vaccination.
Under normal circumstances, the RCGP estimate that well-organised, properly supported flu clinics may be able to vaccinate patients at rates as high as one patient per vaccinator every one to three minutes, as part of a patient journey around 15 minutes in length.
In these altered circumstances, they estimate that the actual vaccination process may take at least four minutes, and potentially five to six minutes depending on the PPE requirements, doubling the usual time needed for vaccination appointments.
With the scale of this year’s campaign, it’s not surprising that many GP practices, CCGs and PCNs are currently looking at, or in the process of setting up sites specifically to administer flu vaccinations and maximise uptake of the jabs. Outdoor sites or drive-through operations offer clear benefits to indoor sites, minimising the risk of airborne transmission of COVID-19 more likely to occur indoors, but they also throw up the challenge of updating patient records with the vaccination information whilst clinicians are working off-site.
How can technology help?
We were approached by one of our CCG clients, to develop a solution to allow them to update patient records at their off-site flu clinics.
We have developed a vaccination and immunisation app which connects with clinical systems EMIS Web and SystmOne, which enables practices to complete the administration process for vaccination appointment in under 30 seconds, helping to halve the estimated time needed for each slot.
The process is simple – in advance of flu vaccination appointments, patients are sent a QR code, which is scanned by vaccinators on arrival using a tablet or smart phone. This automatically retrieves the patient information so all that is left to do is select the batch number and vaccine location from drop down menus before saving to the patient’s record.
The speed at which the administration can be completed minimises the time, contact and interaction needed with patients, meaning it’s also a much safer solution for everyone. And if patients don’t have a phone, the vaccinator can just search for their details using their name, date of birth or NHS number, so the process is still much quicker. It’s an ideal solution for the upcoming COVID-19 vaccination programme but can also drive efficiencies in administrating vaccinations of all types within practices, not just mass programmes.
We’ve recently witnessed how COVID has accelerated the pace of digital transformation in the NHS, and it has certainly taken a huge leap forward in terms of its technological capability. But for the NHS to remain truly sustainable, this rate of transformation can’t slow down.
More key points from the updated DES
- Evidence of patient invites
Practices must maintain clear records of how they have called and recalled patients
- Ethnicity verification
Practices must include within at least one written communication offering vaccination to eligible patients, a request that the patient advises their ethnicity status (if they have not previously provided this information), to record in the patient record
- Timing vaccinations in line with vaccine supply
Vaccinations must be delivered between 1 September 2020 and 31 March 2021. The target timeframe for the influenza programme is three months from 1 September 2020 to 30 November 2020 where possible, in order to achieve maximum impact
Practices should aim to schedule their immunisation services to match vaccine supply and complete vaccination by the end of November, where possible. Because influenza can circulate considerably later than this, clinicians should apply clinical judgement to assess the needs of individual patients for immunisation beyond this point.
- Vaccinations for patients ages 50 to 64
The flu vaccine may be extended to people aged 50 to 64 later in the year, with more information on this available later in the autumn when there is a better idea of vaccine supply after existing eligible groups have been prioritised. When agreed, the decision will be published, together with the start date for the extension, and communicated to GP practices via the Primary Care Bulletin. The General Practitioners Committee of the BMA will be informed ahead of an announcement, and a copy of the announcement will be available at: https://www.gov.uk/government/publications/national-fluimmunisation-programme-plan
- Ensuring reasonable effort to complete vaccinations
Where patients have indicated they wish to receive the vaccination but are physically unable to attend the practice (e.g they are housebound) the practice must make all reasonable effort to ensure the patient is vaccinated.
Click here to access the full Directed Enhanced Service Specification Seasonal influenza and pneumococcal polysaccharide vaccination programme 2020/21.