Flu vaccine delays and Covid boosters – tips for managing flu clinic disruption

Primary care consultant Daniel Vincent outlines some tips for managing the ongoing disruption to flu vaccination clinics

News that Seqirus flu vaccination deliveries will be delayed was yet another blow to many practice teams, with carefully planned and fully booked clinics needing to be rescheduled.

The first thought might be to simply cancel the clinic and notify patients that you will be in touch when you know more. Sadly, the communique from Seqirus supports this. It asks practices to wait for delivery confirmation 7 days prior to delivery day before booking any further clinics.

Logistically booking thousands of patients in 7 days is a near impossible act given current workload pressures.  Here are some tips on different options available to practices to help your team deal with flu clinic disruptions as nimbly and efficiently as possible.

1. Code up vaccination requests. The first step I would recommend is capturing all those patients who have already booked an appointment. You can do this by batch adding a SNOMED code to their record, for example: Influenza vaccination requested – 736818002.  You will then be able to create searches to ensure that no patient is lost in the rebooking process.
2. Reschedule for a later date. The next step is a decision about what to do with those future clinics. One option is to simply shift the whole clinic forward (perhaps to the first week of October to be safe). Rather than texting patients to tell them their appointment has been cancelled you can tell them the new date, keeping their appointment times the same. You will then only need to rebook those patients for whom this new date does not work.
3. Switch to a walk-in clinic. A second option is to change to a walk-in model. Many practices successfully run this year in year out, widely publicising the dates that eligible patients can simply turn up. You will obviously experience peaks and troughs so it is important to have a well thought-out queuing system, with some practices using the old ‘deli style’ ticket system, or raffle tickets.
4. Set up PSD templates if needed. A major consideration around walk-in systems is the use of Patient Specific Directions (PSDs) – without a booked list you will either need to individually review your entire list and authorise a PSD for every individual patient in advance, or set up a system to produce a PSD on demand that can be authorised by a prescriber available during the clinic. This can be done rapidly using a document template.
5. Get ready for any Covid booster co-admin. Many practices, after running PCN hubs last year, decided to return flu vaccinations to the practice premises. There is now an opportunity to use this delay to prepare for the proposed authorisation for co-administration of Covid booster jabs and flu vaccine – see box below. If approved, PCN-wide booking of appointments can be realised using GP Connect, also supporting a mixed estate of clinical system providers. You’ll need think carefully about governance, ensuring that patient group directions (PGDs) and PSDs are appropriately authorised. Depending upon your configuration you might also need to consider how payment will flow back to practices, who clearly rely upon this significant source of income. Co-administration will require a slightly extended appointment time, but cumulatively you should save a significant amount of clinical and administration time overall.
6. Use multiple channels for booking. However you choose to reschedule clinics, maximize your use of asynchronous communication – for example, open up online booking, send text messages with reply function and invite patients to use e-consult to let you know their availability. This will allow your team to fit the requests for vaccinations around their existing workload. Of course, keep the telephone lines for booking as well, for those who can only use a phone.

Whichever path you choose to take, there will inevitably be an additional managerial burden in remaking plans. My own practice held their nerve on booking appointments until a point where they felt safe that delivery was inbound, only for the cancellation notification to come through the next day. No doubt practices will rise to the challenge, remain flexible, keep everyone updated and celebrate saving the day once again.

What is the status of the proposed Covid booster programme?

JCVI interim guidance indicated that any booster programme would need to be done in two stages, prioritising those most at risk first; and the flu vaccination enhanced service specification makes provision for co-administration, at PCN grouping level, if recommended by the JCVI. NHS England said on 3 September that the JCVI advice was expected in ‘the coming weeks’.

The vaccines minister, Nadhim Zahawi, said this week that the JCVI is awaiting study data on boosters before giving the go-ahead – and that key to planning will be whether it recommends a vaccine requiring a 15-minute wait, while health secretary Savid Javid said today that the JCVI advice was expected in the ‘next few days’.

Daniel Vincent is a former practice manager and independent primary care specialist