27th February 2021, Dr Chee L Khoo
Even though there should be no panic in the roll out, as more and more is being flashed across our TV screen, patients may start queuing up at the practice agitating to be first to be vaccinated. We all still have our normal patients to look after everyday and we need some pre-planning to avoid being snowed under and causing stress to GPs and their staff. I know we all have different practice set up, different patient mix, different financial models and different staffing arrangements but the covid-19 roll out is coming up real soon. I thought I will detail out how I will be incorporating the mass vaccination into my practice so that the whole process will occur seamlessly.
I run a solo practice in Ingleburn and is fortunate to have a practice nurse for 3 sessions a week. She is qualified to give injections under supervision at the practice. We are open 4.5 days a week and the occasional Saturday. We have mixed billing but intend to bulk bill all covid-19 vaccinations using the new Covid-19 vaccine item numbers. We have approximately 900-1000 regular patients. We expect about 700 patients would want to be vaccinated. Approximately 200 of these patients will qualify for the Phase 1B roll out
Due storage requirements, we will all be getting the AstraZeneca/Oxford vaccine. Due to supply problems, it is likely that the first shipment will make their way into general practice in mid to end of March at the earliest for Phase 1B. Phase 2 is likely to probably start towards mid to end of April. Thus, by the time we finish the second jab, it will be August or September.
We won’t be making any appointments for any roll out until we have received at least 200 vaccines for Phase 1B and at least 400-500 vaccines for Phase 2. We don’t want a repeat of last year’s fluvaccine roll out debacle when God knows when the shipment arrives.
The roll out plan
- When we are ready to roll out, we will only patients who make vaccination-only appointments which will run parallel to our usually practice appointments. Because the multi-dose vials come in 10 doses, we can vaccinate 10 patients per hour as vaccinated patients need to wait for 15 mins. We will have 3 lots of one-hour sessions over the course of the day (say 10am, 12pm and 3 pm). There will be no ad hoc vaccination of patients outside of these vaccination-only appointments as this will cause problems with half used vials by the end of the day. The vaccination-only appointments have to be in multiples of ten.
- When patient arrives for their vaccination-only appointment, they will come in to read and sign their consent forms. Some may already have read the consent forms before presenting for their vaccines. Once the patient has signed the consent form, the next appointment will be made. This could be the fluvaccine in two-four weeks’ time or the second Covid-19 vaccine in 12 weeks’ time. They will then sit down in the empty waiting room or a second consult room.
- When three patients have been “processed” by reception, I will be notified. The ten vaccines would have been drawn up that morning. I will politely excuse myself from the ongoing consultation and pop out to administer the vaccines to the waiting patients. This should take 15-20 seconds per three patients before returning to my consulting room.
- Patients who have received their vaccine can then either sit in their car if they are parked just outside the practice or on chairs outside the practice on the pavement for 15 minutes. When the 15 minutes is up, they will knock on the locked practice doors and wave to the receptionist to indicate that they are going. The next 3 patients will then be called in to go through the same processing.
We can comfortably vaccinate 30 patients a week or 150 patients a week. It should take 3-4 weeks to complete vaccinating all the 200 patients in Phase 1B and all the 500-600 patients in Phase 2 before we start planning for the second injections.
Behind the scenes
- Consent forms need to be pre-populated and printed before the patients come in.
- The bar code for each vial (10 doses) to be used can be entered onto the desktop and paste into Best Practice for later uploading.
- Signed consent forms need to be scanned into the file.
As we plan for the roll out, we need to be conscious of the additional stress to reception staff. We don’t want them to burn out over the next 6 months.
This is my Plan A as we don’t have any details of the ordering, delivery and paperwork trail yet weeks out from the roll out. No doubt there will be a curve ball thrown in our direction when the roll out truly begin and we will need to improvise. In the meantime, we will need to think about:
- FAQs for the vaccine
- The design of the consent form
- Who to include in Phase 1B
- When to vaccinate immunocompromised patients
- Completing 30-minute the AstraZeneca/Oxford vaccine course (not available yet) – please do not do the currently available 4 hour Pfizer vaccine online course unless you are involved in the Phase 1A roll out
I will keep you informed over the next couple of weeks when the above information become available.
This is how we will undertake the roll out. There is more than one way to skin a cat. If you have other helpful suggestions that you would like to share with your GP colleagues, please email me so that I can publish the suggestions for all to benefit.