In previous years our Practice have only had 4 clinicians (the Practice Nurses) vaccinating the patients against influenza.

This causes a great strain on their “normal” weekly workload, resulting in a serious backlog of appointment availability and soon demoralises the Nurses as they get “fed up” with this repetitive procedure.

The GP’s had grown accustomed to viewing the vaccinations as something that they generally no longer participated in, until perhaps late on in the season when chasing those final numbers.

GP’s have seen their responsibilities change which in turn has altered the work carried out by Practice Nurses and this has also cascaded to the workload of the Health Care Assistants (HCA).

The HCA are now a valuable resource taking ECGs, new patient checks etc. as well as phlebotomy duties.

Many now hold an NVQ 3 in Care and are keen to expand their role further.

With ever expanding numbers of recommended patients to vaccinate, the increasingly specialist role of many Practice Nurses and the knock on effect of weeks of flu clinics, some changes had to be made.

With the above in mind, we therefore decided to investigate the possibility of our HCA partaking in vaccinating the influenza target population.

Medical Insurance Cover

The first port of call was to contact the Defence Union to ensure that they would indemnify our HCA when providing flu vaccinations.

This approval was obtained in writing, subject to various conditions including strictly operating to protocols.

This meant that significant training was required in advance of the actual flu season.

To ensure that we covered everything possible, we took a “belt and braces” approach to the training and fully documented everything.

Training

Firstly, the HCA attended a “theory and technique” training session led by our senior nurse which included a practical session using oranges.

All of the HCA enjoyed the session but initially found the procedure awkward as it was alien to them.

A handout on the Administration of Vaccine (UK guidance on Best Practice in Vaccine Administration) was given to each HCA at the end of the session.

The lead GP then facilitated the next training session, which included actual vaccinations by the HCA, enabling them to experience injecting patients.

We did this with pneumococcal clinics which were closely supervised and enabled us to carry out this training in advance of the flu clinics.

The final training session involved the HCA holding their own short flu clinics, again supervised by a GP.

Immediately after completing this final training session, the HCA completed a self-assessment competency grid.

A separate competency grid was also completed by the lead GP with both parties “signing off” that competency had been achieved.

The HCA were now ready for the flu clinics.

Team Involvement

During the training I saw an opportunity to totally change the way we deal with this large, annual task.

Many other surgeries were now carrying out the vaccinations on a Saturday so as to prevent the impact on the normal working week.

It was an area I wanted to explore further.

I aimed to coerce the 8 GP’s into partaking one Saturday morning each.

This would show support to the HCA and Nurses in what can be a mundane duty, one which seemingly never ends.

By including the HCA and GP’s I would have 16 clinicians vaccinating rather than the historic 4! I estimated that we could vaccinate over 80% of our patients on 2 Saturday mornings with each clinician and admin staff working 1 morning.

Protocols

Protocols were drawn up for the HCA, the reception staff and the GP’s.

The reception staff used the protocol when the patient rang to book an appointment to ensure that the HCA only saw patients without complications, e.g. vaccinated previously with no reaction, not allergic to eggs, not ill, not pregnant etc.

These questions were repeated by the HCA on the day with any concerns or positive responses referred to a nurse or GP.

Each clinician had the option of having an admin person (except the HCA who we felt should have one) to enter the information onto the computer.

The surgery closed for twenty minutes mid-morning for a coffee break with the practice providing cakes or bacon sandwiches.

The team spirit generated was absolutely brilliant (undoubtedly helped by all the GP’s being involved) and a welcome surprise was how successful it was as a patient relations exercise.

We received many compliments throughout the day and during the following weeks.

Of course, it also helped the business (and the nurses) as we did not have endless clinics throughout the winter months.

Additionally it has expanded the skills of our HCA and given them a greater sense of job satisfaction.

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Roy Peckitt, Practice Manager The Hedon Group Practice

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