Access provided by
London Metropolitan University
With all front-line health and social care staff now eligible for their first dose of a vaccine, we look at the logistics of the programme roll-out across the UK
The approval of the Oxford/AstraZeneca vaccine signalled a major acceleration in the COVID-19 vaccination programme.
Nursing Standard. 36, 2, 8-10. doi: 10.7748/ns.36.2.8.s5
Published: 03 February 2021
The first weeks of the programme focused on vaccinating care home residents and staff and those aged over 80, using the Pfizer/BioNTech vaccine. Any unfilled appointments were used to vaccinate healthcare workers identified as being at high risk of serious illness from COVID-19.
But the roll-out of the Oxford/AstraZeneca vaccine from 4 January meant the planned UK-wide vaccination of front-line health and social care staff could begin.
Announcing the move, NHS England chief nursing officer Ruth May said it was ‘only right’, given nurses and other front-line staff had been working ‘tirelessly on the front line of the pandemic’.
The UK government has set a target of offering all front-line health and social care staff their first dose of a vaccine by 15 February, along with the over-70s and the extremely clinically vulnerable.
But, with more than 4 million staff working in the NHS alone, this is an enormous task.
Hospital hubs have been designated as the default providers of staff vaccinations. There were fewer than 100 in operation in the UK before Christmas, but there are now more than 200, with community and mental health trusts opening their own vaccination clinics for their staff.
Both the Pfizer/BioNTech and Oxford/AstraZeneca vaccines are being used for staff vaccinations, with the major acute trusts mainly using the Pfizer/BioNTech one because they can accommodate its ultra-cold storage requirements – it has to be kept at -70°C and once thawed must be used within days.
The hospital hubs have been using the NHS electronic staff records system to invite staff to attend, often enabling staff to make appointments themselves via online booking systems.
Many are operating from 8am-8pm seven days a week, and those that do not have been told to ensure there are appointments available for healthcare staff outside peak times and at weekends.
There is no requirement for employers to ensure staff can receive their jab during their paid hours, although unions have called for this condition.
British Association of Critical Care Nurses chair Nicki Credland says the roll-out to hospital staff has been ‘generally positive’, with nurses happy with the access they are being given.
‘Lots of staff have been receiving the vaccine as soon as it is available,’ she says. ‘It seems to be well organised. We know it is a massive logistical undertaking and staff do genuinely appreciate that, given the pressures we are under.’
As well as providing the vaccine to hospital staff, acute trusts have been asked to offer it to community-based NHS staff and care workers.
‘Lots of staff have been receiving the vaccine as soon as it is available. We know it is a massive logistical undertaking and staff do genuinely appreciate that’
Nicki Credland, chair of the British Association of Critical Care Nurses
In Wales, Scotland and Northern Ireland this process has been aided by the integrated arrangements for health boards, but in England it has required trusts to work in close partnership with the clinical commissioning groups and local authorities that commission many community-based services – and this is where some of the problems have occurred. School and Public Health Nurses Association chief executive officer Sharon White says it is a ‘mixed bag’ when it comes to her members accessing vaccinations.
She says many school nurses are now working as vaccinators and therefore get it at the sites they are working at, but there have been reports of difficulties for others.
‘As ever, there is no consistency. But I would not call it a major issue at the moment.’
Queen’s Nursing Institute chief executive Crystal Oldman agrees: ‘It is a mixed picture – I think it is best to call it that.
‘One of the issues that we picked up is that nurses providing support to older people in care settings have not had vaccines as part of the care home programme.’
2.4 million healthcare staff will be offered the COVID-19 vaccine, along with…
1.4 million social care staff and…
500,000 care home staff
Source: UK COVID-19 vaccines delivery plan: tinyurl.com/UK-COVID-plan
But she says there seem to be ‘clear systems’ in place for nurses working in other community settings.
Guidance issued by NHS England says all front-line staff should be offered a vaccine.
It says priority should be given to those staff at high risk of acquiring infection, at high individual risk of developing serious disease, or at risk of transmitting infection to multiple vulnerable people or other staff in a healthcare environment.
It sets out seven categories this applies to:
» Staff working on the vaccination programme
» Staff who have frequent face-to-face contact with patients
» Those working in independent, voluntary and non-standard healthcare settings, such as hospices and community-based mental health or addiction services
» Laboratory, pathology and mortuary staff
» Those working in facilities services, such as porters and cleaning staff
» Temporary locum or bank staff, students, trainees and volunteers who are working with patients
» Front-line social care workers, including those providing domiciliary care or working in day centres or supported housing. As a group, this is estimated to be about 3.8 million people. There are another 500,000 care home workers who were already prioritised along with the over-80s from the start of the programme in early December
There have been reports of staff that are not on the front line being offered the vaccine. Trusts do have discretion to do this.
Adapted from NHS England guidance on staff vaccination: tinyurl.com/staff-priority-list
Feedback provided to the RCN’s district nursing forum supports this. Members on the forum’s Facebook page reported being pleased with the availability of appointments and how well-run the hospital clinics were in many places.
However, a handful said they had yet to be contacted about vaccination.
Some areas are setting up ‘roving’ vaccine clinics to reach more district nurses and health and care staff working remotely.
While hospital hubs are the default options for staff, local vaccination centres run by GPs and practice nurses are also proving crucial.
By mid-January there were more than 1,000 local centres up and running across the UK. These are being run from a variety of locations, including large GP centres and community venues.
East Sussex Healthcare NHS Trust was part of the early wave of hospital vaccination hubs.
When its team started vaccinations at Conquest Hospital in Hastings in December, they were offering the jab to people over 80.
But by early January, they had moved on to vaccinating staff, with the drive accelerating when the trust’s Eastbourne District General Hospital.
By mid-January, more than 5,000 health and care staff had been vaccinated, including those employed by the hospital, community NHS staff and social care workers.
A boost to staff morale
Staff book themselves an appointment online and then attend one of the clinics, which are situated away from the clinical areas, in a teaching unit at Conquest and a large room close to the staff canteen at Eastbourne.
The clinics are using the Pfizer/BioNTech vaccine, with supplies of the Oxford/AstraZeneca vaccine going to the local community vaccination centres, due to its less challenging storage requirements.
Nurse and clinical lead for vaccination Dee Daly says the programme roll-out to staff was a great way to start the new year.
‘I was so relieved to receive the vaccination and it was emotional to watch front-line colleagues and friends, who’ve been working so hard over the last year, getting their vaccine too.’
Trust chief nurse Vikki Carruth agrees. ‘Members of our team and other health and care staff locally have shown such care, dedication and determination over the past year.
‘This is such a big morale boost for those who are facing such challenges at work at the moment.’
RCN general practice forum member Elia Monteiro, who works as a vaccinator in a north London centre, says centres are working hard to reach staff.
‘Emails have been sent out to staff working in all settings to offer appointments, and we have a WhatsApp group we use to invite staff in at the end of the day when we think we might have doses left over. We know how important it is to vaccinate staff.
‘We have vaccinated a whole range of nurses where I work – from health visitors and district nurses to practice staff locally.
‘We use a WhatsApp group to invite staff in at the end of the day when we think we might have doses left over’
Elia Monteiro, RCN general practice forum member, who is working in a north London vaccination centre
‘Now we have the Oxford/AstraZeneca vaccine I think we are going to see this accelerate.’ The question, of course, is how quickly.
An increasing number of staff are having to isolate or are off sick with the virus; the latest figures from NHS England suggest half of the 100,000 staff absences are COVID-related.
Unison head of health Sara Gorton says the situation is ‘stark’, with the NHS under ‘overwhelming strain’.
‘This underlines the urgency of the vaccine roll-out,’ she says.
Progress is hard to gauge. Some staff received the vaccine before Christmas – hospital hubs were asked to invite care home staff in for vaccination, while unused doses were regularly given to NHS staff.
The government has not yet given figures for the number of health and care workers that have been vaccinated.
On 25 January, health and social care secretary Matt Hancock said progress towards vaccinating the top four priority groups by February 15 was ‘on track’.
Some 6.6 million had received a jab, he said, at a rate of more than 250 people per minute, by the third week in January.
The race to vaccinate is well and truly on.
Visit our COVID-19 resource centre rcni.com/COVID-19