The COVID-19 vaccine roll-out so far: nurses’ experiences in hospitals and GP surgeries

As the programme extends into primary care, teams will need more support, say front-line staff

As the programme extends into primary care, teams will need more support, say front-line staff

  • In the first week of the vaccination programme, tens of thousands of people received the first of two doses
  • Front-line nurses say the approval of a second vaccine will alleviate distribution problems and enable the expansion of the programme
  • How services and staff are overcoming logistical challenges and ensuring other services continue to run
Resident Annie Innes receiving the Pfizer/BioNTech COVID-19 vaccine at the Abercorn House nursing home in Hamilton Picture: PA

The COVID-19 vaccination programme – the biggest in the history of the NHS – is now well under way.

Hospitals kicked off the drive in early December, with GP surgeries following shortly afterwards.

Vaccination programme ‘a light at the end of the tunnel’

6.31am, 8 December 2020

Matron May Parsons gave the first COVID-19 vaccination to 90-year-old Margaret Keenan at University Hospital, Coventry

Eventually the entire adult population in the UK could be offered the vaccine, and at the heart of the programme are nurses from across health and social care.

At University Hospital, Coventry, on 8 December, matron May Parsons became the first healthcare professional to administer the vaccine. Watched by the world’s media, she vaccinated 90-year-old Margaret Keenan, describing it as a ‘huge honour’ to play a part in such a ‘historic day’.

Ms Parsons, who is originally from the Philippines and has worked for the NHS for more than 20 years, says: ‘The last few months have been tough for all of us working in the NHS, but now it feels like there is light at the end of the tunnel.’

‘Historic’: Matron May Parsons with Margaret Keenan as the vaccination programme began Picture: PA

Similar scenes were also happening around the UK during that first week, with more than 70 hospitals involved in the initial roll-out of the Pfizer/BioNTech vaccine.

Phase one includes all health and social care staff

Residents and staff in care homes for older adults were given top priority for the vaccine, followed by people aged 80 and over, and front-line health and social care staff.

However, due to the challenges of transporting the Pfizer-BioNTech vaccine and storing it in care homes, the initial focus of the vaccine programme shifted to the over-80s and care home staff, followed by other front-line health and social care staff.

Provisional statistics from the UK government said 137,897 people received their first dose of the vaccine by the end of 15 December. Some 108,000 people were vaccinated in England.

Eventually all over-50s and younger adults with underlying health conditions will be offered the vaccine, before a potential roll-out to the rest of the adult population.

The tens of thousands of patients seen in the first week will be due to receive their second dose of the vaccine after Christmas.

Priority list for the Pfizer/BioNTech vaccine

A priority list for phase one of the programme was drawn up by the Joint Committee on Vaccination and Immunisation, which advises UK health departments on immunisation, as follows:

  • Care home residents and staff
  • Over-80s and NHS and care staff
  • Over-75s
  • Over-70s and the extremely clinically vulnerable
  • Over-65s
  • People aged 16–64 with underlying health conditions
  • Over-60s
  • Over-55s
  • Over-50s
  • People under 50 will be part of a second phase, subject to data on safety and effectiveness and government advice

Source: Joint Committee on Vaccination and Immunisation

Nurses redeployed to hospital vaccination teams

One of the hospitals involved in the first week of vaccinations was Salford Royal NHS Foundation Trust. Clinical academic nurse Heather Iles-Smith formed part of the trust’s vaccine programme team, having undertaken Health Education England and Public Health England online training that all vaccinators must complete.

Heather Iles-Smith: ‘There is a real positivity about the vaccination programme’

She says it was an emotional week; a lift at the end of a difficult year.

‘We had to work really hard to get things set up quickly. We have used existing vaccinators supplemented by others such as specialist nurses and end of life care nurses.

‘The staff on the wards are obviously very busy so we have tried to find nurses from elsewhere.

‘I vaccinated one member of staff and she said she wanted to help out and do some vaccinating herself. There is a real positivity about it.’

Practice nurses mobilised to lead the vaccine programme in primary care

On 14 December GP practices joined the effort. More than 100 locations began clinics led by practice nurses, with the over-80s among those called up to receive the jab.

Each local area – organised into primary care networks – has been asked to nominate a practice to deliver the vaccine. Nurses from all the local practices work together to run the clinics.

14 December 2020

The UK’s COVID-19 vaccine programme got underway in primary care

More than 200 sites are up and running, most at GP practices although some at community venues, including one at Epsom racecourse.

Eventually there will be 1,200 in England and several hundred more across the rest of the UK, some running 8am-8pm seven days a week.

Logistical challenges: storage, infection control and social distancing

But the logistics have and will continue to be difficult. This is partly because of the social distancing and infection control requirements, but also because of the nature of the vaccine that is being used.

The Pfizer/BioNTech vaccine has to be stored at -70°C and used quickly once it has thawed.

It means vaccination teams’ schedules are reliant on deliveries from hospital hubs, and they then have to use their supplies within three and a half days of receiving them.

Deputy charge nurse Katie McIntosh vaccinates clinical nurse manager Fiona Churchill at the Western General Hospital, Edinburgh Picture: PA

RCN general practice nursing forum member Elia Monteiro, a practice nurse in London, says: ‘It has been very complex. The need for social distancing and infection control means we need much longer than normal – about 10-15 minutes – for each person. Then there has to be somewhere for them to wait for 15 minutes afterwards [to monitor for any adverse reactions]. But there is still the pressure to get through lots of people quickly; we have to be organised.’

She says if the Oxford University/AstraZeneca vaccine, which is being assessed by the Medicines and Healthcare products Regulatory Agency, gets approved that ‘will make things easier’ because it can be stored more easily, in fridges.

Ms Monteiro says: ‘From that point of view, it will be similar to the flu vaccine programme. If we have a good supply, we should be able to run the clinics smoothly.’

Approval of the Oxford vaccine will also be crucial in helping vaccinate residents in care homes - strict rules governing the storage of the Pfizer/BioNTech vaccine means many care homes have not yet started offering the vaccine in the setting.

The Oxford vaccine will also pave the way for mass vaccination centres, such as at conference centres and sports stadiums.

Behind the scenes: the vaccine roll-out in primary care

The St Johns Medical Centre in south London has been part of the first wave of GP practices offering the COVID-19 vaccine, as the designated vaccination clinic for The Lewisham Care Partnership (TLCP), a network of five practices.

A team of practice nurses, GPs, nursing associates and healthcare assistants worked ‘round-the-clock’ to start vaccinating the over-80s in the third week of December.

The aim was to carry out close to 1,000 vaccinations in those aged over 80 using the first batch of the vaccine.

‘It’s hopefully the beginning of the end of the pandemic’

TLCP lead practice nurse Rebecca Corneck says: ‘So much work went on behind the scenes. We had to make sure we had everything right – ground floor access, wheelchairs available for those who need them and the space to monitor the patients afterwards.

‘The week before all the practices were busy ringing all our patients who are over 80 to get them booked in. But that’s what it’s like in general practice – we are used to dealing with whatever is thrown at us.

‘It is tremendous to get going with the vaccination. It’s hopefully the beginning of the end of the pandemic.’

Oxford vaccine will open up the programme – and an ‘army’ of vaccinators will be needed

Approval of the Oxford vaccine will also trigger a further expansion of the programme and allow it to extend into care homes and mass vaccination centres, such as conference centres and sports stadiums.

RCN professional lead for primary care Heather Randle says that a wider army of vaccinators will need to be recruited and trained.

A recent report by the National Audit Office estimated an estimated 26,000 vaccinators and 20,000 administration staff will be needed in England alone.

A vaccination centre in Cardiff on the first day of vaccination. The anticipated approval of the Oxford University/AstraZeneca vaccine will mean that more non-medical venues will be able to be used for the programme Picture: PA

The plans set out by government feature a range of staff, from healthcare assistants and physiotherapists to fire fighters and airline staff, after they have had training.

Ms Randle says even if this happens nurses will play an essential role: ‘You can train others up – giving the vaccine is just the end of the process – but you still need doctors or nurses to be accountable and you need to assess the patient and make sure they are well.

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Ensuring other services continue alongside vaccinations

‘You also need good admin, people helping to organise the flow of patients. You can’t have frail older patients queuing outside in winter.’

She predicts the demands next year will be huge.

‘We will need help from a wider team. We have to be careful that the other work of practice nurses does not suffer.

‘Throughout the pandemic we have been asking patients to wait for other services, but there is a limit to that before it becomes dangerous.

‘Some people are fine to wait longer for their diabetes or asthma reviews, for example, but not everyone is. If their condition is not being well managed, there is a real risk it will damage their health.’

Vaccines in development: how many doses has the UK ordered and when should we receive them?

The Oxford University/AstraZeneca vaccine is being assessed by the UK medicines regulator
PIcture: Alamy

The UK government has ordered more than 350 million doses of seven vaccines that are at different stages of development.

So far, three of the vaccines have been through stage three clinical trials and have submitted data to regulators.

The Pfizer/BioNTech vaccine has been approved for use in the UK. An initial delivery of 800,000 doses has arrived in the UK, with another 4 million expected by the end of 2020.

The other two being assessed are made by Moderna, a US pharmaceutical company, and a partnership between Oxford University and AstraZeneca.

If the Moderna vaccine is approved, the government has been told the earliest it will receive the doses is the spring.

All three vaccines require two doses.

The other vaccines that have been ordered are at an earlier stage of development.

Doses pre-ordered by the UK government

  • Oxford University/AstraZeneca: 100 million doses
  • Valneva: 60 million doses
  • Novavax: 60 million doses
  • Sanofi/GSK: 60 million doses
  • Pfizer/BioNTech: 40 million doses
  • Janssen: 30 million doses
  • Moderna: 7 million doses

Source: UK government

Predicting the hurdles ahead – and preparing for them

As the vaccination expands, nurses working in the wider community, such as district nurses and school nurses, are likely to be asked to get involved first.

Queen’s Nursing Institute chief executive Crystal Oldman says: ‘It is going to be a huge logistical exercise – and nurses working in the community are going to play a crucial role alongside practice nurses.

‘District nurses are supporting housebound patients and people in care homes so they will be ideally placed to help vaccinate some of these groups.

District nurses will be ideally placed to vaccinate housebound patients
Picture: Alamy

‘We don’t know exactly how things will work in the coming months, but it will need everyone to pull together to get this done as quickly as we possibly can to protect those who are most at risk.’

There are two big hurdles to overcome before this is done.

The first is supply. The government has ordered 40 million doses of the Pfizer/BioNTech vaccine, but only about 5 million of those are expected in the country before the end of the year. As people need two doses, that is only enough for 2.5 million people.

That is another reason why approval of the Oxford vaccine is considered essential – the government has ordered 100 million doses and supply could be more reliable because it is made in the UK.

The second issue is vaccine hesitancy.

Nurses need to reassure people who are hesitant about the vaccine

40 million

doses of the Pfizer/BioNTech ordered by the UK government

Source: UK government

A survey by Ipsos MORI and King’s College London of 2,237 adults in the UK found just over half (53%) were likely to have a COVID-19 vaccination, with another 20% saying they were fairly likely.

Healthcare staff are not immune to vaccine hesitancy – figures from Public Health England showed one in three nurses involved in direct patient care in England had not had the 2019-20 flu vaccine by last new year’s eve.

RCN professional lead for public health Helen Donovan says vaccinators need to be prepared for this. ‘It’s natural people want to ask questions and know about the risks – you have to respect that – and staff are no different.

‘The important thing for nursing teams is to be able to listen to concerns and speak to people and build up their confidence to have the vaccine.’

Further information