Delivering services in non-clinical areas: the safety issues nurses need to consider

For some general practice nurses the new normal means administering vaccines in patients’ cars

COVID-19 has transformed how we deliver services in general practice in ways not believed possible even six months ago. 

The impressive way in which general practice nurses have embraced and developed new models of working and new technologies should be celebrated.

But it has not been without its challenges.

Balancing the need to maintain social distancing and limit the spread of COVID-19

Now is a time of great demands on general practice: continuing to maintain essential services, such as child immunisation clinics, while balancing the need to maintain social distancing and limit the spread of the virus has led many practices to investigate alternative ways to continue such services.

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To protect patients and staff, it has been necessary to reduce footfall and maintain social distancing as far as possible in clinical areas. This has been a considerable challenge, particularly for those nurses working in smaller and older premises where safe distancing is difficult.

Coupled with this is a reluctance in many patients and the parents of young children to attend clinics for childhood immunisations or blood tests due to fears around COVID-19. 

View our COVID-19 resource centre

Some general practice surgeries are offering patients services in practice care car parks and, in some cases, have been administering vaccines in the client’s car. In other areas temporary tents or gazebos have been erected to serve as clinical areas for phlebotomy services, for example.

‘Drive-through flu clinics are being discussed as the best way to ensure a wide uptake this coming flu season’

For some, the idea of working in this way is not something to consider or sanction, but for others it has been the only option.

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Wherever possible services should be delivered in a clinically managed environment in the practice premises, but this may not be possible in every circumstance. Drive-through flu clinics are being discussed as the best way to ensure a wide uptake this coming flu season. This may not be necessary in the eventuality, but it is forming part of the planning process in many areas.

Risk assessments are crucial to ensure patient and staff safety at all times

If you or your team are contemplating setting up a drive-through service, then there are a number of factors to consider as part of the risk assessment to ensure the safety of patients and staff.

Remember a risk assessment is the responsibility of your employer and needs to be regularly reviewed and updated. At the very least, it should address the areas below and also reflect the uniqueness of your general practice, strengths and limitations.

You should consider the following:

• Maintaining infection prevention control. 
• Maintaining good documentation and record-keeping. 
• Patient consent and confidentiality. 
• Health and safety of staff and patients.
• Needlestick injury avoidance.
• Traffic considerations.
• Environmental risks, such as weather conditions like rain or heat.
• Equipment and site security.
• Managing post-vaccination anaphylaxis. 
• Would this be appropriate for certain groups, such as vulnerable adults or people with learning disabilities or dementia?
• Safeguarding.

More challenges ahead as practice nurses move to the new normal 

On the RCN's clinical guidance for managing COVID-19 web page, you can find guidance and links to relevant documents on delivering clinical services in non-clinical areas in general practice under the primary and community care section.

Talking to general practice nurses I am aware of the many successes in services continuing in new formats, but there have also been challenges along the way. Undoubtedly, there will be more to come as we move to the new normal.

Remember to take time to reflect and be kind to yourself, you are doing a great job.

Marie Therese Massey, @MarieThereseRCN, is the RCN professional lead for general practice nursing

Further information

RCN – Clinical guidance for managing COVID-19. Information for RCN members