The news that we may have a usable Covid vaccine within weeks was released – like a lot of other government communications during this pandemic – before it was sent to GPs. So when lots of my patients inquired about it, I had no further information to give. The thought of potentially one or more effective vaccines made me cautiously hopeful that we may have an end in sight to this painful and tragic chapter of our lives. It will be groundbreaking if we can make it work.
Indeed, vaccinating the 25,000 patients (if everyone was to be inoculated) at my surgery will be a mammoth undertaking, with capacity issues both for staffing and space. NHS England has not told us to cut down any other work that primary care is currently required to do, or that we’ll be redeployed to mass vaccination centres, although yet again their public announcements suggest otherwise. To keep providing existing primary care while also undertaking the biggest inoculation programme in decades and not allow vaccines to go to waste means we would have to run our surgery from 8am to 8pm, seven days a week. The Pfizer vaccine has to be stored at -80C and once defrosted and prepared, it has to be used within 48 hours. The surgery is already open 8am-6.30pm Monday to Friday, with some weekend and evening surgeries.
It seems likely, although there has been no official guidance yet, that care home residents and workers will be the first groups to be offered vaccinations. They will be followed by the over-80s and health and social care staff, then the over-75s and so on. That’s still a huge logistical undertaking – we have several hundred patients in care homes and similar numbers over 80 and several hundred health and social care staff, and it seems that a second dose of the vaccine would need to be given three weeks later.
If the vaccine is rolled out in stages, then there wouldn’t be a need for the surgery to be open seven days a week or to ration other clinical work. What we don’t know is how many vaccines we will get initially so we can plan. Practices have been told to be ready for 1 December. But for which groups?
Meanwhile, the magnitude of the second wave of the Covid pandemic is filtering through to the NHS, albeit with geographical variations. In the south-west of England, where previously we saw lower Covid-19 rates, Bristol’s rate is almost double the national average, leading to more hospitalisations.
We are seeing more older age groups hospitalised, and many more younger patients such as university students in the community. So far our surgeries and hospitals have been able to manage the workload but the trend is very concerning.
Although national guidance is to continue all routine and urgent work, this depends on local Covid-19 numbers and hospital activity. Already, some areas such as Manchester and Nottingham have suspended routine operations and procedures to maintain staffing and bed capacity for the acutely ill (both Covid and non Covid patients). Here in Bristol, non-Covid and non-urgent procedures continue, although there are still long waits for routine hospital clinics as they catch up with referrals that were held during the first wave. Overall, primary and secondary care continues, through telephone, video or face-to-face consultations.
In line with national guidance, we operate a daily triage list for routine and urgent problems which are either dealt with by phone or video, or patients are asked to come in once the doctor has taken a history of their medical problem. Patients are given same-day face-to-face slots for urgent matters, or within 10 days for routine appointments. Those without phones or computers or who need a sign language or other interpreter are seen at the surgery.
Face-to-face nursing appointments for chronic conditions, blood tests, contraception services, smears and flu immunisations continue. As having flu and Covid simultaneously doubles your chance of dying from Covid, we have been working really hard to make sure everyone who needs a flu jab gets one. So far we have already given 2,300 flu vaccinations.
Nationally GPs and pharmacies have administered 9.5m flu vaccinations this year – 2.5 million more than last year.
But the danger is that those who need to see a GP don’t, as people are once again reluctant to bother their doctor.
And advice for the most vulnerable groups is still unclear. In March, many patients received shielding letters based on incorrect historical data, while others, who arguably should have, received no such recommendations. A transplant patient did not receive a shielding letter, but his wife who was treated for breast cancer 20 years ago did receive one even though she is cancer-free.
It’s incredibly confusing for patients. Those who got letters were told they no longer needed to shield in August, only to receive a text message just hours before this second lockdown advising them to stay at home and exercise extreme caution.
Still, it is clear that general practice remains open for patients even if our surgeries and waiting rooms look starkly different. National figures show this. In September, there were 26.6m appointments in England – a 20% increase on August. Of these, 56% were face to face.
And if we start inoculating patients as early as next month, we GPs will be busier than ever. As we navigate uncharted waters, the government needs to take a proactive approach alongside NHS staff for this to work and end the pandemic.
• Zara Aziz is a GP partner in Bristol
