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BEN JENNINGS
Impossible to plan ahead One major issue for nurses has been difficulty in planning for the coming months because of uncertainty over the possible Covid booster programme .
Nurses are often left out of the loop when it comes to information and decisions . Nursing in Practice reported their frustration last November when their views were not sought over the introduction of the direct enhanced service – a nationally negotiated opt-in contract for a specific service – for delivering the Covid-19 vaccine .
This year , in common with all staff , nurses are behind with preparations for the flu season , which runs from September until the end of March next year , because of the Government ’ s repeated failure to provide clarity on the Covid booster programme , which health secretary Sajid Javid had said would start in September and could be given alongside the flu jab . Announcing the autumn / winter plan on 14 September , Mr Javid finally confirmed booster jabs would be offered – giving just a week ’ s notice for the programme to start , even though some 30 million people will be eligible .
They include over-50s , health and social care workers , older adult care home residents , those aged 16 to 49 with underlying health conditions , adult carers and adults who share a household with vulnerable people .
The Medicines and Healthcare products Regulatory Agency has now determined that co-administration of flu and Covid jabs is safe and can go ahead . But with the flu season already under way , teams have been left scratching their heads as to how the two jabs could now be scheduled together , and to what extent Covid mitigation measures will still be required . Speaking before Mr Javid ’ s long-awaited announcement , nurses shared their concerns .
Emma de Chenu , an ANP and lead nurse at the practice at the University at Sheffield , told Nursing in Practice her team faced uncertainty over preparation for this academic year . They usually begin in the early summer but ‘ didn ’ t really know what was happening ’, she says . ‘ We haven ’ t been able to plan .’
Delivery and storage issues Ms de Chenu highlights the lack of guidance on how the flu and Covid booster programmes could be run together , given the complications over vaccine delivery and storage . Covid vaccines typically arrive in large orders , while flu jabs arrive in ‘ dribs and drabs ’, she explains . This means if practices are told to administer them together , flu appointments may have to be delayed until Covid jabs are delivered . The JCVI has recommended the Pfizer vaccine should be used for booster shots regardless of which brand was received for earlier doses . It can only be stored for 31 days at normal fridge temperatures , so the flu jab – which can last for months – would have to be administered on the same tight schedule .
‘ You ’ ll need a lot of nurses to deliver both simultaneously , working beyond normal time ,’ Ms de Chenu says . ‘ And understandably people are tired and goodwill can be tight .’
Elia Monteiro , a practice nurse who works across multiple practices in London agrees that planning for the flu campaign at her workplace has been delayed by a lack of information around the Covid booster programme . She also worries there will not be enough nursing and other staff available to get the required vaccinations done , especially without the access to volunteers to coordinate and administer vaccinations they had at the height of the pandemic . ‘ I have no idea how we ’ re going to manage to go about it ,’ Ms Monteiro concedes .
Another ANP , who is also clinical director at a primary care network in the south of England , tells Nursing in Practice they wish their PCN had opted out of Covid booster vaccinations . ‘ There ’ s been a black hole of information around the boosters . We didn ’ t know what vaccine we ’ d be using , how it would be delivered or to what cohorts . Without clarity , there ’ s a lot of unnecessary work having to be done . But primary care can ’ t do everything .’
There ’ s been a black hole around the boosters . We didn ’ t know what vaccine we ’ d be using , how it would be delivered or to what cohorts
To complicate matters further , Seqirus , the largest vaccine provider in the UK , revealed in early September that vaccine deliveries would be delayed by up to two weeks because of the nationwide shortage of HGV drivers . This has led to yet more workload for practices through having to cancel or reschedule appointments .
One practice nurse , based in the south-west of England , explains : ‘ We ’ re now having to start our flu jabs at the beginning of October , instead of mid-September . It has meant a lot of disappointed patients and extra admin too , when we ’ re already so busy .’
Playing catch-up But even without the effect of uncertainty about the Covid booster programme , nurses were already snowed under with work and playing catch-up .
This is not surprising . Nurses have been vital to delivering well over 90 million vaccinations so far against Covid-19 and to making a start on the biggest flu vaccination campaign in NHS history . For the first time , the latter will include all secondary school children aged under 17 – making a record 35 million eligible people .
It is also not surprising that demand for mental health support is soaring ( see page 32 ). Ms Monteiro explains : ‘ The number of mental health patients being discharged has increased . Those patients need more input from us . And we ’ re also making more mental health referrals for patients needing this support for the first time because of the impact of lockdown . This then comes with the additional workload of following those patients up .’
Ms de Chenu ’ s university practice usually delivers measles , mumps and rubella vaccines as well as meningitis ACWY vaccines to overseas students during the first week of term in September . But this year , her team has faced decisions on delaying some or all of those clinics to accommodate international students having to isolate on entering the country . ‘ There are all these new things to work around ,’ she says .
Rhona Aikman , a practice nurse based in west Scotland and Nursing in Practice editorial adviser , says : ‘ We are running over six months late calling people for shingles [ vaccination ]. They are coming now but it ’ s taking time to catch up .’ She adds : ‘ Referrals to colposcopy for abnormal smears are waiting much longer than usual – even fairly urgent ones – and calls to patients for smears are themselves running about six months late .’
The PCN clinical director in the south of England has similar concerns : ‘ In my own practices , we ’ ve still got diabetic patients who haven ’ t been seen for over 12 months . I know diabetes has got significantly worse as people have been sat at home and not moving much . On top of that , there ’ s all the prediabetic work – we haven ’ t reached many of those people . I wonder how many more of them have crossed the threshold and become diabetic without our support .’
Ms Monteiro is concerned the pressures also mean nurses cannot dedicate the time they need to patients , and this could compromise patient safety . She used to have 20 to 30 minutes for an annual care planning diabetes appointment covering blood tests , blood pressure , weight and more , but this must now be squeezed into 15 minutes because of workload pressures . ‘ The amount of work is not safe – It ’ s pressurising nurses ,’ she says .
But patients , who have often not seen a clinician in person since the pandemic began , have lots of questions and may come to appointments with multiple issues , Ms Monteiro adds .
‘ People with diabetes might end up with permanent damage if blood sugar levels are high for a long time and it ’ s not being managed effectively ,’ she says .
Lower immunity to normal viruses Practices are also likely to be dealing with higher levels of coughs , colds and flu this year . Lower temperatures and
Autumn 2021 nursinginpractice . com