6 | Nursing in Practice | Autumn 2022
COVER STORY
Preparing for a tough
winter ahead
Winter pressures have begun early , and nurses in primary care face a host of challenges , including rising workload and unknowns around the severity of flu and Covid-19 . Katherine Price reports
Stationed as ever on the frontline of patient care , nurses in general practice are busy supporting their patients as the colder months loom . But it is a daunting task .
With a ‘ depleted and exhausted ’ workforce still tackling the backlog of the past two years , nurses worry about missing the usual opportunities to review patients presented by winter preparations . And while they feel confident in delivering the flu vaccination campaign , concerns remain that vaccine fatigue may affect uptake .
What ’ s more , the UK is likely to face the peak of the cost-of-living crisis this winter – threatening not just people ’ s wallets , but their health . As QNI chief executive Dr Crystal Oldman warns , nurses can expect to see people unable to heat their homes , worsening long-term conditions and putting nurses under yet more pressure . The Government has promised further support but had yet to announce it as Nursing in Practice went to press . As nurses prepare to tackle the winter months , many are wondering whether any support will be enough .
Confidence despite confusion The Department of Health and Social Care ( DHSC ) is expecting a resurgence in flu this winter , with potential co-circulation with Covid and other respiratory viruses .
Planning in advance for the winter has been complex , worsened by ministers ’ delays in decision making on vaccinations . In May , The Joint Committee on Vaccination and Immunisation ( JCVI ) issued interim guidance recommending autumn Covid boosters for over-65s , care home residents and staff , frontline health and social workers and adults aged 16 to 64 years in at-risk groups . But NHS England had told commissioners to plan for a ‘ maximum scenario ’ of autumn boosters for all over-50s and in July , the JCVI duly extended eligibility to this group .
Similarly , the decision in March to scrap free flu jabs for 50- to 64-year-olds this year was also reversed in July . Everyone in this age group is being offered a free jab , with eligibility also expanded to some secondary school children , focusing on Years 7 , 8 and 9 ( ages 11-14 ).
Inevitably , this has brought extra problems for nurses delivering the vaccines , and uncertainty for the public .
‘ I understand the reasons , but it ’ s quite difficult on the ground to plan … and I think it ’ s also quite confusing for the public ,’ says Helen Donovan , RCN professional lead for public health .
Marilyn Eveleigh , nurse advisor to Nursing in Practice and a Covid vaccinator at a hub in south-east England , agrees the shifting eligibility has been ‘ muddling for the public ’, as the spring booster was focused on the over-75s .
‘ When policies are announced , it would be so helpful if those who were going to deliver on those policies would either be a part of that policy being developed or be forewarned before it ’ s in the media ,’ says Dr Oldman .
Barnsley Healthcare Federation ’ s head of nursing and allied health professionals Andrea Parkin adds : ‘ I would like to have known sooner that the cohorts would change for flu to make sure we were ordering enough vaccines , but I did pre-empt it and luckily ordered over and above , which I think many nurses will have done .’
Despite hopes of delivering Covid and flu vaccines together , she says it is likely they will be given separately : Covid through vaccination hubs and flu via GP practices and pharmacies .
‘ It will depend on receiving flu and Covid deliveries at similar times . If one is delayed it can compromise the co-administration ambition ,’ Ms Parkin says . ‘ We would benefit from a clear strategy for future years to deliver both flu and Covid together .’
Relying on goodwill Adele Parsons has worked in general practice for more than 16 years and maintains an honorary general practice contract while working as a senior lecturer at the University of Lincoln . She points out that the success of a flu campaign often depends on the goodwill of practice nurses who , she says , ‘ do what they need to do to make it work with what they ’ ve got ’. However , she warns this goodwill is ‘ starting to ebb a little bit ’.
‘ The PCNs have been fantastic because they ’ ve been able to pool resources , and in some areas they are really well integrated ,’ she continues . ‘ I have no doubt that the goodwill again will be a major factor . The only problem might be the vaccine hesitancy for patients .’
However , she adds that general practice nurses are used to discussing vaccine hesitancy with patients and ready to have those conversations .
‘ Staff are having to juggle priorities … we have to build all that into all the other asks of us ,’ Ms Parkin says .
She says strong communication campaigns are needed to highlight the need for boosters , although that itself can be challenging locally if multiple vaccination campaigns have to be run together .
Ms Eveleigh says that in her experience , the elderly and vulnerable are ‘ as keen as ever ’ and the hub is anticipating a good uptake . However , she says it has been a challenge ensuring the [ original ] Moderna vaccine , of which vials hold up to 20 doses , matches the numbers of patients being vaccinated each day , as punctured vials have to be discarded after 12 hours . But vials of the firm ’ s newly authorised bivalent Original / Omicron vaccine will contain 5-10 doses , which could ease this pressure .
In Scotland , changes to regulations have seen responsibility for vaccinations and immunisations shift away from general practice to health boards .
Rhona Aikman , a practice nurse based in west Scotland and Nursing in Practice editorial adviser , is concerned about the impact this will have on uptake in
BEN JENNINGS