Administering the Pfizer vaccine at Newbury Racecourse – a view from the front line

Vaccine centre Newbury

14 January

Update from Jo Reeves Project Manager, Newbury Racecourse – COVID Local Vaccination Service and Newbury Locality Manager, Berkshire West CCG:

I am writing on behalf of the entire project team to advise you of our progress to set up a service from Newbury Racecourse to deliver Covid vaccinations to patients in West Berkshire. We have been restricted so far in what we are able to communicate so I hope that some further detail at this stage will be helpful and address some of your questions. I aim to keep you informed of our progress on site regularly as I understand the strong appetite to understand how we are doing. I am however unable to give precise figures for the numbers of people in each group vaccinate or planned to be vaccinated.

The Plan

Nine practices have decided to work together to meet the challenge of the largest vaccination programme in history.

Which Practices?

  • West Berkshire Rural PCN: Lambourn, Hungerford, Kintbury
  • A34 PCN: Downland, Strawberry Hill, Eastfield House
  • Kennet PCN: Falkland, Thatcham, Burdwood

What about the rest of the practices in West Berkshire?

  • Pangbourne Surgery and Chapel Row Surgery have already commenced vaccinations from Rosewood Hall, adjacent to Pangbourne Surgery. They are supporting Theale and Mortimer patients also.

Reasons for setting up a joint centre:

  • Minimise disruption to practices so we are still able to support patients when they need us
  • Easier to manage logistics and social distancing
  • Builds on our history of working closely in West Berkshire such as with the hot hub.

Why the Racecourse specifically?

  • Large space, used to managing complex logistics, helpful team
  • Central location and good parking and access
  • Familiar with site as used for the hot hub

Why has it taken so long?

  • Because we were keen to minimise the impact on patients who need to access primary care in their surgeries, we have essentially set up our own version of a mass vaccination centre. This has required a lot of planning and GPs have been fitting this in around seeing patients. Likewise Practice Managers have been fitting this in around their day jobs.
  • Now we are up and running we can easily catch up and overtake sites who have gone live before us, so long as we get the supplies through.

How will it work?

  • Patient is directed to one of three lanes. There are four vaccinator pods in each lane.
  • Vaccinator completes assessment and administers vaccine. They have a data clerk with them recording patient information onto clinical IT systems, with paper back up if needed.
  • Patient moves to waiting area for 15 minute period. After that they are free to leave.

How many people can you vaccinate?

  • We can do up to 1200 patients per day at the moment although actual numbers depend on vaccine supplies. This number does not include care home residents and staff who we are also vaccinating at the moment.
  • As we get used to the processes on site and get quicker we might well expand the number of vaccinators to do even more than 1000 a day.
  • By the end of Sunday 17th we believe we will have vaccinated more than 1500 people including patients aged over 80, primary care staff and care home residents and staff.
  • Between Monday 18th and Sunday 24th we believe we will have vaccinated all of the remaining care home staff and residents, the vast majority of practice staff and around 1500 patients aged over 80.
  • If supplies of the vaccine continue to increase in quantity and regularity we will easily meet the government’s vaccination targets by working jointly at scale.

What about people who can’t travel to the Racecourse?

  • We are going out to care homes to vaccinate staff and residents there.
  • We are also going to work jointly with the Community Matrons to vaccinate housebound patients.
  • We will work with local voluntary groups around transport as we begin to receive more notice of vaccine deliveries and can arrange transport to coincide with clinics.
  • We have informed the taxi companies so they will know what to do if any patient comes by taxi.
  • Community volunteers and NHS Volunteer responders can be called upon.
  • In the interests of social distancing, patients should travel here independently if they can.

Thank you all for your support in this very busy time.

5 January 2021

The issues with the storage and handling of the Pfizer vaccine have been widely reported. The following was extracted from a note by a Governor of the Royal Berkshire NHS Foundation Trust and might be of interest in highlighting quite what a rigmarole it is…

“While volunteering at our local surgery during the first three days of Covid vaccinations, I became aware of the considerable complexity of the preparation of the Pfizer vaccine preparation and the time constraints that this imposes on the throughput rates.  It is far more complex and time-consuming that the current flu jabs.

“In essence, the preparation process has a number of stages which need to take into account that each vial contains enough vaccine for five doses, that each dose then needs to be diluted with saline and – most importantly – that the vaccine is fragile and can be degraded by light, by time and by rough handling.

“It typically takes a well-trained team three minutes of very careful and precise work in aseptic conditions to produce five doses resulting in a maximum rate of administration of 60 doses per hour per team. The failure to handle the vaccine very gently during preparation and to keep it in the dark whilst being brought up to room temperature may well render the dose only partially effective. In three days we managed to do nearly 1,000 vaccinations in about 17 hours, largely between 11 am and 5pm, whilst still keeping morning surgery in operation.

“The second booster vaccination will similarly take another 17 hours for the same cohort from Jan 5 to 7.  At any given time, in addition to traffic management, there were approximately 20 volunteers (involving nearly all PPG members) and staff working to register patients from four different practices (outside in gazebos) and to conduct them, in groups of five at a time,  though the vaccination process and into the 15-minute observation area. There was also a team of some 10 to 12 nurses doctors and pharmacists working inside the surgery preparing and administering the vaccine.

“This has major implications for care-home residents as the vaccine needs to be administered very close to the aseptic room where it is prepared in order to minimise degradation arising from handling and time duration during transportation. Rightly or wrongly, I am concerned that political pressure to speed up the process or to deskill it will backfire and end up wasting huge sums of money if it results in vaccine being injected in sub-optimal condition. I believe that the Pfizer vaccine costs the NHS about £15 per dose compared to the Oxford vaccine at about £3 and is in limited supply. We can’t afford to waste it.

“As a footnote, the requirement to observe patients for 15 minutes added an additional layer of complexity and significantly limits the choice of sites where the vaccine can be delivered.  A very large room in an adjacent sheltered living facility with 15 socially distanced disinfectable chairs just about allowed us to cope with 60 patients per hour. By filtering out all patients with significant allergies we did not experience a single reaction from any of the nearly 1,000 frail elderly patients that we vaccinated during this observation period.”

 


(c) Can Stock Photo / geargodz

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One Response

  1. I think that we all need to thank Bryan and his team for the hard work they are doing to get the vaccine program implemented, while I at the same time, based on the article, feel that speeding up the process of administering the Pfizer vaccine might prove unsafe and inefficient in the long run. We have all waited this long, so I think that we can wait for a few more weeks until the ‘Oxford’ vaccine is broadly distributed across the country.

    Well done to Bryan his team and the rest of NHS.

    All the best
    Steen Sorensen

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Covering: Hungerford, Marlborough, Wantage,   Lambourn, Newbury, Thatcham & Theale