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Vaccinating Harrogate and beyond

Dr Chris Preece

Dr Chris Preece is a GP Partner at Church Lane Surgery in Boroughbridge and the Clinical Director of the Knaresborough and Rural District Primary Care Network. In a special post for our ‘Doctor Diaries’ feature, Dr Chris talks about the COVID vaccination programme in North Yorkshire and the setting up of centres in Harrogate and Ripon.

I’ll be honest, when I first heard that GPs were being tasked with providing the COVID vaccine, I thought it simply wasn’t possible. At the time we were in the midst of delivering an already challenging flu vaccination programme and increasingly exhausted from the pressures created by trying to deliver services in a global pandemic.

Yet, here we are, having just opened another COVID vaccination centre in Ripon to sit alongside the existing site at the Yorkshire Event Centre in Harrogate. As such it seems like a good time to look back at what’s been achieved in a few short months, and how we’re getting on with that “impossible” task.

So let’s rewind back to early December and the historic announcement that the Pfizer COVID vaccine had been approved in the UK. The excitement at finally having a weapon to fight back against this virus was tempered slightly by the knowledge that the vaccine came with a number of restrictions. It had to be stored in a frozen state, and once thawed there were significant limits on movement, as well as a need to use it within several days of delivery.

Equally, there was a need to monitor everyone who had received the vaccine for 15 minutes after their injection. These restrictions were in part the result of the Pfizer vaccine’s relative novelty. We knew it was safe, but we didn’t yet know for sure how forgiving it would be to movement and temperature change, and we didn’t want to damage this precious resource. So, we had a vaccine that would be delivered in batches of roughly 1,000 doses, couldn’t be moved from the delivery site, and would need to be used shortly after receipt – as well as needing space to seat everyone who’d had the vaccine.

To paraphrase Jaws, we were going to need a bigger surgery.

The first step was that every one of the 17 GP surgeries in the region, along with the GP Federation – Yorkshire Health Network (YHN) – agreed to work together to solve the problem. The search was then on for a suitable site.

Many locations were looked at – and we’re grateful to all of those who showed us round halls, swimming pools, supermarkets and more. Ultimately, however – thanks to the invaluable support of NHS North Yorkshire Clinical Commissioning Group (NYCCG), we settled on the Yorkshire Events Centre (YEC), as it became clear that if there was one location with the sheer space, both inside and out, to give more than 1,000 vaccines in a sitting, the YEC was it.

If we had imagined that finding a venue was the hard part, we were wrong. There then followed several intense weeks designing the internal layout, securing the required equipment, and ensuring we had adequate staffing. It felt like we wrote a thousand protocols. We penned detailed descriptions for job roles that had never existed before, and complicated instructions on maintaining the cold chain and mixing the vaccine. Much time was spent designing a layout that ensured the vaccine was moved as little as possible once it reached the fridge. Whilst everyone else was Christmas shopping, we were drawing wobbly chalk lines on the floor of an empty hall.

On 21 December we took our first delivery of vaccine, and the very next day we opened the doors and vaccinated our very first person against COVID-19. 

The clinical team consisted of doctors, nurses, receptionists, managers, pharmacists and administrators from every GP surgery, as well as YHN, Harrogate Hospital and the CCG. Every bit as important. however, were the amazing volunteer marshals who kept everything moving smoothly, whilst providing warm greetings and enthusiasm despite the biting cold.

If anything we were perhaps a little too efficient at first. We were getting through doses faster than this brand new vaccine could be provided, resulting in the site sometimes sitting empty, and members of the public wondering if we had forgotten them. Suffice to say, we had not. As vaccine supply has increased so have both the number of days the site is open, but also the numbers of people going through it. The YEC site now gives more than 1,500 vaccines in a single day.

Yet we’re not finished.

Whilst the site in Harrogate is able to deliver large amounts of vaccine, it represents a significant journey for some of our more rural patients. The question we had been asking ourselves from the outset, was whether there was any way we could bring vaccines closer to some of those people.

Initially this was extremely challenging. The rules around the Pfizer vaccine were relaxed slightly – we were now allowed to move it one more time after arrival at the site – but the other rules around storing it at 2-8 degrees and observing people for 15 minutes after their vaccination remained. We took advantage of this as best we could, and managed to give the vaccine in some of the larger local care homes, but it was clear this process was going to be slow.

This changed with the rollout of the AstraZeneca (or Oxford) vaccine. Whilst this has some complications of its own, it was clear that it would be easier to implement it in care homes. On learning that we would receive a large quantity of this vaccine on Thursday 21 January, we again called upon GP surgeries to make a further push, and carried out vaccinations in every remaining elderly care home in the region over the following two days. Roughly 50 homes in 48 hours.

However, this still leaves some people without vaccine. We’re acutely aware that whilst the majority have been able to travel to Harrogate, this hasn’t been true for everyone. The first step to solving this dilemma has been to open a second site in Ripon.

This was the intention from the outset, but we’re grateful to Ripon Racecourse for stepping forward to offer their site for this, as it solves many of the problems presented by other locations. It will be a smaller site, delivering roughly 500 vaccinations a day for those who would find travelling to Ripon easier, but is another significant step in increasing coverage in the region.

We are of course, still not finished. This is the story so far but with much left to do. Remember, every single vaccine given will need to be repeated 12 weeks later, so this project will be continuing for quite some time to come. Meanwhile, everyone – even those who’ve been vaccinated – needs to continue to do what they can to prevent spread of the virus. GP surgeries will continue to remain open, screening all patients online or by phone in the first instance to ensure that risks to our patients are kept at a minimum.

None of this would have been able to happen without a huge number of people working together, and I would therefore like to thank every single one of them. The 17 GP surgeries and their staff, that have pulled together to provide this despite immense pre-existing pressures. The extraordinarily hard working teams at Yorkshire Health Network, NHS North Yorkshire CCG and the Vaccine Steering Group, who I fear may not have slept since November. The wonderful army of volunteer marshals, bolstered by the support from the local community support organisations. The teams at the Yorkshire Events Centre and Ripon Racecourse who have not just provided venues, but endured our ever changing requirements and demands. North Yorkshire County Council and the Fire Service for fielding our panicked calls about clearing snow. And all the people I’ve forgotten to mention.

Finally, thank you to every single person who has visited the centre. Your patience, good humour and enthusiasm has meant that it’s a joy to help you all. 

How then can we achieve the impossible?  By doing it together.

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