Covid-19 vaccinations in Shropshire
Dr Ella Baines, GP at Marden Medical Practice in Shrewsbury and Named GP for Safeguarding Adults and Children, Shropshire, Telford & Wrekin CCG, describes how she and the local PCN Clinical Director provided Covid-19 vaccinations in many of the learning disability care homes across their PCN in one single day in January 2021. It is followed by an account of a mother and son’s experience since March 2020.
At the end of January 2021, I went out, as Named GP for Safeguarding, with our PCN (Primary Care Network) Clinical Director to vaccinate residents in many of the Learning Disability care homes across our PCN. We used the JCVI (Joint Committee on Vaccination and Immunisation) guidelines, December 2020.
noting in particular the following:
‘…flexibility in vaccine deployment at a local level with due attention to:
- Mitigating health inequalities, such as might occur in relation to access to healthcare and ethnicity
- Vaccine product, storage and administration constraints
- Exceptional individualised circumstances
- Availability of suitably approved vaccines’
We also used ‘GP discretion’ to ensure all those on LD registers (and their carers) are prioritised as extremely clinically vulnerable. This decision was made in light of the high mortality rate for those with LD in the first wave of Covid-19 and the difficulties this group faces in terms of protecting themselves from Covid-19; including contact with care staff, wearing masks, hand washing and social distancing. The guidance was subsequently updated to prioritise those with LD in Group 6 with adults with Down’s Syndrome in Group 4. https://www.gov.uk/government/news/jcvi-advises-inviting-people-on-learning-disability-register-for-vaccine
It was just the two of us (with additional help from one GP with his patients) and we vaccinated residents in six homes with the AstraZeneca vaccine. The other doctor prepared the vaccine and I looked through the consent forms and where necessary, assessed mental capacity and made Best Interests decisions. I administered the vaccine. All eligible residents were vaccinated and a few staff with leftover doses, as an open vial had to be used before we moved on. The unvaccinated frontline social care staff were advised to contact their GP to arrange a jab.
It was a brilliant day with a really positive atmosphere. Most residents were happy and enthusiastic – some hadn’t been out since March 2020. We were able to help staff at the care homes understand the consent process and the involvement of family members, Best Interests decisions and use of ‘appropriate restraint’ (staff are protected by the Care Act using restraint under these circumstances).
I used distraction techniques and reward a lot (cheering afterwards) and very mild restraint (holding an arm still) with swift vaccination in about four people. My Makaton signing skills helped too! GP surgeries were also able to vaccinate their own LD homes if they wanted to.
Our supported living units were vaccinated next, with GP practices using reciprocal agreements to ensure all residents at each unit were vaccinated at the same time where possible. Our housebound patients and their unpaid carers (usually family members) were vaccinated at home and our more mobile patients with LD were invited by text or phone (whatever suited them) to attend the local PCN hub with reasonable adjustments. If they were unable to get there, we would vaccinate them at home or at the surgery.
A mother and son’s experience since March 2020
My son is 24 and has profound and multiple learning difficulties, is registered blind, PEG fed and a wheelchair user. He has been living in a small purpose-built care home with four other young adults for the past 5 years.
I think back to March 2020 and remember the last time I lay in his bed next to him and cuddling him and listening to country music bands on his iPad. I can hardly wait for this to be the normal visit again. Seeing him from a distance of 2 metres or over FaceTime and not being able to touch him has been difficult so I have concentrated on how healthy he has been this year and thank my lucky stars that he hasn’t been admitted to hospital – he usually has at least one stay a year in hospital with chest problems.
My son seems very happy whenever I see him and thankfully is blissfully unaware of the situation that we all find ourselves in. He is always very pleased to see us whether in person or FaceTime and this in itself helps us cope – I think if he was more aware and got upset this would make things much harder than they already are.
He received his vaccination as soon as his GP surgery received the Oxford vaccine. They immediately arranged to go to his home and vaccinate all the residents. Hopefully this is the light at the end of the tunnel we have all been waiting for.
I have warned the staff that as soon as I get the go ahead, I’ll be bouncing back into his bed again!
First published on this site in April 2021.