There cant be anyone working in general practice who has not yet been asked what their plans are for the flu season.  But I am not 100% sure those asking always understand why the question is so difficult this year.

We are still very much in the planning stage, as we await the arrival of the first vaccines.  It is difficult to know how well prepared practices are, but what is certain is preparations are much more difficult than in previous years.

In part this is because of national shifting sands on three fronts: the cohorts to be vaccinated; the PPE requirements; and getting hold of the vaccines.

The season started with a message that 50-64 year olds are to receive the flu vaccine this year.  This was then changed to a message that this will only happen later in the season, if vaccine supplies allow.  So now we have a vocal cohort of individuals contacting practices demanding a vaccine that practices won’t be paid to administer, and confusion across practices as to exactly what they are supposed to be doing.

Initially the PPE requirements were a face mask for every session, with new gloves and apron to be worn for each patient.  Once forward thinking practices, PCNs and GP federations had dutifully mass purchased the required equipment, the guidance was changed so that only sessional face masks are now required.  And who knows whether it will change again in future.

As for vaccine supplies, no one knows how that is supposed to work.  Because practices generally order vaccines a year in advance, the orders placed are for the normally expected amounts.  This would be 50-55% of a practice’s usual cohort, which means practices are well short of the 75% needed to achieve the target, even before this year’s additional cohorts are added on.

Anyone who has tried to order additional supplies will know all remaining vaccine stocks are being purchased centrally.  What we don’t know is how any central supply will work in practice, and how these vaccines will be distributed to practices.  But given the recent experience of central purchasing and distribution of PPE, it is not surprising there is little confidence amongst practices that this will work well.

However, these are not even the biggest challenges practices face in developing their flu plans.  Traditional systems of flu delivery (bringing in large numbers of patients over a weekend or two) simply will not work this year.

The social distancing requirements mean that patients need to be given more specific appointment times, and the usual method of “stacking” multiple patients at once cannot be used.  The high DNA rates that can usually be offset using this method will have a significant impact.  Practices will also need additional staff to ensure social distancing standards are adhered to and manage any queues that form.

At the same time, the social distancing and PPE requirements mean that clinicians will be able to vaccinate far less patients per session.  I have seen the overall impact of this estimated at a vaccination rate of one patient every six or even eight minutes, compared to one roughly every two minutes in previous years.

What this means is that practices can see less patients in a session, but with higher staff costs.  The net impact has been estimated as meaning that the costs of vaccination will rise by between £6 and £9 per patient.  This of course calls into question whether practices can even carry out the vaccinations this year for the fee that is being offered (which currently remains unchanged from previous years).

This is why flu planning is so difficult this year.  I am not sure the system fully yet understands the extent of the challenge this creates for general practice, but I suspect when we move from the planning to the delivery phase these challenges will become much more evident.