As I was wondering how to start this blog, for some reason the Stealers Wheel’s song “Stuck In The Middle With You” came into my mind. Now I’m not for one minute saying that MHRA are clowns or Pfizer jokers; I’m merely emphasising that we’re stuck in the middle! Maybe I should have called the blog “Christmas jumpers for goalposts”.

The first COVID-19 vaccination was broadcast on national TV and declared a momentous victory in the battle against COVID, a huge step forward for healthcare. There certainly has been much hype about the vaccine and some conspiracists even suggested that the vaccine contained a microchip so we’d all be tracked!

The reality, though, is that we need the vaccine to help us return to a state of normality, and in order to roll out a vaccination programme, we need to know what we ought to be doing. When the guidance was released, it was rightly scrutinised by the BMA, LMCs, PCNs and individual practices, and much debate took place.

In fact, the COVID-19 DES triggered a lot of discussion with some, including LMCs, urging practices not to sign up to it. And then the goalposts moved; it became “an enhanced service directed by NHS England”! What’s in a name, you say? Potentially flexibility and NHS England’s ability to change the requirements. Did the thoughts of the opposers change? Not really, and still some were refusing to sign up to deliver the vaccine.

As the guidance rolled out and primary care was able to begin planning how they’d facilitate vaccination clinics in COVID-secure environments, further questions were asked, a popular question being, “How long do we have to monitor the patient after they’ve had the vaccination?” You can imagine the sigh of relief when it was advised in November that there’s no need for a 15-minute observation to take place in practice post vaccination. Woo-hoo! The planning continues; a hurdle overcome.

But with so much changing day by day, caution prevailed, and it was a case of waiting for the facts to be provided – a case of ‘hurry up and wait’ or a case of tackling the admin that had been on hold while the COVID clinic planning was in full swing. On the planning front, you’d be forgiven for assuming (I know what they say about assumption!) that you could run vaccination clinics without a GP being present as that’s usually OK – it is, contrary to popular primary care myth!

So far so good; you can have patients come in one door, be jabbed and leave through the other door, following your COVID-secure route, and if your GP needs to do their rounds at the care home or go on a home visit, it’s OK as you can continue to vaccinate. The more you’re thinking about the COVID vaccination clinic, the more you’re thinking, this could probably be achievable. Logistics appeared to be covered too – delivery to designated sites was scheduled for 14^th December.

At this stage, you were potentially thinking about the 1,000 vaccinations per week expectation set by NHS England; there was talk of this increasing, should logistical constraints ease. There was even funding set aside to the tune of £20m for one-off setup expenses should additional facilities be required to enable vaccination clinics to be established. All seemed good: bases covered, training complete and payments for administering the vaccine detailed. Not long to go and then the clinics will begin.

We’re now at Monday 7^th December 2020, a week away from service delivery; designated sites are raring to go, patients aged 80 and over will soon be receiving their jabs. Then you receive another letter from NHS(E), giving information to support you to start up your vaccination service. Lots of useful information in the letter – but wait, what’s this? A requirement to have a GP on-site whilst COVID-19 vaccinations are being administered. Another change, so late in the day, and you’ve got until 10^th December to finalise your workforce plans!

Grumbling, you discuss the changes with the team and the wider PCN and you’re now thinking, right, that’s us sorted. We’re now ready to support the programme. Phew! But not so fast; there are more changes on the horizon and changes which significantly impact the delivery of the programme.

Perhaps the most infuriating change was forced upon practices on the evening of Wednesday 9^th December. Following two instances of anaphylaxis in two NHS workers, both of whom have a significant history of anaphylaxis, the goalposts were once again on the move. This time the observation goalposts were shifted from not requiring observation to patients being monitored for 15 minutes post vaccination, and potentially longer where clinically indicated.

Is this practical? In a normal world, probably. But sadly, today’s world isn’t normal. Being COVID-secure isn’t normal. How on earth are practices going to achieve this? Is it even a realistic probability? I think the target of 1,000 vaccinations per week may now be about as feasible as your seeing me play for the England Rugby Union team at Twickenham (#dreams)!

Anger, frustration, and an urge to sing another couple of lines from the opening song: “Trying to make some sense of it all, But I see it makes no sense at all.” It appears I’m not alone in these thoughts:

“It’s going to be impossible and it just isn’t financially viable”; “We’re going to be down by a few thousand pounds based on our operating model”; “small practice means we need to halve the number of patients and run another clinic the next day”; “logistically a nightmare”; “it is too rushed, and these changes don’t make it realistic”.

There were a couple of, erm, shall I say unprintable quotes too. At a time when general practice has come under some unwarranted negative feedback, are we being set up to fail? The desire to succeed will surely not let this happen; we can, and we will, score goals, even in moving goalposts!

The road may be long and there may appear to be mountains in our way. But we need to deliver, we need the vaccination, and we need to get back to normality. We will make the changes work; we will succeed, and primary care will deliver.