How to set up a NHS COVID-19 vaccination centre? Interview with Tejal Patel
How was the process to get such a massive project running?
With a significant project like setting up a large-scale vaccination centre there is a lot of involvement across different disciplines within a NHS Trust, from Executive Board level to Pharmacy. I have been working on a secondment at Barts Health NHS Trust since August 2020. The Group Chief Pharmacist Dr. Raliat Onatade provided me with this opportunity, to lead on this project. I am very grateful to Raliat for this opportunity. She is truly an inspirational leader!
Of course, I accepted straight away, even though it was a daunting suggestion. I was asking myself How will I manage this massive project? However, from my past experience of leading on large projects and heading up Pharmacy departments at other NHS Trusts, I knew it was all about taking one step at a time, meticulous planning and then finally engaging and deploying. There was a lot of planning and discussions with the Executive board. We had daily meetings and visits to the ExCeL Centre in London to simulate process flows and dummy walk-throughs. We looked at every stage of the process from the moment a citizen entered the ExCeL Centre to when they left.
It was very important to look at our Pharmacy processes too. We had a vast amount of space to organise, however, the expanse of space brought its own challenges. One of our main concerns was how would the vaccinations be sourced to the vaccination areas on the main floor. We therefore had to look at the vaccine supply process, storage and staffing to ensure our citizens could receive their vaccinations safely.
Pharmacists are there to provide the clinical leadership and help with clinical questions. The type of questions we are faced with as part of the vaccination process are: "Am I eligible for the vaccine?" "When can I have the second dose?" "I am taking Warfarin; can I still have the vaccine?”
All in all, setting up the vaccination centre has been a great success, achieved through tremendous effort and dedication. I truly believe that such success has only been achieved through my leadership and due to the Trust working as one team. It wasn´t just about Pharmacy or Management. Yes, I am a Pharmacist, but it was all about teamwork. It was us working together, understanding the whole process and supporting each other wherever we could.
What was your turnaround time?
Initially, we were meant to be up and running in early December. However, this date was pushed back as there were a few teething problems that were out of our control. We then received the go-ahead for the 11th of January and had a period of intense planning before opening.
How many people were working onsite?
The staffing levels depend on how many Pods (vaccination areas) we have open, how many citizens are expected and how many staff are available to work. On an average day, we have about 30-40 staff. However, we always ensure that we have enough staff to operate safely at all times. In addition to staff, we have a large number of volunteers at the centre who help us immensely.
How do you know how many people are signed up per day and how are they being notified?
It all comes down to the National Booking system. Letters go out to the priority groups. The over 80’s were the first group, so letters would have gone out to them telling them how to access the National Booking system and how to book an appointment to receive their vaccination. From our perspective, we do not receive time slots. We only have oversight of how many citizens have booked appointments via the National Booking system.
How would you describe the personal journey?
This is an experience I will not forget very quickly, setting up such a large-scale vaccination centre! I believe it is possibly one of the largest vaccination centres in London. Having been given the opportunity to lead on the Pharmacy element of this project, by the Group Chief Pharmacist, meant she had a lot of confidence in my ability, which in turn gave me a lot of confidence in my own ability. When I was offered the project, I was a little unsure where to start. All I knew, and needed to know, was that there was a dedicated team and we would all work together. We are all learning together building upon our professional knowledge and specialties. The key to our success is working as one team. Everyone has their specialty and knowledge that was needed to set up the centre, and keep the centre running successfully as it is today.
It was a big challenge even on the approach to the opening day. There were many questions constantly running through my mind (and keeping me awake at night!): Will everything go as planned? Have I thought about each and every step? Have I missed anything or not accounted for something critical to the process? But most importantly Do we have the vaccines? Self-question and self-doubt are just part of the learning process.
I had to make sure the vaccines were on-site on the weekend prior to go-live, as we were going live on a Monday morning. The vaccines had been ordered in a timely manner. However, the thought of a failure in the delivery process was constantly playing in the back of my mind. It would be a disaster if we opened on a Monday morning, citizens turning up and staff in place but no vaccines. It wasn’t until I had the vaccines in the fridges at ExCeL that I felt assured.
Like with everything in life you learn as you progress. You can plan in as much detail as you like but sometimes you just need to make it happen, be flexible and change/enhance processes at a drop of a hat! The planning evolves as the project takes shape, so we all learn and improve with time. This is what the whole of our first week live was about, learning and analysing what was working well and was not working so well and improving and changing our processes accordingly. We have a Quality Improvements team onsite to work on the processes and we have daily huddles to discuss what has worked and what has not, what we can improve on to make sure the processes are sleek so that we are ready to go again every morning at 9:00 am.
How was the storage with the vaccine?
We are using the AstraZeneca vaccine; it can be stored at normal fridge temperature from 2-8 degrees centigrade. Each of the fridges are fitted with temperature monitoring devices which alert me if the temperature is out of range. So, storage was not such a big obstacle for us. We just needed to ensure that we were maintaining a cold chain during the transport of the vaccine vials from Pharmacy store fridges to the vaccination rooms.
What was the biggest challenge?
There were two major challenges we were initially faced with: ExCeL Centre London is such a big site, how could we set up a large-scale vaccination centre in such a big empty site? Logistics in a large place such as ExCel are always difficult, how do we get things in place? How would the vaccine supply chain from the Pharmacy stores to the vaccination Pods work? Second major challenge, and more importantly, was Workforce. Have I got the right number and the right type of people to make this happen?
I was looking at it from a Pharmacy perspective but I had colleagues looking at Nursing, Paramedics, Vaccinators etc…. We also needed to consider the training we would need to put in place. Everyone who sets foot on the vaccination floor must be properly trained before being allowed contact with the vaccination vials and the citizens. So, the workforce was a big challenge, especially as hospitals were already struggling with workforce at this time due to patient admissions being extremely high. It was a big challenge, but the team did an amazing job and we now have a brilliant workforce of dedicated staff who are expertly trained, delivering the vaccine, and supported by wonderful volunteers. Pharmacy played a big role in delivering staff training.
How did you organise the workforce?
The overall workforce element was led by my colleagues but I had input for Pharmacy recruitment. We had some staff where I work at Barts Health NHS Trust (Pharmacy department) who are happy to do weekend shifts and/or late evening shifts, so they volunteered to work at the ExCeL centre in addition to their regular hospital shifts. I was very impressed with their dedication and commitment! We also sourced staff from our Bank partners (temporary staff sourcing agency.) They advertised our job vacancies and accepted CV’s on our behalf. I reviewed the Pharmacy related CV’s. I spoke with the potential recruits on the phone and then invited them on-site to assess their skills, not just in Pharmacy but people and team interaction as well, before making a decision. The entire workforce: Pharmacy, Nursing, Paramedics, Vaccinators were predominantly selected via our Bank partners. We also have many volunteers from the Army, the London Ambulance Service and St John Ambulance. We ensure that everyone has done their training before they start working within the vaccination areas. We continuously receive messages from Pharmacy staff suggesting they are always happy to volunteer for shifts at ExCeL London.
We have also received much positive feedback from citizens who have visited ExCeL. This is a great morale booster for all the hard working, dedicated staff and volunteers here at ExCeL!