Background: Salford City, Greater Manchester
A snapshot: At the end of 2020, there were approximately 1160 active individuals classed as homeless in Salford and approximately 1000 individual Asylum Seekers.
People are housed in statutory accommodation, emergency accommodation and with independent registered providers. This includes hostels, dispersed properties: HMOs and self-contained flats.
Partnership Working
To identify the target group, we first turned to our established links with Salford Council and the Rough Sleeper Initiative team, local hostels and the voluntary sector organisations to build a list of accommodation providers and begin to enquire about peoples’ general feelings towards the vaccination.
Our initial communication plan included emails, telephone calls and informal chats with people.
Contacting those eligible registered with our practice was straight forward, however the first barrier to offering the vaccine to the entire group was with accessing personal data.
Developing links with the Public Health Engagement Team and the Covid-19 – Notice under Regulation 3(4) of the Health Service Control of Patient Information Regulations 2002 document supported in obtaining 20% of this data.
The Vaccinating Team
One team includes a vaccinator (who has completed vaccination training) and one member of the administrative staff with an ‘Outcomes for Health’ account. Our wider Inclusion Service team is made up of 2 x part time GPs, 1 ANP, 1 HCA, 1 Case Manager & 1 Administrator.
Logistics
Up to now, solely Inclusion Service staff have been coordinating the process: identifying and obtaining numbers, booking in accommodation visits, communicating with support staff, arranging agency and own staff to roll out the programme and keep records.
A large part of the role has been to engage with support staff at accommodations to offer advice on engagement strategies with individuals and offering advice regarding vaccine hesitancy. We have provided advice on marshalling and numbers, ensuring Covid-19 measures and precautions are in place.
Public Health England have now offered PHE admin and have been engaging with vulnerable groups to encourage uptake of the vaccine.
On the day planning…
- Numbers of vaccinations to be given, within the 6 hour window, to be confirmed the day before to ensure no wastage. Vaccinations to be given in multiples of 8 or 10
- Each vaccinating morning, the team must contact the Pharmacist half an hour in advance to ensure that the cool bag has reached the correct temperature in order to store the vial.
- Kit must contain the following paper work: Home Visit SOP, Preparation of vaccine SOP, transportation of vaccine SOP, PGD, sessional checklist, practitioner and staff authorisation sheet, National protocol from PHE, the vaccination record form, information sheet and vaccination cards. Alongside: PPE, sharps box, clinical waste bags and an Epi Pen.
- We are currently using experienced agency staff to increase capacity.
Outreach
Visiting accommodations and drop-in centres maximised uptake and removed barriers created by a mistrust of health professionals and traditional medical settings.
Outreach also facilitated opportunistic registrations although individuals did not need to be registered with ourselves or another GP to receive the vaccination.
Homeless Workers Vaccines
The Inclusion Team acknowledged that the staff working with people experiencing homelessness were eligible for the vaccine and were part of the priority group for vaccination at the time, we therefore coordinated their vaccines as well.
In doing so, a platform was provided for the staff to encourage residents at their accommodation to consider having the vaccination.
Along with the Inclusion team staff, many accommodation staff and housing officers have been champions for the vaccine.
Barriers that have been experienced
- Accessing personal data
- Time constraints regarding the expiry of the vaccine vial
- Time constraints visiting dispersed properties with single occupancy (unable to travel to pop up site)
- Vaccinating in a public space (i.e. Rough Sleepers)
- General public frustration that this group of people has been vaccinated before them
- Multiple logistical steps in arranging staff and individuals for vaccination
- Vaccine hesitancy
Successes
- To date, with an exceptionally small team, we have coordinated and successfully vaccinated 653 people.
- Engaged with multiple individuals, who were vaccine hesitant, who have since requested and received the vaccine.
- Built stronger relationships with accommodation providers.
- Allowed opportunities to build trust with people experiencing homelessness.
- Registered individuals with the Inclusion Service, many who had not accessed primary care for some time.
- Supported other vulnerable groups in accessing the vaccine.
For more information please contact:
Liz Farrell, ANP / Service Lead
Inclusion GP Service, Salford Primary Care Together
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