Staffing is the issue keeping NHS leaders awake at night - and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence

The health service has had to react quickly to the approval of the Pfizer/BioNtech vaccine, and within just a few days around 50 vaccine hubs have been mobilised and first patients received their dose.

When speaking to people involved in the logistics in regional areas, there was frustration last week around the frequent change in guidance from the centre (one person describing it as "chaos") but there was also a real sense of optimism and a keenness to get started and do a good job.

There are immediate questions around who will actually give the vaccinations, the logistics behind it and how this could affect NHS staff.

So what do we know? HSJ learned a few weeks ago the NHS is expecting to need over 40,000 staff to carry out the mass vaccination programme. We know the hubs will be run by lead employers and there will be additional sites in primary care, expected to start vaccinating next week.

And more recently, further details have been confirmed as to how the hub models could work in practice, for example, vaccine plans for Greater Manchester have revealed 1,000 vaccinations are expected daily at the Etihad stadium campus, with the project led by Tameside and Glossop Integrated Care Foundation Trust. And it seems other areas will follow suit.

The recruitment challenge

It has come to light in recent days that integrated care systems will lead on recruitment for vaccination hubs, as it is thought they have a better system overview and the relationships already in place to call on the third sector and volunteers. This will be managed by the previously mentioned lead employer, which could be a trust, CCG or PCN.

The interest from volunteers has been described as “huge”, with already more than 40,000 people expressing an interest – about a quarter of whom already work in the NHS. NHS Professionals, the Royal Voluntary Service and St John’s Ambulance will also play key roles, and are recruiting both clinical and non-clinical roles.

It sounds similar to the recruitment of returners and others to staff the Nightingales and work on covid wards during the first wave, although some I have spoken to said they hope the process is more efficient this time around. During the spring experienced nurses described their frustration after signing up to work and then hearing nothing back.

Various sources have confirmed band three vaccinators will be recruited and supported by nurses. But it is important these nurses themselves are supported to do this supervisory role, and hospitals are not left in the lurch if staff are called away.

On a similar vein, a line in NHS England’s legal mechanism for administering the vaccine said “all delivery models will need to include additional prescriber roles” within the point of delivery staffing models, and acknowledged the normal structure does not include these.

It added: “In general practice and within trust hubs more prescribers are available, however they will have to be released from other commitments to support with the delivery of vaccinations.”

This raises the question – who will cover the work of those “released from other commitments”, and where will the additional prescribers be recruited from? They must be medical practitioners, independent nurses or pharmacist prescribers (who are suitably trained with experience in immunisation) meaning the pool to recruit from is limited, especially when the NHS is still heavily occupied by covid patients.

It also says the prescriber must take full accountability and responsibility for the patient and members of staff administering the vaccine. This is different from the usual national protocol where staff would take responsibility for their own tasks. In this scenario the prescriber holds a lot of responsibility and the guidance makes clear they must be “content” with taking it on.

Big ask

The vaccination programme is another big ask from NHS staff who have already had extraordinary demands placed on them.

But Kate Jarman, director of corporate affairs at Milton Keynes University Hospital FT, told The Ward Round: “The teamwork and ability and – as importantly – the willingness of staff to respond to this very significant ask, is frankly, amazing.

“We cannot underestimate the scale and pace at which we are asking our staff to work and we should take time to recognise this and express our gratitude for those willing to give more having given so much already.”

“We also know those asks will continue – and we need to safeguard our staff against burn-out and over-burdening them.”

Of course, combined with this huge vaccination effort, the yearly staff flu campaign cannot be forgotten. It is understood there should be three weeks between receiving the flu vaccine and being immunised against covid-19.

As it is still fairly early in the flu season, this will put immediate pressure on trusts to complete their staff flu programme, possibly alongside vaccinating staff against covid.

Winter is always a busy time in the NHS, but this year is unprecedented. And getting the logistics – and support – around staffing the vaccination programme right, will be a crucial part of its success.