Table 3. Characteristics, strengths, and weaknesses of new delivery models and adaptations to practice
ModelCharacteristicsStrengthsWeaknesses
At GP siteDrive-throughImmunisations given within vehicle by nurse in practice car park, often through window or car door.
  • Whole family can be immunised at once when needed

  • Reduced contact risk by not entering practice

  • Patients reassured by reduced contact risk

  • Efficient and short appointment times

  • Patients need own vehicle

  • Practice needs appropriate car-park space

  • Additional staff needed to support vaccinator with equipment, such as sharps bins

  • May impede the ability to monitor for post-vaccination anaphylaxis

Outside walk-inImmunisations given by practice nurse outside under tent or gazebo cover.
  • Reduced contact risk by not entering practice

  • Patients reassured by reduced contact risk

  • Efficient and short appointment times

  • Weather-dependent, temperature risk for small children

  • Reduced contact means there may be less opportunity for parents to ask opportunistic questions and for staff to reassure children and families

  • Multiple staff may be required outside to support vaccinator with equipment, such as sharps bins

Off-site delivery in non-health buildingsDrive-through and walk-inImmunisations given by practice nurse outside at alternative site, such as retail car park or sports ground.May be drive-through, walk-in or both.Used for mass flu vaccination campaigns.
  • Reduced contact by not entering practice

  • Accessible site with public transport links

  • Efficient and short appointment times

  • Patients reassured by reduced contact risk

  • May still be able to see ‘own’ or familiar practice staff

  • Patients may need own vehicle, if drive-through site

  • May be further to travel from usual practice

  • May only offer to certain groups, such as aged >18 years, <80 years

  • Weather-dependent, if uncovered

  • Additional staff needed to support vaccinator with administrative tasks and equipment, such as sharps bins

  • May not be able to see ‘own’ practice staff and may miss opportunities for holistic assessment of children and families, and detection of wider health issues such as postnatal depression

  • May impede the ability to monitor for post-vaccination anaphylaxis

General practices designated as hot or cold hubsGeneral practices designated as hot (red) hubs — only for patients with COVID-type symptoms, or cold (green) hubs — for all other work, including immunisations. Decision making at GP federation, primary care network, or CCG level
  • Safety of keeping all potential COVID-19 cases away from at-risk patients

  • Patients reassured by reduced contact risk

  • May be further to travel from usual practice

  • Health professionals less familiar with families may be less able to identify and follow up safeguarding concerns

  • Some practices may not benefit, owing to different IT systems

  • CCG = clinical commissioning group