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Poor decision making

Posted By Mrs MB

"Poor decision making"

About: NHS Grampian / Vaccination Service

(as a service user),

The decision to move B12 injections from General Practitioners out to Vaccination Centres in Aberdeenshire is, in my opinion, an extremely ill-considered decisions. This comment is by no means a reflection on the staff within my GP surgery nor within the Vaccination Centres; rather it is very much focussed on the decisions made within NHS Grampian. The people making these decisions do not appear to understand, experience nor appreciate the regular inconvenience for service users.

I have B12 injections every twelve weeks, I have done for the past 10 years and I will do for life. I am reliant on B12 injections, my body can't produce B12, and this can have a significant impact on my work life balance.

In recent times the decision was made to take this regular injection away from the practice nurse at the GP surgery and instead to the nearest Vaccination Centre; but for me, that is a 10 mile journey that is reliant on my taking the car, whilst in comparison, my GP surgery is less than a 2 minute drive. There is no bus nor a train direct to the Vaccination Centre and the parking is either on a blind bend or within a private parking area that is reserved for residents. The fact that this venue became a Vaccination Centre (Stonehaven) is controversial in its own right (a elderly persons day care facility was closed).

There is also no flexibility on attendance for Vaccination Centres; whilst I work in the City of Aberdeen, I am not allowed to use any of the city Vaccination Centres, I can only attend the Vaccination Centre aligned to my GP surgery.  Additionally, I am only allowed to attend on one allotted day per week, which is a Tuesday. I have to rush the 17.3 miles from my work at 5pm to arrive for one of the latest appointments in the day, it can take me 50 plus minutes in rush hour traffic, and I then have the 10 mile journey home. I have asked if I could attend on my day off from work (a different week day) though this too has been refused because my GP surgery is only allotted for patients to attend on a Tuesday.

I am only allowed to order one ampule of B12 (Cyanocobalamin) at any one time, if I forget to take the ampule with me or forget to order from my GP on my repeat prescription in advance then I have to miss my appointment, this causes some anxiety! In latter times I was fully able to look after a box of ampules, the fact that I am now only allowed to order one at a time is in itself ridiculous, we are not speaking about a controlled drug here!

I am lucky that I am relatively young and able to travel, but I do feel for those who are much older, possibly more infirm or do not have access to transport; and it is this demographic that is statistically more likely to require this regular medication. Would it not have made more sense to move a service that is more required for a different demographic, perhaps for those who are younger and more likely to have access to a car and not in as regular need?

More importantly, why was there no consultation with service users? This is, in my opinion, an example of poor decision practices within NHS Grampian and yet another example of poor use of financial resources.

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Responses

Response from Operational Lead Nurse - Vaccinations, Aberdeenshire, NHS Grampian 2 months ago
NHS Grampian

Submitted on 23/04/2025 at 12:28
Published on Care Opinion at 12:28

Dear Mrs MB

Thank you for your feedback to the Care Opinion Service.

In 2018, the GMS Contract was changed with agreement between GPs and Scottish Government in order to address the workload within General Practice. Certain tasks such as Vaccinations and Treatment Room tasks have been removed from GP Practices as a whole or in part to some extent.

In deciding which tasks to take out of GP Practices, it was determined that Vitamin B12 injections are the least often intervention (ie 12 weeks) and are offered, in general, to younger cohorts of the population as opposed to three times weekly chronic wound dressings for the elderly.

Whilst it would always be the preference to have services as close to home as possible, the current policy drivers do not support this for all services and it is for this reason, that each task must be considered, taking into account all factors when reaching decisions such as these.

We have consulted with service users and discussed ways in which the transformation process could be easier for those who find it the most difficult to attend due to travel.

Whilst I understand the frustration of not being able to attend a City venue, there cannot be a sharing of information between General Practices Patient Record Systems due to data protection agreements which is outwith the control of the Aberdeenshire Health and Social Care Partnership.

I was sorry to hear that you found the Stonehaven Vaccination Centre was not flexible with the day of your appointment however, we do only have one day per week where the Vit B12 is administered for your practice. That said, I am sure that if there is the odd occasion that you were unable to manage a particular day, the staff would consider an alternative if the staffing and the access to data aligned.

Kind Regards

Primary Care Lead Nurse

Aberdeenshire Health and Social Care Partnership

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by Mrs MB (a service user)

The response from the Primary Care Lead Nurse from Aberdeenshire Health and Social Care Partnership fails to respond adequately to a number of points fed back by a service user.

The decision to move “certain tasks” to address workload has been ill considered in respect to the person centred approach towards care, the very ethos of NHS Grampian where the core values, derived from NHS Scotland, are to Listen and Improve.

The NHS representative responder to my query advised quote “In deciding which tasks to take out of GP Practices, it was determined that Vitamin B12 injections are the least often intervention (ie 12 weeks) and are offered, in general, to younger cohorts of the population as opposed to three times weekly chronic wound dressings for the elderly”

With the patient centred approach in mind; for certain clinics I agree that it makes sense to retain tasks such as chronic would dressings within the GP surgery, particularly when these are undertaken regularly for those whom are more likely to require physical support to attend (such as the elderly).

However; when considering tasks that require least intervention, tasks that are largely utilised by a younger demographic, those whom are more likely to have access to transport, I disagree with this response from the NHS representative and my reason for this is twofold. Firstly, women's smear tests are a good example of nursing tasks that are undertaken at the GP surgery, these are offered very infrequently (every 5 years) and are offered to individuals aged 25 to 64, the “younger demographic”. Other tasks undertaken by the GP surgery such as family planning and lifestyle advice, also geared towards a younger demographic and required less often, could also have been moved. Indeed, for a large proportion of patients, smear testing, diabetes/asthma/COPD/Spiromentry clinics etc. Would not necessarily require weekly intervention. Secondly, for the nursing team within a GP surgery a far shorter appointment time would be required for a B12 injection in comparison to other nursing tasks such as wound dressing, ECGs, smear testing,diabetes/COPD/Asthma/Spiromentry clinics, family planning and lifestyle advice. Hence I fail to accept that the move for B12 injections to Vaccination Centres was patient centred for this and for further reasons as quoted below.

The NHS representative responder to my query advised quote “it would always be the preference to have services as close to home as possible”. This matter is not about services being “close to home”, this matter is about services in the Shire being some 10 plus miles from home, frequently travelled on country roads where there are minimal bus services and no train connections. The response from the NHS representative sounds to be as though it was written by someone whom either works from home or lives out with the Aberdeenshire area! The Vaccination Centres for those residing in Aberdeenshire are based in Elgin, MacDuff, Fraserburgh, Peterhead, Huntly, Inverurie, Banchory and Stonehaven. For a patient in Alford they are likely to have to travel 18 miles to Huntly, for the patient in Portlethen, it is a 9 mile journey to Stonehaven. For a patient residing in Westhill they will have to travel 11 miles across country to Inverurie, the patient residing in Ballater will have a 24 mile trip to Banchory.

The NHS representative responder to my query advised that a service user consultation took place then as a (very) regular service user, for a ten plus year period, I did not receive advance notification of the change nor was I offered the opportunity to provide comment. I would question to what degree a survey had been undertaken and to whom was involved. A simple FOI would result in this information being obtainable. I further fail to understand why arrangements could not be made to utilise Vaccination Centres fully in the sharing of data across the city and shire in order that patients have informed choice. Too often I hear friends and colleagues stating that they have been unable to make an appointment for a Vaccination Centre because it is not a fully functioning unit operating every day, particularly those within the city of Aberdeen.

The NHS representative responder to my query expressed sorrow that I was unable to change appointment day and time, they failed to “listen” when I advised on this particular experience. They further failed to respond when I spoke in regards to the inability to receive more than one ampule of B12 (Cyanocobalamin) at any one time from the GP surgery.

I reiterate that the response from the Primary Care Lead Nurse from Aberdeenshire Health and Social Care Partnership fails to respond adequately to a number of points fed back by a service user.

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