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Vaccinations- North East is top

So we are doing something right in the North East-thats good news. Over 95.5% of children here have had their first MMR by their second birthday. Immunisation is such a controversial subject. Health professionals preach one thing and do another when it comes to their own views? So I ask how many of you have had your Flu vaccine? Technically just over 54.5% of health and social care staff have the vaccine. This has slightly increased from last years statistics but still not convincing. The fact is that we have a responsibility to our patients and our families to be protected. The BMA stated last year that all health care professional should be vaccinated against communicable infectious disease.

When it comes to childhood immunisation- another area that’s difficult for patients. Patients needs us as health care professionals to be able to discuss their anxieties and worries. Very often they worry most about MMR. The controversy surrounding the old autism debate still affects parents today. Sometimes parent fall out about it and its a difficult scenario for practice nurses to deal with. I advise its best to discuss this at home and not on the day of the vaccine.  Parents need to be decisive. We can’t make that decision for them. We give them the facts and recommendations and leave the rest to them. It can be  the most difficult  decision for them.

So we are getting something right in the North East and I like to think that our training programmes are contributing to some of this success.



 Today I attended the Institute of Directors convention called “Game Changers” at the Royal Albert Hall London and what a great day.   It started out with a speech and interview with George Osborne speaking to us about the economy and it was resounding echoes of we are on the right path and things are getting better.

 Followed by Susan Sobbott from American Express who inspired us by taking about Small Business Saturday. This is an event that encourages customers to shop local and support their local communities. This year it’s December 6th 2014.

She spoke of the need to understand our clients, give our clients/customers what they want and treat our staff the way we would want to be treated. This was a resounding theme from most speakers.

There were 2 other speakers who stood out for me.

Jimmy Wales Founder of Wikipedia who was a true inspiration. He has transformed the way information is shared with his emphasis on transparency and openness. He spoke about a wiki project in Africa where the children of a local school wrote to their mobile Internet supplier to provide Wikipedia free of charge and they were successful.

 Travis Kalanick, co-founder of Uber technologies told us about how his affordable reliable transport service has expanded worldwide in just 4 years. Uber will find you a stylish personalized taxi service in under 4mins in London and you can track the taxi. It gives you a picture of the driver, his mobile number and car registration. It’s half the price of Addison Lee. I tried it tonight on the way home and I was not disappointed.

He spoke of how we will not be using our cars in big cities that we will be sharing “rides” and that it will be cheaper than running a car. Our cities will be places that are a pleasure to visit because car usage will reduce by over 50% therefore reducing our carbon footprint significantly,

Whether we like it or not we are in a digital technological revolution and I for one want to get involved. I love technology.

A truly wonderful day with some great speakers and I left feeling very inspired. There was one statement that stood out for me and it was this “ when there is uncertainty around it’s a good time to take a risk” When other people go right, take a left! I am heading left!

 Written By Annie Barr, MA, BSc Hon’s RGN, PGCert, INP,ANP, Clinical Director, Annie Barr Associates


Practice Nursing- What’s happening?

Practice Nursing-What are we going to do?


With more nurses leaving the UK each year than arriving from abroad, there are staff shortages across the profession and this is acutely felt in primary care. Additionally, an impending retirement is coming, with many older nurses in primary and community care. We urgently need to draw more student and newly qualified nurses to pursue a career in general practice, and training is key to this.

90% of all patient contacts occur within general practice and practice nursing is a great chance for nurses to work at the heart of the community, with exposure to a widespread and diverse case load and the chance to make a difference to the outcomes of patients.

In 2009, just 16% of practice nurses work full-time with 82% working part-time and 1% occasional/various hours or part of a job share.

The Department of Health said that in 2013 there were 14,943 full-time equivalent GP practice nurses, compared with 14,695 in 2012, a 1.7% increase.

In a recent survey 86% of practice nurses spent their time in clinical activity compared to 69% of other nurses. Just 16% of practice nurses work full time.

What do practice nurses do? This is a question I am often asked. The truth is it varies from practice to practice and nurses to nurse. Some practice nurses are doing very skilled and specialist roles such as diabetic clinics, asthma and COPD clinics. Very often they are the ones who will alter the patients treatment according to their clinical findings and diagnosis. Practice nurses are skilled in childhood and travel immunisation. However,  some are doing duties that Health Care Assistants (who are trained) can do.

I have often found whilst talking with practice nurses that they feel threatened by the HCA role. That’s somehow the HCA is taking over their roles. This is simply not true. Its important to understand that resources are scarce and we must be mindful of matching every team member to their abilities and tasks for which they are trained. It is in fact freeing up the practice nurses to be able to take on more specialist roles using their skills and abilities. However, we must acknowledge the importance of training and regular updates, which are essential.

With nurse revalidation due in 2015 practice nurses will need to demonstrate competence and skills that are relevant for the roles they undertake. Every nurse and midwife will be required to confirm they:

  • Continue to remain fit to practise.
  • Have met the requirements for practice and continuing professional development.
  • Have sought and received third party feedback which has informed their reflection on their practice. This feedback could be from patients, carers, students (for educators) or peers.
  • Have sought and received third party confirmation that they are fit to practise. A third party (likely to be a manager, another registrant or a supervisor) will need to confirm that the nurse or midwife is adhering to the Code and standards, and is fit to practise.

So we must provide a career framework in general practice so nurses of today and the future can easily access careers in general practice. We must do this now as there are many practice nurses due to retire in the next 2-3 years.

Annie Barr


Clinical Director

Annie Barr Associates

Part 2 B12 Deficiency Signs Symptoms and causes

Here are some of the signs and symptoms of B12

Mental Changes

  • Irritability
  • Apathy
  • Sleepiness
  • Suspiciousness
  • Personality changes
  • Depression
  • Memory loss
  • Dementia
  • Intellectual deterioration
  • Hallucinations
  • Violent behaviour
  • In children developmental delay and autistic behaviour

Neurological Signs

  • Abnormal sensations pain tingling, numbness of legs feet arms, trunk
  • Dimished sense of touch pain, temperature
  • Loss of position sense awareness of body position
  • Weakness arms legs trunk
  • Clumsiness (stiff or awkward movements
  • Symptoms mimicking Parkinson’s or MS
  • Spasticity of muscles
  • Incontinence (urine or stool)
  • Paralysis
  • Vision changes
  • Damage to optic nerve (optic neuritis, inflammation or atrophy

Physical Signs

Hair Loss

Common symptoms include: tiredness, lethargy, feeling faint, becoming breathless.

Less common symptoms include: headaches, palpitations, altered taste, being ‘off food’, and ringing in the ears (tinnitus).

Pale Look

So my message is if you are suffering any of those symptoms ask your doctor to test you. Ask for B12 Serum tests, Methylmalonic acid (MMA) and Homocysteine (hcy) blood tests. These tests are more specific and will give you  a more specific result. 

B12 Deficiency and Pernicious Anaemia

B12 deficiency and pernicious anaemia was the very first course I ever wrote. I wrote it because I  thought it deserved a whole day to discuss rather than added onto the end of the Immunisation course like may other companies do.  B12 deficiency can be present with the anaemia. When I ask delegates what foods contain B12 they all say ‘ green vegetables like spinach and cabbage and fruit”. The answer is no they do not contain B12! B12 is found in dairy produce, eggs, fish, red meat but not green veg. 

B12 is Vitamin B-12, or Cobalamin, is the largest and most complex vitamin currently known to man.  Vitamin B12 deficiency  can lead to anaemia, fatigue, mania, and depression, while a long term deficiency can cause permanent damage to the brain and central nervous system. Doctors frequently misdiagnose B12 deficiency as Alzheimer’s disease, multiple sclerosis, heart disease, mental retardation, Parkinson’s disease, depression, or other mental illnesses.

The Centre for Disease Control (CDC) 2009 Report states that 1 out of 31 people over the age of 50 is B12 deficient. In a practice in the North East of England a local GP finds that 18% of his patients have symptoms of B12 deficiency in contrast to the official figures 0.01%

A person who has B12 deficiency stemming from crohn’s disease, gastric bypass, celiac disease, or dietary causes does not have pernicious anaemia. However doctors as well as patients need to understand that no matter what the cause of B12 deficiency it can be as deadly or pernicious if not diagnosed and treated.

Alcohol, medications ranging from gastro-esophageal reflux (GORD) drugs (Ranitidine, Cimetidine, Pepcid and antacids), Metformin, Colchicine Omeprazole, Lansoprazole, Neomycin, Phenytoin, Potassium chloride, Cholestyramine, Statins, Oral Contraceptives all inhibit B12 absorption. 


Health Care Assistants and Shingles Vaccinations

This week I have received many enquiries regarding Health Care Assistants (HCA’s) and Shingles vaccination (Zostavax) so I thought I would discuss this here. 

As you all probably know the role of the HCA has increased and developed rapidly over the past few years and I have written in my first blog (July 2014) regarding the roles they may develop.  Regarding vaccinations and Immunisations its always just been influenza and Pneumococcal. However the RCN have recently stated the following: 

“It would not be in the best interest of the patient for them to be passed to a different health professional for administration of the shingles vaccine, as this could raise unnecessary concerns about the vaccine or the HCSW’s competence’.

 RCN position on HCSWs administering specific vaccinations, given as part of the routine national schedule (RCN 2014)

So that leaves us with some questions.

  1. Shingles (Zostavax) is a live vaccine
  2. Zostavax is limited in age range 70, 78, 79 year olds this year
  3. Zostavax is given subcutaneously (S/C)
  4. Zostavax has to be drawn up, mixed with the diluent and then given

So its more complicated than just opening up a pack of pre filled syringes and being able to administer relatively quickly and  easily. Influenza and Pneumococcal vaccines come in pre filled packs.  Zostavax does not. 

My view is that I am sure some HCA’s are capable of giving this vaccination however, I want to add caution. Please consider the following: 

  1. HCA’s will need competence assessed and mentored throughout this process to be able to administer the vaccine competently. They will need to be signed off by a RGN or GP
  2. The practice manager and clinical lead will need to check with the relevant companies/organisations whether they will indemnify HCA’s to give this vaccine
  3. They will need this in writing

My final caution is that the Health Care Assistants giving any immunisation should be adequately trained, be working in the HCA role for at least 2 years and have completed or be working towards level 3 study. It is unacceptable in my view to have a Health care Assistant working in a dual role. One minute and Health Care Assistant and the next a receptionist is not good enough. Following the HPA guidance on Health Care Support Workers and vaccinations is essential.