Table 3. Characteristics, strengths, and weaknesses of new delivery models and adaptations to practice.

Model	Characteristics	Strengths	Weaknesses
At GP site	Drive-through	Immunisations 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-in	Immunisations 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 buildings	Drive-through and walk-in	Immunisations 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 hubs		General 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