Flu 2020/21 NHSE & PHE Updates
On the 20th November, the DHSC updated their published guidance for general practice on accessing DHSC centrally supplied flu vaccines for the 2020/21 vaccination programme. The guidance gives details on each individual manufacturer and how practices can order from this stock, including the addtional Flublok vaccine. As this stock is centrally supplied, practices will not be able to claim re-imbursement through the FP34D process nor the dispensing fee. Practices can of course claim the IOS fee under the influenza DES.
23rd October 2020 - NHSE publised a Primary Care Flu FAQ. The frequently asked questions (FAQs) provide information to general practices (and community pharmacies) to support delivery of the 2020/21 annual flu programme. NHSE will update them periodically to reflect new queries or additional information. NHSE say they should be read alongside the updated annual flu letter published on 5 August and the relevant General Practice (and Community Pharmacy) Service specifications.
23rd October 2020- NHSE & I have made available an additional £15.4m to local systems and primary care providers to cover reasonable additional costs (over and above the usual fee structures) associated with this year’s extended flu programme. This is in recognition of the fact that considering social distancing, some flu providers may need to adopt alternative delivery models – eg drive-in vaccination or mass vaccination clinics – as well as deliver vaccinations from alternative locations.
They have published a document for claiming reimbursement for reasonable additional costs for flu delivery. It explains that funding will be restricted to contributions towards the costs of:
• additional venue hires and associated costs (signage, external temporary shelters)
• additional fridges/mobile cold storage.
It further says that claims will not be authorised for costs that are already funded via other routes, such as other national funding streams, the vaccination Item of Service fee, existing GP contract or CCG funding or locally agreed contracts. The funding will therefore not cover:
• additional staff costs
• routine vaccination consumables ie syringes, disposal of sharps
• communications and advertising.
Details for how to claim can be found in the full document.
PHE have produced a leaflet for patients asking "Why am I being asked to wait to have my flu vaccine? Practices may wish to have this to hand or upload to the practice website.
NHS national flu immunisation programme guidance to manage locally held vaccine stock in primary care providers and NHS Trusts
On 10th Sept 2020 NHSE & I published information about how the MHRA will allow transfer of flu stocks during this season's influenza programme as follows: -
The flu immunisation programme continues to play a critical role in protecting those who are most at risk of complications and/or severe disease should they develop influenza. It is important to ensure the continued delivery of vital NHS public health services.
While there are no known central supply issues of flu vaccine stock, it may be necessary for CCGs, Primary Care Networks (PCNs), General Practitioners or NHS Trusts to facilitate the transfer of locally held vaccine stock from one NHS provider to another to ensure the continued delivery of the flu immunisation programme in the event of acute local supply issues.
The Medicines and Healthcare Products Regulatory Agency (MHRA) has the role of regulating the supply of medicines. Routinely, medication can only be distributed between providers where a wholesaler licence exists, however the MHRA has confirmed that with regards to the flu vaccines in the 2020/2021 flu season, during COVID-19, it would not prevent the transfer of locally held flu stock for the NHS Flu immunisation programme, in the circumstance of acute, temporary, local supply issues, provided that:
- The CCG, PCN, General Practice or NHS Trust believes the transfer of flu vaccine(s) is necessary to support the continued delivery of the NHS flu immunisation programme either in primary care or NHS Trusts during the COVID-19 response and will ensure the effective use of available resource;
- The CCG, PCN, General Practice or NHS Trust that is holding the vaccine stock has assurance that the flu vaccine has been stored in the correct temperature-controlled conditions;
- confirmed daily record keeping of temperature monitoring is available;
- The CCG, PCN, General Practice or NHS Trust that requires locally held flu vaccine stock can verify the assurances given; and
- the flu vaccine(s) can be transported appropriately under the right cold chain conditions.
CCGs, PCNs, Primary Care and NHS Trust providers should refer to Public Health England’s protocol for the ordering, storing and management of vaccines https://www.gov.uk/government/publications/protocol-for-ordering-storing-and-handling-vaccines.
Please be aware that errors in vaccine administration and/or vaccine related incidents should be reported to the regional NHSEI public health S7a commissioning team.
An open consultation is underway on changes to Human Medicine Regulations to support the rollout of COVID-19 vaccines which considers provisions for wholesale dealing of vaccines, ending Friday 18th September 2020. https://www.gov.uk/government/consultations/distributing-vaccines-and-treatments-for-covid-19-and-flu/consultation-document-changes-to-human-medicine-regulations-to-support-the-rollout-of-covid-19-vaccines. Changes to regulations resulting from this consultation may supersede any guidance in this document.
Community Pharmacies are already able to transfer medicines to other healthcare providers without a wholesalers licence under specific circumstances, and should refer to the relevant guidance at https://www.gov.uk/government/publications/repeal-of-wholesale-dealer-licence-exemption-for-pharmacists.
The NHS Specialist Pharmacy Service has made available guidance on the use of Patient Group Directions in Primary Care Networks. This can be accessed at https://www.sps.nhs.uk/articles/patient-group-direction-use-in-primary-care-networks/
Annual Flu Letters
- NHSE have published the Annual Flu Letter setting out the current eligible cohorts. We understand that further guidance will be published shortly about both the cohorts and the service delivery.
- The 20/21 Seasonal Influenza DES specification is available on NHSE website.
- NHS England have published an advice and guidance letter on the recommended vaccines for the 2020/21 annual seasonal flu vaccination programme.
Following on from the advice and guidance letter, there has been a further update from Public Health England (PHE) to clarify the position on vaccines for those aged 65 years and over and is as follows:-
JCVI advises the use of the following vaccines:
- Adjuvanted trivalent inactivated influenza vaccine (aTIV)
- high-dose trivalent vaccine (TIV-HD)
- Quadrivalent influenza cell-culture vaccine (QIVc) is also suitable for use in this age group if aTIV or TIV-HD is not available. (Reminder - TIV-HD is currently not eligible for reimbursement)
JCVI advise that the QIVc is considered preferable to standard egg-culture influenza vaccines (TIVe/QIVe).
The expectation is that practices should order the preferred vaccine - aTIV for this age group. QIVc is suitable and should be offered as an alternative when aTIV is not available.
PHE published a further letter dated 31.3.2020 with some additional national guidance on flu vaccine ordering for the 2020/21 seasonal flu programme. This advises that aTIV is the vaccine that will be reimbursed for the >65 cohort. QIVc will only be reimbursed for the >65 where aTIV is not available from the manufacturer.
Annual Flu Letter update - August 2020
This second annual flu letter details the expansion of the programme and also the vaccine uptake ambition of at least 75% across all cohorts.
This year as part of our wider planning for winter, and subject to contractual negotiations, this season flu vaccination will be additionally offered to:
household contacts of those on the NHS Shielded Patient List. Specifically individuals who expect to share living accommodation with a shielded person on most days over the winter and therefore for whom continuing close contact is unavoidable.
children of school Year 7 age in secondary schools (those aged 11 on 31 August 2020).
health and social care workers employed through Direct Payment (personal budgets) and/or Personal Health Budgets, such as Personal Assistants, to deliver domiciliary care to patients and service users
PHE also aim to further extend the vaccine programme in November and December to include the 50-64 year old age group subject to vaccine supply. This extension is being phased to allow you to prioritise those in at risk groups first. PHE advise that providers will be given notice in order to have services in place for any additional cohorts later in the season. Click on the document image to download the full details.