Guidance

Flu 2023 / 2024


Please note, this is a working document that we will update if and when further advice and guidance is published. It is recommended that you check back from time to time to ensure you have the most up to date copy.


Published 11th August 2023

Last Updated 14th December 2023 (V 1.7) – see all updates

Page Contents

1. Introduction

2. Background

3. Flu Programme 2023/24

3.1 Enhanced Service Specifications.

3.2 Collaboration.

3.3 Who is eligible to receive the vaccine under the enhanced service?

3.3.1 Vaccinating patients not registered at the practice.

3.4 What are the vaccine Age indications and Ovalbumin content.

3.5 Which vaccines should be used?

3.6 Childhood flu vaccination programme.

4. Covid-19 Autumn/Winter Programme.

5. Service Delivery.

5.1 Models of Delivery.

5.2 CQC and alternative locations for delivery.

5.3 Indemnity at other locations.

5.4 PPE.

6. Storage and Movement of Vaccines.

6.1 How should the vaccines be stored and handled?

6.2 What if there is a vaccine storage incident, including cold chain issues?

6.3 Can vaccines be moved between providers?

6.4 Practice vaccine stock supplied to District Nurse teams.

6.5 IMPORTANT INFORMATION: Fluenz® Tetra

7. Running a Clinic.

7.1 National Protocol, PGDs & PSDs.

7.1.1 Authorising Signature.

7.1.2 PSDs.

7.1.3 PGDs use in Primary Care Networks.

7.1.4 Registered Nurses Employed by a Care/Nursing Home & PGDS.

7.2 Recording Information.

7.2.1 Use of Administrators.

Security and confidentiality.

7.3 How is the injectable flu vaccine given?

7.4 Can you give the vaccine subcutaneously?

7.5 Can the flu vaccine (LAIV) be given with other vaccines?

7.5.1 Can the flu vaccine (aQIV) be given with Shingrix?

7.6 Coding and Recording.

8. Administration and Achievement

8.1 Vaccine Uptake Ambition.

8.2 Claiming for vaccines and other funding.

8.3 Centrally procured vaccine stock.

9. FAQs.

9.1 What about vaccination of patients taking anticoagulants or with a bleeding disorder?

9.2 What if you are unsure if a patient has already had a flu vaccination?

9.3 What about patients who have recently been diagnosed with the flu?

9.4 Pregnancy.

9.5 Does a GP have to be on the premises when the flu clinic is running?

9.6 Can HCAs work alone without direct supervision/access to a registered professional?

9.7 Accountability & Delegation.

9.8 Staff Training.

9.9 Practice Staff

10. Useful Websites / Resources

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1. Introduction

The JCVI published their advice for the flu vaccines 23/24, and UKHSA published the annual flu letter (updated on 8th June 2023) to confirm the cohorts for this season.

On 4th August 2023 NHSE published the 23/24 Seasonal Flu Enhanced Service Specifications for Adults and a separate one for children. With confusion around commencement of the programmes, NHSE published a further letter on 10th August 23 to clarify. (See Section 3 for further details).

As COVID-19 is likely to be co-circulating with flu again this year, protecting those at high risk of flu, who are also those most vulnerable to hospitalisation as a result of COVID-19, is vitally important. The covid vaccination programme should continue to help minimise hospital admissions, however other control measures may still be required to prevent the spread of the SARs-CoV-2 virus. Added to this, the possibility of delivering both programmes side by side will create more challenges as previously.

The aim is to use the most effective vaccine for the population.

This year there are 5 influenza vaccines.

We have put together a comprehensive list of common questions with answers adapted and taken directly from the NHS, UKHSA and Government’s publication for 2023/24. This guidance will be regularly updated as and when more information is published, so you are advised to check back and make sure you have the most up to date. This document also has details and added links to some useful resources throughout.

* Whilst QIVe is included on the above list, it can only be used for those aged 18-64 (in an eligible cohort), where supplies of QIVc/QIVr have been exhausted. If used in any other cohort revaccination may be required. Where QIVe is used commissioners may request evidence of the attempt to use QIVc/QIVr before reimbursement is agreed.  National flu immunisation programme 2023 to 2024 letter – GOV.UK (www.gov.uk)

You can sign up to receive regular vaccine updates to the Governments flu vaccination programme.

N.B. The Green Book – Chapter 19 is published on Gov.uk and you are recommended to check here for the most up to date version.

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2. Background

There are three types of influenza viruses which affect humans: types A, B and C. Influenza is highly infectious with a usual incubation period of one to three days.

Types A and B are responsible for most clinical illness. Influenza is spread by droplets, aerosol or through direct contact with the respiratory secretions of someone with the infection.

A viruses

  • cause outbreaks most years and are the usual cause of epidemics and pandemics.
  • live and multiply in some animals and may spread between them
  • birds, particularly wildfowl, are the main animal reservoir

B viruses

  • tend to cause less severe disease and smaller outbreaks
  • predominantly found in humans
  • burden of disease mostly in children

For otherwise healthy individuals, Flu is usually a mild self-limiting disease with recovery occurring within two to seven days. Further information on influenza infection is included in the Green Book (chapter 19) on Influenza. (See also Green Book Chapter 14a – Covid-19 for any updates).

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3. Flu programme 2023/24

3.1 Enhanced Service Specifications

4th August 2023 NHSE published the enhanced service specifications for 23/24. There was much confusion about the commencement date for vaccinations and they published a further letter on 10th August to clarify that:-

Payment for vaccinations will ordinarily only be made following the service commencement date. However, we understand that some firm commitments and appointments have already been made, so where this is the case and the patient wishes to receive flu vaccination in September, NHS England will permit payment claims to be submitted.

However, we would strongly recommend that practices keep a systems audit trail, so that it can be evidenced, should it be needed at post payment verification, of vaccines given in September. It would also be useful to have evidence that you were committed to running the clinics in September e.g. staff rotas, vaccine delivery and storage arranged, room bookings etc.

Further to this, on 30th August, NHSE published details to accelerate the programme for winter vaccination that offers a time-limited funding uplift for Covid-19. For those who have signed up to deliver Seasonal Flu only, this update overrides the official delay that was originally requested for the adult’s programme to start in October and the “ask” is now to start on the 11th September.

However, if you have firm commitments for clinics prior to this date, then we believe the NHSE letter 10.8.23, as above, stands, and you can continue as you originally planned.

SIGN UP

  • To sign up to the enhanced service for adults and at risk, practices must

4.1.1. indicate their willingness to participate in this ES before 23:59pm on 31 August 2023; or

4.1.2. have signed-up to this ES before 5pm on 29 August 2023 where the Practice has indicated their willingness to participate in the COVID-19 ES;

  • To sign up to the enhanced service for children, practices must:-

4.1 indicate their willingness to participate in this ES before 31 August 2023 23:59 unless otherwise agreed with the Commissioner (NHSE).

SIGN UP CQRS

For both Enhanced Services it states that practices must sign up to CQRS for these services by 23:59 on 30th September 2023

  • A payment of £10.06 shall be payable for the administration of each vaccination to patients.

Of note this year:-

  • 11.2.3. Practices submitting claims to the Commissioner (NHSE) for payment monthly wherever possible and Practices must:

(a) validate and submit a claim to the Commissioner (NHSE) for payment within 3 months of the date of the administration of the completing dose of the vaccine; and

(b) ensure that claims submission are validated to enable the Commissioner (NHSE) to correctly calculate the payment.

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3.2  Collaboration

ES specification chapter 6. Collaboration – Influenza only

Practices may, under the terms of this ES and where relevant the Childhood ES, collaborate to deliver influenza vaccinations to their patients in accordance with this paragraph 6 and Annex B, as part of an Influenza Collaboration. All Practices which choose to collaborate as part of an Influenza Collaboration, where they are members of an established PCN or not, will be expected to sign up to an Influenza ES Vaccination Collaboration Agreement. 

ES specification chapter 7. PCN Groupings – Collaboration Covid-19 delivery

Practices may be a member of a PCN grouping to deliver COVID-19 vaccinations in accordance with the COVID-19 ES. Where a Practice is a member of a PCN grouping it may choose to work together with other Practices in that PCN grouping to deliver influenza vaccinations in accordance with this ES through

  • co-administration with COVID-19 vaccinations or
  • synergistically with COVID-19 vaccinations.

For either type of delivery with the Covid-19 vaccinations a specific collaboration agreement will also be required

Equally, they may now choose to work together with other practices just to deliver influenza vaccines as part of an Influenza Collaboration (as above).We strongly recommend checking the details of each options in the ES specification.

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3.3 Who is eligible to receive the vaccine under the enhanced service?
Groups eligible for national influenza immunisation from practice as a registered patient
Eligible Groups Further Details
All those aged 2-3 years but not aged less than two years of age or aged four years of age or over on 31 August 2023

(i.e. they were born on or after 1 September 2019 and on or before 31 August 2021), unless the influenza vaccination is contra-indicated.

All patients aged 65 years and over Those aged 65 years and over on 31 March 2024.
Chronic respiratory disease aged six months and over Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission.

Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).

Children who have previously been admitted to hospital for lower respiratory tract disease.

Chronic heart disease aged six months and over Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. This includes individuals with atrial fibrillation, peripheral vascular disease or a history of venous thromboembolism.
Chronic kidney disease aged six months and over Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation.
Chronic liver disease aged six months and over Cirrhosis, biliary atresia, chronic hepatitis.
Chronic neurological disease aged six months and over

muscles; or severe neurological disability.

Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers).

Clinicians should offer immunisation to all patients with a learning disability given their increased morbidity and mortality due to preventable pneumonia.

Clinicians should offer immunisation, based on individual assessment, to vulnerable individuals including those with cerebral palsy, severe or profound disabilities (PMLD), Downs syndrome multiple sclerosis, dementia, Parkinson’s disease, motor neurone disease and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.

Diabetes aged six months and over Type 1 diabetes, Type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes. Addison’s disease, secondary or tertiary adrenal insufficiency requirement steroid replacement.
Immunosuppression aged six months and over Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, patients undergoing radical radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients, people living with HIV infection (at all stages), multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement deficiency, SCID).

Individuals who are receiving immunosuppressive or immunomodulating biological therapy including but not limited to, anti-TNF-alemtuzumab ofatumumab, rituximab, patients receiving protein inhibitors or PARP inhibitors, individuals treated with steroid sparing agents such as cyclophosphamide and mycophenolate mofetil.

Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20 mg or more per day (any age), or for children under 20 kg, a dose of 1 mg or more per kg per day.

Anyone with a history of haematological malignancy, including leukaemia, lymphoma, and myeloma and those with systemic lupus erythematosus and rheumatoid arthritis, and psoriasis who may require long term immunosuppressive treatments.

It is difficult to define at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of influenza and should be offered seasonal influenza vaccination. This decision is best made on an individual basis and left to the patient’s clinician. Some immune-compromised patients may have a suboptimal immunological response to the vaccine.

Asplenia or dysfunction of the spleen aged six months and over This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction.
Eligible Groups Further Details
Pregnant women Pregnant women at any stage of pregnancy (first, second or third trimesters).
Morbidly obese (class III obesity) Adults with a BMI > 40 kg/m2 (adults aged 16+).
Carers Those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill.
Close/Household contacts of immunocompromised individuals aged 6 months and over Vaccines should be offered to close/household contacts of immunocompromised individuals, who share or expect to share living accommodation on most days over the winter and therefore for whom continuing close contact is unavoidable.
Frontline health and social care workers In order to protect patients in a vulnerable care setting health and social care staff employed by a registered domiciliary care provider who are directly involved in the care of vulnerable patients or clients who are at increased risk from exposure to influenza should be vaccinated by the practice where they are registered as a patient.
Frontline workers without employer led occupational health schemes Frontline workers employed through Direct Payments and/or Personal Health Budgets (such as personal assistants) to deliver domiciliary care to patients and service users.

 

Groups eligible for national influenza immunisation from any practice either as a registered or unregistered patient
Eligible groups Further details
Locum GPs Where locum GPs wish to be vaccinated, they should be vaccinated by any practice either as a registered or unregistered patient
People in long-stay residential or homes Vaccination is recommended for people living in long-stay residential care homes or other long-stay care facilities or nursing homes where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality.

This does not include, for instance, prisons, young offender institutions, or university halls of residence.

Frontline health and social care staff without employer led occupational health schemes In order to protect patients in a vulnerable care setting the following groups should be vaccinated by any practice either as a registered or unregistered patient:

• frontline staff employed by a registered residential care/nursing home who are directly involved in the care of vulnerable patients or clients who are at increased risk from exposure to influenza

• frontline staff employed by a voluntary managed hospice provider who are directly involved in the care of vulnerable patients or clients who are at increased risk from exposure to influenza.

• frontline patient-facing staff working in general practice (Note – not eligible for payment under the ES)

UKSHA states that this list is not exhaustive, and the clinicians should apply clinical judgement to take into account the risk of influenza exacerbating any underlying disease that a patient may have, as well as the risk of serious illness from influenza itself. Influenza vaccine should be offered in such cases even if the individual is not in the clinical risk groups specified above.

However, there is a footnote in the enhanced service specification that states: – “Only those patients eligible for vaccination as defined in this ES specification will be paid for under this ES”.

There is then a further paragraph at 9.7 that states

Practices will not be eligible for payment for the administration of influenza vaccinations outside the announced and authorised cohorts unless they are able to evidence exceptional clinical circumstances requiring influenza vaccination to be administered at the request of the Commissioner (NHSE).

(*N.B. School aged children between 4 – 15 years are also eligible to receive the vaccination but not via the enhanced service unless they fall into one of the “at risk” categories)

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3.3.1 Vaccinating patients not registered at the practice

The enhanced service specification at 10.3 tells us that:-

Where an influenza vaccination is administered to a registered Patient of the Practice by a provider other than the Practice and the Patient’s record is not automatically updated electronically, the Practice must update the Patient records on the same day that the vaccine is administered or on the day that notification is received from the other provider

Practices should record influenza vaccination events relating to patients who are not registered with the practice in line with national guidance.

The Enhanced Service Additional Guidance (Chapter 2.2) details how this should be dealt with. We recommend taking a look at this chapter in full, but in brief: –

  1. Practices should first register the patient within their existing GP IT clinical system using the Immediately Necessary Treatment (INT) registration status. The use of INT registration status is being used simply for administrative purposes in order to create a patient record for the purposes of influenza vaccination to eligible unregistered patients only under the terms of the Seasonal Influenza ES. It does not oblige the vaccinating practice to provide INT owing to an accident or an emergency to patients not registered with the practice that they are administering an influenza vaccination to.
  2. The use of the Immediately Necessary Treatment (INT) registration status provides a mechanism to record the vaccination event given to eligible patients that are unregistered with the practice under the terms of the seasonal influenza ES specification.
  3. Practices should then code the influenza vaccination event, using clinical codes as per the normal process for registered patients, as follows: i. using the clinical codes only to capture the vaccination event for those patients living in long-stay facilities, nursing homes, other long-stay health or social care facilities; and ii. using the clinical codes AND ‘needs influenza’ code for eligible unregistered health and social care staff (i.e. frontline workers as per paragraph 12.i and locum GPs).

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3.4 What are the vaccine age indications and Ovalbumin content.

All influenza vaccines available in the UK for the 2023 to 2024 season

Supplier Name of product Vaccine type Age indications Ovalbumin content micrograms/dose Contact details
AstraZeneca UK Ltd Fluenz® Tetra Quadrivalent LAIV (live attenuated influenza vaccine) supplied as nasal spray suspension From 24 months to less than 18 years of age Less than 0.024 micrograms per 0.2 ml dose 0845 139 0000
Sanofi Quadrivalent Influenza vaccine QIVe (standard egg- grown quadrivalent Influenza vaccine), split virion, inactivated From 6 months Equal to or less than 0.05 micrograms per 0.5 ml dose

Need to confirm with company

0800 854 430
Viatris Influvac® sub-unit Tetra QIVe (standard egg- grown quadrivalent Influenza vaccine), surface antigen, inactivated From 6 months Equal to or less than 0.1 micrograms per 0.5 ml dose 0800 358 7468
CSL Seqirus UK Cell-based Quadrivalent Influenza vaccine Seqirus QIVc (cell-based quadrivalent Influenza Vaccine), surface antigen, inactivated From 2 years Egg-free 08457 451 500
Sanofi Supemtek QIVr (quadrivalent Influenza vaccine (recombinant, prepared in cell culture)) From 18 years Egg-free 0800 854 430
CSL Seqirus UK Adjuvanted Quadrivalent Influenza vaccine Seqirus  aQIV (adjuvanted egg-grown quadrivalent Influenza Vaccine), surface antigen, inactivated, adjuvanted with MF59C.1 From 65 years Equal to or less than 1 microgram per 0.5ml dose 08457 451 500

Ref: All influenza vaccines marketed in the UK for the 2023 to 2024 season (publishing service gov.uk)        = Off label in some instances – see PGD and/or SPC for details.

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3.5 Which vaccines should be used?
Eligible group Type of flu vaccine
At risk children aged from 6 months to less than 2 years
  • Offer QIVc*

Cell-based quadrivalent Seqirus (offered off-label)

JCVI recommended that an egg-grown quadrivalent influenza vaccine (QIVe) is also suitable for use in children aged 6 months to under 2 years and for those aged 2 to less than 18 years if QIVc is not available. However, this vaccine is not being supplied by UKHSA via its ImmForm website.

At risk children aged 2 to under 18 years
  • Offer LAIV 

Offer QIVc** where LAIV is contraindicated or otherwise unsuitable (e.g. parents object t LAIV on grounds of its porcine gelatine content)

 

Aged 2 and 3 years on 31 August 2023 

All eligible school aged cohorts

  • Offer LAIV 

offer QIVc ** where LAIV is contraindicated or otherwise unsuitable (for example parents object to LAIV on the grounds of its porcine gelatine content)

Aged 18 to 64 in an “at risk” group (including pregnant women) Offer:

  • QIVc
  • QIVr 

Or offer QIVe (only when every attempt to use QIVc or QIVr has been exhausted – evidence of this may be requested by the commissioner before reimbursement is agreed)

Those aged 65 years and over Offer:

  • aQIV
  • QIVr

Or offer QIVc (only when every attempt to use aQIV or QIVr has been exhausted – evidence of this may be requested by the commissioner before reimbursement is agreed)

As in previous years, it is recommended that aQIV is offered ‘off label’ to those who become 65 before 31 March 2024.

* Check the ‘off label’ section of the relevant PGD

** JCVI recommended that an egg-grown quadrivalent influenza vaccine (QIVe) is also suitable for use in children aged 6 months to under 2 years and for those aged 2 to less than 18 years if QIVc is not available. However, this vaccine is not being supplied by UKHSA via its ImmForm website.

UKHSA have produced a handy colour coded poster that you download here.

 

 

 

UKHSA have also published another entitled “Which flu vaccine should children and young people have?” The poster can be downloaded here.

 

 

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3.6 Childhood flu vaccination programme

Which children are eligible?

  • All children from 6m old – under 18 years in a clinical “at risk” group
  • All those aged two and three years old

(but not aged less than two, or aged four or over on 31st August 2023 – date of birth on or after 1 September 2019 and on or before 31 August 2021) are eligible for flu vaccination in general practice under the enhanced service.

  • all school aged children (from reception to Year 11) *

(from aged 4 on 31 August 2023) will be offered through a school age immunisation service

* Practices can vaccinate “at risk” children only and other children will need to attend their school.

At-risk children who are eligible for influenza vaccination via the school aged service because of their age will be offered immunisation at school. However, these children are also eligible to receive vaccination in general practice if the school session is late in the season, their parents/ guardians prefer it, or they missed the session at school. GP practices should invite children in at-risk groups for vaccination so that parents/ guardians understand they have the option of taking up the offer in either setting.

  • Healthy School Aged Children

We have been asked about healthy children who attend private/independent schools or who are home schooled, how do they access the flu vaccination.

Under the Enhanced Service practices can vaccinate any child who is in an “at risk” category if they or their parents choose to request from the surgery rather than the school immunisation service.

  • All healthy children will be vaccinated by the SAIS – School Aged Immunisation Service. If any child has missed their vaccination for any reason, then parents can contact the SAIS to find out about mop up or community clinics they are running.

You may find the following links useful in directing parents:-

    • BSW – SAIS for Wiltshire, Swindon and BaNES
    • Dorset – SAIS
    • Southampton, Portsmouth & IOW – SAIS
    • Hampshire, SE, SW, NE, NW – SAIS 
Hampshire Healthy Families – see contacts below by area for SAIS
SE Havant, Fareham, Gosport southeasthantsimmunisationteam@southernhealth.nhs.uk
SW Eastleigh, Chandlers Ford, Romsey, New Forest southwesthantsimmunisationteam@southernhealth.nhs.uk
NE Aldershot, Farnham, Rushmoor, Hart & East Hampshire northeasthantsimmunisationteam@southernhealth.nhs.uk
NW Andover, Winchester & Basingstoke northwesthantsimmunisationteam@southernhealth.nhs.uk

 

What about children who are in the clinical risk group?

Children in clinical risk groups aged 6m to less than 9 years who have never had a flu vaccine before should be offered 2 doses at least 4 weeks apart.

What about those children who are not in a clinical risk group?

A single dose of LAIV should be offered per season, unless contraindicated, irrespective of whether influenza vaccine has been received previously.

NOTE- Healthcare professionals are reminded that in some circumstances, the recommendations regarding vaccines given in the Green Book chapters may differ from those in the Summary of product Characteristics (SmPC) for a particular vaccine. When this occurs, the recommendations in the Green Book are based on current expert advice received from the JCVI and this advice should be followed. The Green Book recommendations and/or further advice from the Department of Health and Social Care and UKHSA should be reflected in PGDs

Please refer to your local PGD and Public Health guidelines on the administration, contraindications and precautions when administering a flu vaccine to children.

What are the types of vaccines available for children?

There are two types of vaccine available for children in 2022/23

  1. Live nasal vaccine LAIV
  2. Inactivated injectable flu vaccine – QIVc & QIVe (N.B QIVe can be used if no QIVc (via ImmForm) is available).

Both the live and inactivated flu vaccines are quadrivalent vaccines – they contain two subtypes of Influenza A and both B types.

LAIV should be offered unless contraindicated.

LAIV is offered to children as it is more effective in the programme than the injected vaccines. This is because it is easier to administer and considered better at reducing the spread of influenza to others who may be vulnerable to the complications of influenza

Note: – LAIV is not licensed for those under 2, who should be offered QIVc*- Cell-based quadrivalent Seqirus (offered off-label)

*JCVI recommended that an egg-grown quadrivalent influenza vaccine (QIVe) is also suitable for use in children aged 6 months to under 2 years and for those aged 2 to less than 18 years if QIVc is not available. However, this vaccine is not being supplied by UKHSA via its ImmForm website.

Porcine Gelatine

LAIV is based on a form of gelatine derived from pigs. Some faith groups do not accept porcine gelatine in medical products.

If the parent of an eligible child refuses LAIV because of its porcine gelatine content (and they understand that it is the most effective product in the programme), a policy decision has been made that they can request an alternative injectable vaccine. Where parents object to LAIV on the ground of its porcine gelatine content, the injectable cell-based Quadrivalent Influenza Vaccine (QIVc) will be centrally supplied for these children and should be ordered from ImmForm.

The British Fatwa Council have wrote a letter in support of using the nasal flu vaccine in 2022 and we have requested a similar update for 23/24.

How is the vaccine administered?

Administration of the vaccine is via a nasal applicator which delivers just 0.1ml (around 1/50th of a teaspoon) of fluid into each nostril. Clear diagrams showing administration are provided in the SmPC and NHS Education for Scotland has made a video for health professionals on how to administer the vaccine.

Can other people present be at risk of catching the vaccine as it is ‘sprayed’?

There is not a ‘mist’ of vaccine virus in the air when children are being vaccinated and therefore others in the room should not be at risk of “catching” the vaccine virus. The room or school in which administration of nasal influenza vaccine has taken place does not require any special cleaning afterwards.

In theory, healthcare workers may have low level exposure to LAIV viruses during administration of the vaccine and/or from recently vaccinated patients. The vaccine viruses are cold-adapted and attenuated and are unlikely to cause symptomatic influenza.

  • as a precaution, very severely immunosuppressed individuals should not administer LAIV
  • other healthcare workers who have less severe immunosuppression or are pregnant, should follow normal clinical practice to avoid inhaling the vaccine and ensure that they themselves are appropriately vaccinated.

Note- Vaccine recipients should be informed that LAIV is an attenuated live virus vaccine and has the potential for transmission to immunocompromised contacts. Vaccine recipients should attempt to avoid, whenever possible, close association with severely immunocompromised individuals (e.g. bone marrow transplant recipients requiring isolation) for 1-2 weeks following vaccination.

Do you have to defer the vaccination due to acute illness?

  • Acute severe febrile illness

If the child has an acute severe febrile illness, LAIV administration should be deferred until recovered. Minor illnesses without fever or systemic upset are not valid reasons to postpone immunisation. If an individual is acutely unwell, immunisation may be postponed until they have fully recovered. This is to avoid confusing the differential diagnosis of any acute illness by wrongly attributing any signs or symptoms to the adverse effects of the vaccine.

  • Heavy nasal congestion

There are no data on the effectiveness of LAIV when given to children with a heavily blocked or runny nose (rhinitis) attributable to infection or allergy. As heavy nasal congestion might impede delivery of the vaccine to the nasopharyngeal mucosa, deferral of administration until resolution of the nasal congestion should be considered, or if appropriate, an alternative intramuscularly administered influenza vaccine could be given instead.

  • Antiviral agents

There is a potential for influenza antiviral agents to lower the effectiveness of LAIV. Therefore, LAIV should not be administered at the same time or within 48 hours of cessation of treatment with flu antiviral agents.

Administration of influenza antiviral agents within two weeks of administration of LAIV may adversely affect the effectiveness of the vaccine

What if you think you have administered an incomplete dose of the LAIV vaccine?

Administration of either dose does not need to be repeated if the patient sneezes or blows their nose following administration.

An incomplete dose of LAIV does not need to be repeated as long as at least 0.1ml of the vaccine has been given intranasally as each half dose (0.1ml) contains enough viral particles to induce an immune response.

If the vaccine is accidentally squirted into the child’s eye, it may cause some slight irritation to the eye and eyewash/normal saline should be used to wash out the eye. The child/parent should be advised to seek medical advice if any irritation occurs and persists beyond what might reasonably be expected.

  • What to do if the child refuses the second half of the vaccine dose after the first half has been given?

As each half dose (0.1ml) contains enough viral particles to induce an immune response, it is not necessary to offer an inactivated vaccine or a repeat live vaccine on another occasion as each half dose (0.1ml) contains enough viral particles to induce an immune response.

  • What if you inadvertently give LAIV to a child who is aged less than 24 months?

LAIV is contraindicated in children aged less than 24 months due to an increase in adverse events in this age group. An increase in wheezing and hospitalisation was observed in clinical trials that included children aged from 6 to 23 months of age. The decision not to license the vaccine for use in children aged less than 24 months was based on these observations rather than vaccine efficacy in this age group.

Children who have received LAIV at less than 24 months of age do not require a replacement dose. The inadvertently administered vaccine should count as a valid dose as LAIV will provide protection in this age group. However, the child’s parents or carers should be informed of the possible adverse events in the short term and advised to seek medical care if adverse events occur. They should be reassured that no long-term effects from receiving LAIV are anticipated.

Children from 6 months of age in clinical risk groups who have not received a flu vaccine previously should count the inadvertently administered LAIV as the first dose. The child should also be offered the inactivated flu vaccine 4 weeks later to complete the 2-dose schedule (in line with the recommendation that children in clinical risk groups aged 6 months to under 9 years who have not received inactivated flu vaccine previously should be offered a second dose at least 4 weeks after the first dose). If the child reaches their second birthday in the 4 weeks between the dose of LAIV and when a second dose of flu vaccine would be due, a further dose of LAIV can be given (if not contraindicated).

Healthcare professionals should report the administration error via their local governance system(s) so that lessons can be learnt, and the risk of future errors minimised. 

  • Inadvertent administration of LAIV to a child who is immunosuppressed

If an immunocompromised individual receives LAIV then the degree of immunosuppression should be assessed. If the individual is severely immunocompromised, antiviral prophylaxis should be considered, otherwise they should be advised to seek medical advice if they develop flu-like symptoms in the four days (the usual incubation period) following administration of the vaccine. If antivirals are used for prophylaxis or treatment, then in order to maximise their protection in the forthcoming flu season, the patient should also be offered inactivated influenza vaccine. This can be given straight away.

Healthcare professionals should report the administration error via their local governance system(s) so that the appropriate action can be taken, lessons can be learned, and the risk of future errors minimised.

Contraindications to LAIV

  • confirmed anaphylactic reaction to a previous dose of flu vaccine
  • a confirmed anaphylactic reaction to any of the vaccine components (see details below on egg allergy)
  • is clinically severely immunodeficient due to conditions or immunosuppressive
  • This includes
  • acute and chronic leukaemias
  • lymphoma
  • HIV infection not on highly active antiretroviral therapy (HAART)
  • cellular immune deficiencies
  • Taking high dose corticosteroids –

Those who are receiving or have received in the past 3 months (>40mg prednisolone per day or 2mg/ kg/day in children under 20kg) for more than 1 week – children on lower dose corticosteroids (>20mg prednisolone per day or 1mg/kg/day in children under 20kg for more than 14 days)- see Green Book, chapter 6 for more details

  • Individuals receiving salicylate therapy (other than topical treatment for localised conditions) because of the association of Reye’s syndrome with salicylates and wild-type influenza infection.
  • is pregnant.
  • individuals with unrepaired craniofacial malformations.
  • Fluenz Tetra should not be used during breast-feeding.

Also, contraindications for children with acute and severe asthma – see next section

Acute and Severe Asthma

  • children with asthma on inhaled corticosteroids may safely be given LAIV as these are non-systemic corticosteroids and do not cause substantial systemic immunosuppression.
  • LAIV is not recommended for children and adolescents currently experiencing an acute exacerbation of symptoms including
    • those who have had increased wheezing and/or
    • needed additional bronchodilator treatment in the previous 72 hours.

Such children should be offered a suitable inactivated influenza vaccine to avoid a delay in protection

  • children who require regular oral steroids for maintenance of asthma control, or have previously required intensive care for asthma exacerbation should only be given LAIV on the advice of their specialist

As these children may be at higher risk from influenza infection, those who cannot receive LAIV should receive a suitable inactivated influenza vaccine. Children with significant asthma and aged under nine years who have not been previously vaccinated against influenza will require a second dose (of either LAIV or inactivated vaccine as appropriate).

Egg Allergy

  • children with egg allergy (including those with previous anaphylaxis to egg) can be safely vaccinated with LAIV in any setting (including primary care and schools)
  • children who have required admission to intensive care for a previous severe anaphylaxis to egg should be given LAIV in the hospital setting
  • children with both egg allergy and a clinical risk factor that contraindicate LAIV (e.g. immunosuppression) should be offered an inactivated flu vaccine with a very low ovalbumin content (less than 0.12µg/ml). QIVc quadrivalent inactivated egg- free vaccine, is licensed for use from the age of 2 years for egg- allergic children , the JCVI has also advised this year that this can be also given to egg- allergic children under 2-years ‘off label’ – see ‘off label’ section of PGD for further guidance.
  • children in a clinical risk group and aged under nine years who have not previously been vaccinated against influenza will require a second dose whether given LAIV or inactivated vaccine.

Useful Resources

UKHSA Annual flu immunisation slideset for 2023 -2024

UKHSA – Flu vaccination programme: information for healthcare practitioners 2023-24

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4. Covid-19 Autumn/Winter Programme

The Enhanced Service Specification for Autumn/Winter Covid-19 vaccination programme was published by NHSE on 4th August 23. It says it runs from September 2023 to 31st March 2024 (unless it is terminated in accordance with paragraph 3.8.). However, there is also a clause that says “The Services Commencement date shall be announced in the Primary Care Bulletin”. NHSE subsequently sent out a letter asking that COVID-19 vaccinations for adults commences in October.

There is, as previously, the option to co-administer the Covid vaccination with the seasonal flu vaccination where appropriate, as specified in the ES documents.

One noticeable difference is the IOS fee. This has now been further reduced to just £7.54. In light of this, the BMA/GPC have urged practices/PCNs to look closely at the Covid vaccination programme with regards to its financial viability.

Collaboration details can be found in Section 5 & 6 of the Covid-19 enhanced service. It will require a Collaboration Agreement in place for this activity and NHSE have published a template for this purpose.

You may also find it useful to read Additional guidance on recording of influenza vaccination events, payments and collaboration.


Stop Press :- However, on 30th August, NHSE published a letter about a new variant of Covid-19 BA2.86 for which they have decided to accelerate this vaccination programme and offer additional time-limited funding. We believe that this is a huge ask at such very late notice and please be assured that Wessex LMCs support practices in whatever decision they make, that they consider is in the best interests of both their population, weighing up everything, and also the wellbeing of an already exhausted and overwhelmed practice workforce.


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5. Service Delivery

5.1 Models of Delivery

With the advent of Covid-19 in 2020, there were several examples of delivering the flu vaccination programme in alternative settings last winter. Examples of both practices and PCNs looking at various different service delivery options to manage increasing uptake, social distancing and PPE measures required to maintain both staff and patient safety.

Service delivery options included, but not limited to:-

  • Practice Premises – e.g. One-way system in and out and/or utilising the car park
  • Use of other NHS Estates
  • Drive To – possibly another purpose-built venue, such as school or community hall
  • Drive Thru – Use of large car park or filed space, whereby the patient stays in their car

NHSE have published a Seasonal Flu vaccination collaboration agreement to support the delivery of the individual and collective responsibilities of the collaborating practices and PCNs as part of the influenza vaccination programme. They have also published a template for PCNs wishing to co-administrate Flu and Covid vaccination. 

FutureNHS Platform  – Top tips: Experiences and lessons learned from people setting up drop-ins and pop-up models to deliver vaccines. There is also a document for setting up a drop-in service, however, this is labelled sensitive – commercial and as such we can provide the link for this on the Futures platform only.

We would strongly recommend signing up to the FutureNHS, it is quick to do and holds a vast number of documents.

We have put together a handy crib sheet/checklist for both practice based and alternative venue settings. Click on the image to download a copy.

     

 Practice Based                                      Other Locations

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5.2 CQC and alternative locations for delivery

There are considerations for operating in alternative locations and venues, one of which is CQC registration.

CQC have published details for providers who are planning the ways in which they will deliver both flu and covid vaccination clinics. They acknowledge that providers may deliver flu, and potential coronavirus (COVID-19) vaccinations, in a different way to their usual winter vaccination delivery model. The CQC have given examples of registration requirements for various scenarios.

For the model/example that we understand many practices may wish to use is that of another perhaps larger community venue. CQC advise the following in their example 4: –

Vaccination site: not listed in your conditions of registration or any other CQC registered provider and will only be used as a vaccination site. (for example sports venues, schools, other community venues).

Responsibility: you are responsible for:

  • carrying on the regulated activity, and
  • the quality and safety of the service at the location, and
  • making sure the location is equipped and maintained to the standard expected for patient healthcare.

You will not need to make any application to vary your registration BUT

If you are responsible (as a lead practice), you will need to:

We may inspect this location separately.

 

Groups of practices could work together at such sites to deliver vaccinations to patients from any practice within the group. This would include groups in a Primary Care Network. In these cases, the group could either:

or

  • all the providers share responsibility. They should all update their statement of purpose to tell us they are running the vaccination site as a ‘satellite’ of their own practice or NHS trust registration.

For other model examples, please refer to the CQC webpage for full details

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5.3 Indemnity at other locations

In looking at alternative models of delivery, the question of indemnity is very relevant. The state backed clinical negligence scheme (CNSGP) will cover the service delivery of NHS primary care services, the location is not relevant. However, this is for clinical negligence claims only. It is strongly recommended that practices consider and check their Public & Employer Liability Insurance and ensure that this will cover service delivery in alternative locations and for any loss or damage to property or persons. Practices are further advised to confirm with their MDO for any clauses in their policies that would preclude this activity.

5.4 PPE

Providers will be expected to deliver the programme according to any guidelines on social distancing and PPE that are current at the time.

PPE continues to be provided free of charge via the government PPE Portal until 31st March 2024

At the time of writing Gov.uk Management of COVID-19 patients in health and care settings guidelines, says:-

non-pharmaceutical interventions (such as mask wearing and enhanced ventilation) may be used, depending on local prevalence and risk assessment, with the aim to reduce the spread of SARS-CoV-2.

We would suggest that it would be prudent to continue mask wearing during such clinics with such high volumes of patients (possible circulation of a number of viruses) and keeping windows open where possible to maximize ventilation.

The IPC guideline should also be checked.

Practice may also like to use the BMA COVID-19: toolkit for GPs and GP practices (bma.org.uk) that includes some risk assessment suggestions.

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6. Storage and Movement of Vaccines

6.1 How should the vaccines be stored and handled?

A recent article in the national vaccine update (Issue 338 May 23) says that:-

The importance of maintaining the cold chain – Can you help towards reducing overall vaccine wastage and cost to the NHS?

During 2022, vaccine wastage incidents reported through ImmForm due to both avoidable and unavoidable incidents remained significant, at £5.7 million based on the list price. This is potentially an under-reporting of vaccine wastage and the true cost may be higher. Of note, expiring seasonal vaccines were the largest contributory factor (18% of the total cost of wastage, £1.1 million).

Please consider best practices around ordering, receipt and storage of vaccines which are provided centrally for the national immunisation programme. If vaccines are not stored correctly, it is not only wasteful and expensive for the NHS but vaccines may lose their effectiveness, and this could result in a failure of the vaccine to provide the required immune response.

We would suggest that with the possibility of co-administration and also new staff who may not have previously worked on a flu campaign, it is vital that everyone is aware of the importance of storage and handling. (See our webpage – The Cold Chain)

  • Fridges should not be overstocked – Does the practice have fridge capacity for all the additional vaccines arriving.
  • Temperature readings should be recorded and a log of any events and actions.
  • Everyone involved in the administration and giving of vaccines should be familiar with the cold chain.

The practice policy should be updated on an annual basis.

NOTE :- The safety of vaccines is a frequent issue raised by the CQC.

Vaccines should be stored in the original packaging in accordance with the manufacturer’s instructions, between +2°C to +8°C and protected from light.

All vaccines are sensitive to some extent to heat and cold, vaccines must not be frozen and should not be exposed to heat as this can lead to a decline in potency and subsequent reduced shelf life.

Before use, LAIV may be out of the refrigerator for a maximum period of 12 hours at a temperature not above 25°C as indicated in the Summary of Product Characteristics (SPC/SmPC). If the vaccine has not been used after this 12-hour period, it should be disposed of.

Recommended vaccine storage containers should be used when transporting vaccines between different locations. Vaccines should be kept in their original packaging and the cold chain should be maintained; max / min temperatures should be monitored when the container is in use. The box should be the adequate size for the number of vaccines required (only take as many as indicated for the session), any remaining unused vaccines should be marked before returning to the fridge, to be used at the earliest opportunity.

Clinicians administering the vaccine are recommended to check manufacturers advice.

Medicines.org.uk is a useful resource for SPC.

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6.2 What if there is a vaccine storage incident, including cold chain issues?

Should vaccines be inadvertently stored outside the recommended temperature range of 2°C to 8°C, the vaccine should be quarantined, and risk assessed for suitability of continued off-label use or appropriate disposal. This should be raised as a significant event.

Refer to the national Vaccine Incident Guidance document and seek further advice on vaccine stability and cold chain storage incidents from the vaccine manufacturer and your local screening and immunisation teams.

South East – HIOW england.hiow-sit@nhs.net

South West – BSW & Dorset england.swvast@nhs.net

6.3 Can vaccines be moved between providers?

Vaccine purchased by one provider cannot normally be distributed to another provider without a legal basis for doing so – usually this is limited to providers that have wholesale distribution authorisation (wholesale dealer’s licence).

The exemption that was put into place in 2020 in accordance with regulation19 (4A) of the Human Medicines Act 2012 has been extended by Statutory Instrument No. 350 – the Human Medicines (Coronavirus and Influenza) (Amendment) Regulations. The new exemption started on 1 April 2022 and expires on 1 April 2024.

Under the exemption, vaccine stock may be supplied by one GP practice/ community to other providers in the area, as long as:

  • it is from excess stock that the supplying practice/community pharmacy ordered, which resulted from forecasting demand that did not materialise.
  • it was not a result of deliberate over ordering
  • the supply is specifically approved by NHS England; and
  • that the vaccine supplied will not be used for onward

The following guidance is from the NHS England central team on the movement/sharing of flu vaccines.

Movement of vaccines between GP practices must only be done where there is a collaboration agreement in place.

This could be either a seasonal flu collaboration agreement, which can be between any group of GP practices, or a Covid/Flu collaboration agreement as part of a PCN grouping. Further information on collaboration arrangements is set out in the Enhanced Service specification and associated guidance.

Practices collaborating under either of the above arrangements will be deemed a temporary single medical practice for the purpose of regulation 3(5), (8) and (9) of the Human Medicines Regulations 2012 (as amended). This means they can supply a proportion of their flu vaccine to their temporary single medical practice under Regulation 19(4A) of the Human Medicines Regulations 2012 (as amended).

In supplying their flu vaccine to the temporary single medical practice, practices must set out within the relevant collaboration agreement:

  • the vaccine sharing arrangements, including details of the proportions of the flu vaccine shared;
  • how collaborating practices will govern the supplied proportion of flu vaccine; and
  • how collaborating practices will claim reimbursement for any administered flu vaccine supplied and any personal administration (PA) fee (where eligible).

For example, if Practice A received all of its flu stock early in the season, and Practice B is not receiving flu vaccine until October, the two practices may agree a flu collaboration agreement which states that the practices will create a stock of 2000 vaccines for the temporary practice with each practice contributing 50% (1000 vaccines); each practice would accept that they would be able to use 50% of the shared stock and each would claim reimbursement according to the proportion of their share that they used. In practical terms:

  • Practice B would have access to 1000 vaccines early in the season using stock contributed by Practice A
  • Practice A could use (get back) the 1000 vaccines from the stock delivered to Practice B in October.

N.B. Outside of the above arrangements, NHS England has stated that movement of influenza vaccine cannot take place under Regulation 19. In summary, the process widely known as ‘mutual aid’ in the COVID-19 vaccination programme cannot be used for movement of influenza vaccines.

6.4 Practice vaccine stock supplied to District Nurse teams

We understand that practice stock is often supplied to District Nursing teams for use on practice registered housebound patients. We understand from colleagues in the NHSE Screening and Imms team that, as DNs are not employees of the practice, a Vaccine Agency Agreement is required to pass your stock onto DN teams to be used to vaccinate your housebound patients.

A template is provided for this purpose that requires amending as appropriate with the relevant details.

Vaccination_Agency_Agreement_vTemp

 

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6.5. IMPORTANT INFORMATION: Fluenz® Tetra  – Updated expiry dates for specific batches of Fluenz® Tetra and product recall.

Updated expiry dates for specific batches of Fluenz® Tetra and product recall.

Following routine stability testing, it has become necessary for AstraZeneca to reduce the shelf life of 6 batches of Fluenz® Tetra issued between 30 August and 13 October 2023 by 5 days.

The expiry dates for these batches have subsequently been updated as follows:

Batch Number Printed Expiry Date Amended Expiry Date
TH2127 28-Dec-2023 23-Dec-2023
TH2127B 28-Dec-2023 23-Dec-2023
TH3110 01-Jan-2024 28-Dec-2023
TH3110B 02-Jan-2024 29-Dec-2023
TJ2290B 10-Jan-2024 05-Jan-2024
TJ2290 11-Jan-2024 06-Jan-2024

 

Except for the amended expiry date, there are no other changes made to the product information.

AstraZeneca assure full effectiveness until the amended expiry date, and the quality, safety and efficacy of Fluenz® Tetra is not affected. Parents/care givers do not need to be concerned about their child’s vaccination.

In agreement with the Medicines and Healthcare products Regulatory Agency (MHRA), AZ will also undertake a medicines recall exercise for these batches as a precautionary measure.

If you have received any vaccine from these batches, please ensure where possible, that they are fully administered by the amended expiry dates listed above. Any remaining stock should thereafter be quarantined and returned to AstraZeneca. To arrange a stock return in Great Britain, please contact Movianto customer care on 01234 587 207 or Moviantouk.NHSCC@movianto.com. For stock returns in Northern Ireland, please email contact.nireland@movianto.com.

Official notification from MHRA and AstraZeneca can be found here:

Class 3 Medicines Recall: AstraZeneca UK Ltd., Fluenz Tetra nasal spray suspension, EL(23)A/39 – GOV.UK (www.gov.uk)

MDR 298 0923 Fluenz Tetra (astrazeneca.co.uk)

All customers who have received a delivery containing one or more of these batches should also be contacted directly by both post and email, advising them of this issue.

AstraZeneca Contact Point

For further information on this matter or medical information enquiries, contact AstraZeneca Medical Information medical.informationUK@astrazeneca.com  or call 0800 783 0033.

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7. Running a Clinic

7.1 National Protocol, PGDs & PSDs

NHSE published guidance on the legal mechanisms available for the covid-19 vaccination programme. Whilst the information was primarily for the covid programme, the principles around each mechanism are the same. We recommend taking a look at this document in full. It does have a useful table – image below.

The National Protocol for the administration of inactivated influenza vaccine can be seen  at National protocol for inactivated influenza vaccine – GOV.UK (www.gov.uk)

Both the LAIV PGD template and the Inactivated Intramuscular Influenza PGD template will be made available on the NHS England webpages at: –

PGDs Hants, IOW & SurreyNHS England — South East » South East Patient Group Direction downloads

PGDs BSW & Dorsethttps://www.england.nhs.uk/south/info-professional/pgd/south-west/downloads/

Written Instructions for peer to peer vaccination can be seen on the SPS website.

See also:- SPS Specialist Pharmacy Service – An introduction to PGDs: definitions and examples of use

Please also refer to the advice on our Wessex LMCs webpage re the use of PGDs & PSDs.

Of note – Based on recent evidence from the United States, guidance has changed and Shingrix can now be given at the same time as adjuvanted quadrivalent Influenza vaccine (aQIV). Both the Shingles Green Book chapter and Shingles Healthcare Practitioner guidance have been updated to reflect this.

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7.1.1 Authorising Signature

We have been informed by the Specialist Pharmacy Service (SPS) this can be a GP, NMP, Clinical Manager, Practice Manager or other person who is signing to say they are assured the healthcare professional acting under the PGD is appropriately trained and competent to do so.

7.1.2 PSDs

PSD for “group” administration e.g. flu vaccines

We do have to be mindful of the guidance around PGDs & PSDs and ensure we fulfil the recommendations. Note, whilst we are making reference to PSDs, the national protocol may also be useful to use in particular at a large vaccination site.

What is a PSD?

“A written and authorised instruction to administer a medicine to a list of individually named patients where each patient on the list has been individually assessed by that prescriber. The prescriber must have adequate knowledge of the patient’s health and be satisfied that the medicine to be administered serves the individual needs of each patient on that list.

A written instruction applying to a group of patients where the patient/s are not individually identified i.e. a PSD should not state ‘All patients attending the practice’s ‘flu vaccine clinic on date dd/mm/yyyy’. To be a PSD it needs to be a list of all named patients due to attend the clinic who have been individually assessed by the prescriber as suitable for treatment and be signed and dated by a prescriber (this does not need to be completed for each entry but can be once for the entire list).

See SPS.nhs.uk

“Group PSD”

This is a link to a Group PSD on our website, adapted from one written by Diane Coulthard who is an excellent trainer in vaccinations and immunisations. You could adapt this in your practice to allow HCAs and staff not directly employed by the practice and who are not non-medical prescribers e.g. paramedics/pharmacists to administer flu vaccines.

In addition, we would recommend that the following needs to be put in place :-

  • The PSD must clearly identify which flu vaccine is to be administered under this specific PSD as there should be a separate PSD for each vaccine. This may require practices organising separate clinics for administration of each vaccine.
  • The person signing the PSD must be satisfied that they are not aware of any contraindications to the patients on the list receiving the stated vaccine, as they are taking responsibility for making the clinical decision.
  • The person signing the PSD must be confident that they are signing that the person administering the vaccine is competent, has received training in administering the flu vaccines, is aware of the cold chain policy, clinically supervised and has attended annual up to date training around basic life support, management of anaphylaxis and use of the defibrillator.
  • There should be a record in the patient’s notes that the vaccine has been administered via a PSD. You would benefit from speaking to your IT person to add in a short cut key or read code.
  • The printed list of patients under the PSD should be retained for at least 2 years and preferably stored electronically.
  • As with all vaccines the patients name, DOB, type of vaccine, expiry date, vaccine code, method of immunisation and site of injection should be recorded in the patients notes together with patients consent to administration.

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7.1.3 PGDs use in Primary Care Networks

Questions have been asked as to how Patient Groups Directions (PGDs) can be used across PCNs.

The Specialist Pharmacy Service (SPS) have very helpfully published details on this.

Where such use of a PGD across a PCN occurs the PCN should ensure that any agreement is written within a Memorandum of Understanding (MOU), Service Level Agreement (SLA) or similar, agreed to by all PCN member practices and approved by the clinical governance group of the PCN.

Such agreements may be made on a service-by-service basis or as a single overarching agreement to cover all combined services where PGD medicines are involved.  Where PCN wide services are being offered consideration should be given to responsibility for stock ordering, storage and any required transportation of stock and disposal including ensuring compliance with Wholesaler Dealer legislation.

In addition to the factors outlined above the MOU/SLA or similar should include aspects such as agreed training requirements, record keeping and incident reporting.  Any financial aspects and how any practice leaving a PCN is managed should also be considered and included in a MOU/SLA or similar document.

Many of the principles involved are included in the PGDs in Complex Commissioning Scenarios Q&A. This Q&A should be referred to if PGDs are being used by a service the PCN has commissioned from an external provider (e.g. a physiotherapy service being commissioned by a PCN from an acute Trust

Example in practice

All the practices within a PCN wish to develop a single Musculoskeletal Service (MSK) clinic within one of the PCN member practices.  One of the service’s provisions will be the administration of intra articular injections to patients registered with practices within the PCN.  The clinic is run by a registered physiotherapist employed by one of the member practices on behalf of the whole PCN. 

  • Which PGD is to be used?

The MSK service will need to produce or adopt a PGD for the administration of an intra articular injection, with the agreement of the ICB, who will be commissioning the service and who will be responsible for authorising the PGD.  The PGD will need to meet all the legal and good practice requirements outlined in the NICE guidance.

  • Who can operate under the PGDs and how are staff authorised to operate under the PGDs?

The physiotherapist who will administer the intra articular injections within the clinic must be authorised as competent to operate under the locally approved PGD.  This authorisation must be undertaken by the employing practice.   The employing practice will be responsible for any educational and training requirements and to ensure that appropriate indemnity insurance is in place. 

Currently Nursing Associates, Physician Associates and HCAs cannot operate under a PGD. (SPS 2021)

  • Does there need to be a formal agreement between the PCN practices for this to take place?

A MOU, SLA or similar should be in place between the practices detailing the arrangements that have been agreed This should include those points outlined above and state that a registered Health Care Practitioner authorised and legally able to operate under a PGD within one practice within the PCN can also operate under that same PGD when managing patients registered with other practices within the PCN for the purpose set out in the MOU/SLA or similar.

Additionally, this should include details of how records will be maintained, any incidents recorded and how stock will be requisitioned/funded, stored, and if required monitored and disposed of, as should any additional financial aspects and staff indemnity cover.

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7.1.4 Registered Nurses Employed by a Care/Nursing Home & PGDS

Care homes cannot operate under a GP practice’s PGDs within the legislation, therefore they will need to work under a PSD – there is further information within the linked SPS Q&A (it applies to Tamiflu but the principles apply).

A practice nurse could administer the flu vaccination to residents under a PGD who are registered with their practice.

7.2 Recording Information

Practices are required to record ethnicity status for those patients if it is not already recorded in their record.

Wherever possible the use of macros/hotkeys is advisable. This can save time and maintain accuracy. There is a variety of software that can facilitate setting up macros, check with your system suppliers which ones they allow.

Ardens have instructions on how to set up a vaccination and immunisation templates at:-

Vaccination Template : Ardens

Adult Immunisations Template : Ardens EMIS Web

If the practice is using lists of named individuals that are reviewed in advance by a clinician, signed and authorised as a written instruction to administer the vaccine, then we strongly recommend that the practice scan and keep a copy of the written documentation in the practice records that the HCP has used as the instruction to administer.

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7.2.1 Use of Administrators

It should be noted that in using a PGD, no element of the process can be delegated. However, the national protocol does allow for this, and we would suggest that this be used should there be a need to delegate any tasks for the clinics.

To be clear, if an HCP is working under a PGD, then there can be no delegation to any part of the process including documentation.

However, SPS have advised that when using a PSD

The prescriber is responsible for all delegated tasks whether these are delegated to one individual or several – the prescriber should be assured that all those tasks delegated to are appropriately trained and competent.  If the tasks are separated then there should be a clear and agreed standard process/procedure in place and this should follow all relevant record keeping policy and procedures/national guidance such as that from the GMC (‘Keep clear, accurate and legible records/Make records at the time the events happen, or as soon as possible afterwards.’)

It needs noting that if an administrator is inputting data from the documentation (under a PSD), then they should be doing so with their own smartcard. However, it is equally important for audit trail purposes that the data is accurate. As such the name of the HCP administering the vaccine should be recorded. There is usually an option in a dropdown box for this. It is recommended that all staff are fully trained and aware of how to record this information. To aid accuracy and as previously suggested we would further suggest wherever possible the use of macros or pre-programmed shortcut keys.

It is strongly recommended that the practice scan and keep a copy of all the written documentation/instruction in the practice records that the administrator has used to input the data from.

We think that it is worth reminding all staff about the use of Smartcards.

 NHS Digital “smartcards and access controls” says: –

 

Security and Confidentiality

All staff issued with an NHS smartcard have a duty to keep patient information secure and confidential at all times.  Any access to patient data is auditable and traceable back to the holder of a smartcard.  Smartcards should, therefore, be treated the same as a credit or debit card.  Passcodes should never be shared and should be kept safe and secure.

Smartcard holders must follow these simple rules:

  • Never allow anyone else to use your smartcard.
  • Never leave your smartcard unattended.
  • Never leave your smartcard in a smartcard reader when you are not using it.
  • Always keep your smartcard in a safe and secure place when not in use.
  • Any lost, stolen or damaged smartcards must be reported immediately to the local RA team or local smartcard administrator.

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7.3 How is the injectable flu vaccine given?
  • inactivated flu vaccines should be given intramuscularly into the upper arm (deltoid muscle) of those aged 12 months or older and into the anterolateral aspect of the thigh in infants aged six months to one year of age
  • inactivated and live flu vaccines can be given at the same time as, or at any interval before or after, other currently used live and inactivated vaccines. (Green Book)
  • Based on recent evidence from the United States, guidance has changed and Shingrix can now be given at the same time as adjuvanted quadrivalent Influenza vaccine (aQIV). Both the Shingles Green Book chapter and Shingles Healthcare Practitioner guidance have been updated to reflect this. However, Shingrix should be offered all year round to the eligible cohort rather than just a seasonal offering.
  • if any new vaccines are introduced during the flu vaccination season, please ensure any specific guidance given about concomitant administration for these is followed.
  • if given at the same time, different vaccines should be given at separate sites, preferably in a different limb. If given in the same limb, they should be given at least 2.5cm apart. Because of the increased risk of local reaction following aQIV, this vaccine should be administered in a separate limb to any other vaccines that need to be given at the same time.
  • due to the presence of adjuvant and therefore increased potential for more local reactions if administered by subcutaneous injection, aQIV should only be administered intramuscularly using a 25mm length needle.
  • The SmPCs provide further guidance on administration and are available from the electronic medicine’s compendium website: medicines.org.uk

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7.4 Can you give the vaccine subcutaneously?
  • The cell-based quadrivalent vaccines (QIVc and QIVr) and adjuvanted quadrivalent vaccine (aQIV) are not licensed for subcutaneous administration so should only be administered intramuscularly. If these vaccines are given subcutaneously in error, they do not need to be repeated but the vaccinated individual should be warned of the increased risk of local reactions at the injection site.

NOTE– we advise that for each individual vaccine, the SmPC and PGD is checked for guidance on license and use. More info on anticoagulants and bleeding disorders can be found in the chapter 19 of the Green Book (pg.13)

7.5 Can the flu vaccine (LAIV) be given with other vaccines?

It was previously recommended that, where vaccines cannot be administered simultaneously, a four-week interval should be observed between live viral vaccines. This advice has now been updated and The Green Book, Chapter 11 – “Intervals between vaccines” states that doses of inactivated vaccines can also be given at any interval before, after, or at the same time as a live vaccine and vice versa. Please check the Green Book for full details, if unsure.

7.5.1 Can the flu vaccine (aQIV) be given with Shingrix?

Based on recent evidence from the United States, guidance has changed and Shingrix can now be given at the same time as adjuvanted quadrivalent Influenza vaccine (aQIV). Both the Shingles Green Book chapter and Shingles Healthcare Practitioner guidance have been updated to reflect this.

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7.6 Coding and Recording

NHS Digital publish the 23/24 business rules for the seasonal influenza programme.

It’s important to remember that a patient record needs two pieces of information for a claim. Both an “eligibility” as well as a “flu given” code. A patient may be eligible by their age e.g. over 65 or be in an “at risk” group. If they are in an “at risk” group, they will need to have a suitable code that identifies them as such.

N.B We are aware that Multiple Sclerosis, which is an “at risk” group is not included in the business rules. As such practices will need to search locally for these patients for call/recall and also code as “Flu needed” and “Flu given” to ensure payment. We would suggest practices check each month that they are paid for these and if not make a manual claim at the next available opportunity to ensure it is within time limits.

The Influenza Snomed codes can be found at the Primary Care Domain – reference sets You can use the filters to select a specific group of codes as below.

Systems 

There has been confusion around which system can or should be used for recording vaccinations within a PCN Grouping. Following feedback from practices, NHSE are updating the 2023/24 seasonal flu ES specification to amend the recording requirements for synergistically delivered flu vaccinations by PCN groupings (i.e. flu only clinics run by a PCN grouping).

A PCN grouping’s constituent practices will now be able to elect to record flu only vaccination events in either their GP IT clinical system or their PCN grouping’s point of care system (PoC).

The system to be used must be agreed and adopted by all practices in the PCN grouping to reduce the burden of post payment verification work to address any duplicate recordings and payments.

The position with regards to the following has not changed:

  • PCN groupings that co-administer flu and COVID-19 vaccinations must still record their flu (and COVID-19) vaccination events in a PoC system.
  • Individual practices must continue to use their GP IT system for practice delivered flu vaccinations or Flu only collaborations, under an Influenza Collaboration Agreement.

PharmOutcomes

We understand that pharmacists will record vaccinations given on PharmOutcomes. For each vaccination, their system will automatically generate a notification in line with the NHS England National Service Specification. This will be sent to the patient’s GP Practice, from where the data can be saved to the patient medical record. We understand that all notifications will include relevant SNOMED codes. If this isn’t possible or set up, then the pharmacy will be prompted to send a hardcopy printout to the practice for manual entry.

Please note that the way that notifications are fed into GP systems is determined by the GP system supplier. GP Practice teams should contact their system supplier for information message management within their systems.

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8. Administration and Achievement

8.1 Vaccine Uptake Ambition

Whilst vaccination rates were generally higher last year than those of pre pandemic times, the rate had dropped from 21/22.  UKHSA want to build on the momentum gained during the pandemic and in particular improve uptake in children aged 2-3 years old and pregnant women.

The aim of the 2023 to 2024 flu programme is to:

  1. demonstrate a 100% offer to all those eligible
  2. aim to equal or exceed the uptake levels of 2022-2023 particularly in clinical risk groups, children aged 2 and 3 years old, and pregnant women.
  3. Providers should also ensure they have robust plans in place for tackling health inequalities for all underserved groups.
Eligible Cohort 2022 – 2023 vaccine uptake (provisional data) 2021 -2022 vaccine uptake
Aged 65 years and over 79.9% 82.3%
In clinical “at risk” group 49.1% 52.9%
Pregnant Women 35% 37.9%
Aged 2 years old 42.3% 48.7%
Aged 3 years old 45.1% 51.4%
Frontline healthcare workers 49.9% 61.4%

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8.2 Claiming for vaccines and other funding

Subject to compliance with this ES, a payment of £10.06 shall be payable to the Practice for the administration of each influenza vaccination to patients.

Practices may also claim a dispensing fee (as set out in paragraph 16(2) and 16(3) of the NHS General Medical Services Statement of Financial Entitlements Direction 2023) for influenza vaccinations administered to patients. Where any vaccine is centrally supplied, no claim for reimbursement of vaccine costs or personal administration fee apply to those vaccinations delivered to patients.

Payment will be £10.06 for each vaccine administered and claiming will be via CQRS.

Please see the following: –

Of note, it does say that practices must validate and submit a claim to the Commissioner (NHSE) for payment within 3 months of the date of the administration of the completing dose of the vaccine. We would suggest checking claims on a monthly basis to ensure none are missed.

Similar to last year’s flu season, 2023/24 flu vaccine reimbursement claims are expected to be reviewed. This means you might get asked to submit information to support your reimbursement claims. Throughout the flu season you should keep records of the vaccines you order, receive and administer. These records are important to enable accurate and timely submission of reimbursement claims. In particular this year, if you administer vaccines in September, we recommend keeping a system audit trail and evidence of firm commitments to run clinics in September e.g. staff rotas, vaccine delivery and storage arrangements, room bookings etc.

For those working in PCN Groupings, NHSE have also published on FutureNHS platform, Financial and Payment Guidance for both Covid-19 and Seasonal Influenza 2023/24. We would strongly recommend checking this document in detail.

Don’t forget there is also funding available within the PCN DES under the IIF. Note that the LTs (lower thresholds) for achievement have increased from last year, however the points available have also been raised and are as follows:-

Indicator Thresholds Valuation Data source
VI-02: Percentage of aged 18 to 64 years in a clinical at risk* group who received a seasonal influenza vaccination between 1 September 2023 and 31 March 2024 72% (LT), 90% (UT 113 pts GPES
VI-03: Percentage of children aged two or three years on 31 August 2023 who received a seasonal influenza vaccination between 1 September 2023 and 31 March 2024 64% (LT), 82% (UT) 20 pts GPES
* Includes the following at-risk groups eligible for a free influenza vaccination: Chronic respiratory disease; Chronic heart disease; chronic kidney disease; Chronic liver disease; Chronic neurological disease; Learning disabilities (as captured by being on the QOF Learning Disability register); Diabetes; Immunosuppression; Asplenia or dysfunction of the spleen; Morbidly obese; People in long stay residential or homes. Excluding the following at-risk groups eligible for a free influenza vaccination, on the basis that membership of these groups is not reliably recorded in GP systems: Pregnant women; Household contact of immunocompromised individual; Household contact of person on NHS shielded patient list; Social care worker; Hospice worker.

 

8.3 Centrally procured vaccine stock

NHSE have said that there is no centrally procured stock for the 2023/24 season’s eligible adults.

Vaccine stock for the children’s programme will be available via ImmForm, this includes the injectable cell- based Quadrivalent Influenza vaccine (QIVc) for healthy children whose parents object to the Live Attenuated Influenza Vaccine (LAIV, nasal vaccine) on the grounds of porcine gelatine content. Note that QIVe is not being supplied by UKHSA via its ImmForm website.

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9. FAQs

See also “Flu vaccination programme 2023 to 2024: information for healthcare practitioners”, that includes a list on common issues.

9.1 What about vaccination of patients taking anticoagulants or with a bleeding disorder?

Individuals on stable anticoagulation therapy, including individuals on warfarin who are up to date with their scheduled International Normalised Ratio (INR) testing and whose latest INR was below the upper threshold of their therapeutic range, can receive intramuscular vaccination. The cell-based quadrivalent vaccines (QIVc and QIVr) and adjuvanted quadrivalent vaccine (aQIV) are not licensed for subcutaneous administration so should only be administered intramuscularly. If these vaccines are given subcutaneously in error, they do not need to be repeated but the vaccinated individual should be warned of the increased risk of local reactions at the injection site.

A fine needle (equal to 23 gauge or finer calibre such as 25 gauge) should be used for the vaccination, followed by firm pressure applied to the site (without rubbing) for at least 2 minutes, and the individual, parent, carer should be informed about the risk of haematoma from the injection. If in any doubt, consult with the clinician responsible for prescribing or monitoring the individual’s anticoagulant therapy.

Individuals with bleeding disorders may be vaccinated intramuscularly if, in the opinion of a doctor familiar with the individual’s bleeding risk, vaccines or similar small volume intramuscular injections can be administered with reasonable safety by this route. (Green Book– chapter 19 – pg13)

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9.2 What if you are unsure if a patient has already had a flu vaccination?

If there is nothing documented, then the patient should be offered a flu vaccination. An additional dose is unlikely to cause them any harm. Any adverse reactions are likely to be similar to any other person receiving one dose of the vaccine, such as local redness and/or pain at the injection site and malaise. The patient must be informed and consent to this procedure and be made aware of possible adverse reactions.

9.3 What about patients who have recently been diagnosed with the flu?

These patients should be offered the vaccine. Both the inactivated flu vaccine and the LAIV can be given at any time following recovery providing there are no contraindications to vaccination and the patient is not acutely unwell.

9.4 Pregnancy

Can all pregnant women have a flu vaccine?

All pregnant women, including those who become pregnant during the flu season, should be offered an inactivated quadrivalent influenza vaccine, regardless of their stage of pregnancy. The vaccines recommended for use in pregnancy are QIVc or QIVr. (If neither of these vaccines are available, QIVe can be used). The Green Book – chapter 19 can also be referred to.

Studies have demonstrated that infants also receive some protection from maternal antibodies as a result of their mother having the vaccination whilst pregnant.

The vaccine can be provided by the GP surgery, pharmacies and in some regions the maternity services. Where maternity providers or pharmacies provide the influenza vaccine, it is important that the patient’s GP practice is informed in a timely manner (within 48 hours) so their records can be updated accordingly and included in vaccine uptake data collections.

Can the flu vaccine be given at the same time as other vaccines in pregnancy?

Both the flu vaccine and whooping cough vaccine are inactive and therefore can be given together as can anti-D immunoglobulin. Covid-19 vaccine can also be given at the same time as the flu vaccine. See NHS.uk Vaccinations in Pregnancy.

Can breast feeding women have the flu vaccine? Breast-feeding is not a clinical indication for influenza vaccination. However, inactivated flu vaccine can be given to breast-feeding women if they are pregnant or in a clinical risk group.

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9.5 Does a GP have to be on the premises when the flu clinic is running?

The short answer is No, but beware.

The GP should be aware that if they delegate flu vaccinations, they are still responsible for patients’ overall care. They must ensure the healthcare professional administering the flu vaccines has the relevant knowledge, skills and experience to carry out the procedure and be able to deal with a potential emergency or life-threatening event.

Practice Nurses and registered health care professionals should only work within their levels of competence, we would suggest that if they have access to a GP, which could be by phone, this should be sufficient. HCAs and unregistered professionals are advised to have direct access to a registered health care professional on site.

You do need to ensure someone else is also available who can provide assistance if there was a medical emergency i.e. Basic Life Support (BLS) trained, all staff should have evidence of undertaken annual training.

9.6 Can HCAs work alone without direct supervision/access to a registered professional?

HCAs and unregistered professionals are advised to have direct access to a registered health care professional on site.

This is a response from the RCN on this issue:

Our view is that there should be a registered nurse available on site. The rationale for this is that the HCSW should not be in a position where they might need to make or take a clinical decision. You could have a HCSW going into a care home with a registered nurse and vaccinating the residents, they would have the RN available to support on site but being in a patient’s home on their own with more remote support, we would not recommend.” Sept 17th, 2020.

As an employer you are advised to ensure that all staff included HCAs have attended recent training in vaccs/imms and BLS and truly understand the processes involved and can manage and escalate a situation should it arise.

Requires Login Login | Royal College of Nursing (rcn.org.uk)

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9.7 Accountability & Delegation

The trained nurse, GP or another qualified healthcare professional may delegate a task/role to other colleagues including HCAs but should ensure, if delegation takes place, that: –

  • the person who has been delegated a task has received appropriate training and can provide evidence of competency.
  • are supervised.
  • has appropriate indemnification.
  • receives regular training/updates and support.
  • has an up-to-date job description.

Registered nurses have a duty of care and a legal liability to their patients. Every registered nurse must adhere to the NMC code and work within their scope of practice. Please see below some useful links:

Wessex LMCs – Accountability & Delegation

RCN – Professional Development

GMC – Ethical Guidance for Doctors (Delegation & referral)

9.8 Staff Training

UKHSA have updated their guidance on flu immunisation training to support healthcare professionals for the 23/24 influenza season.

There are some useful and important resources on the UKHSA link above and in particular a table showing their recommended training requirements by workforce group for flu vaccination. Download a full copy here.

  • UKHSA also publish recommended training requirements for Covid-19 vaccination administration.
  • Don’t forget to check our Wessex LMCs training events as well as lunch & learns available here.
  • E-learning for health (e-lfh) also have online training available this year for flu immunisations.
  • UKHSA have produced a ” A Flu vaccinator competency training tool “. This can be used as a self-assessment tool, an assessment tool for use with a supervisor or both depending on the previous experience of the vaccinator.

Training Standards

We are often asked about HCA training requirements for immunisation training and in particular that they must have an NVQ level 3 or equivalent qualification to enable them to be able to give flu vaccinations.

There has, for a number of years, been the recommendation for HSCW to have NVQ level 3 or equivalent qualification to enable them to be able to give flu vaccinations, we believe that this is based on the HCSW Training Standards document 2015  and states on page 6 that:

“It is recommended that only HCSWs who have achieved education and training to Level Three of the Qualifications and Credit Framework (QCF)4 or equivalent in England and Wales with at least 2 years’ experience as a HCSW should be considered for training in vaccine administration”.

Please note this is national guidance and is a recommendation only, therefore the responsibility lies ultimately with the practice to make sure you keep patients and staff safe.

Fundamentally it is important that if anything untoward happened in your practice, the Partners could stand in front of a Coroner or Judge and justify that the training they had provided for their staff was sufficient to ensure they were competent, and confident to undertake the task given to them.

HCAs who are trained and deemed competent can play a key role in the flu vaccine programme. Wessex LMCs: HCA Training Standards

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9.9 Practice Staff

The seasonal flu enhanced service specification includes the provision under eligible cohorts to allow for:-

9.2.10 vaccinating frontline patient-facing staff working in general practice.

This inclusion allows practices to fulfil their occupational health responsibility in regard to this activity, and within the provision of the Clinical Negligence Scheme for General Practice (CNSGP).

It is important to note that whilst this now means that practices are indemnified to vaccinate their staff, themselves, practices will not receive reimbursement of either the IOS fee or vaccine costs.

As this does still remain an occupational health activity, then the PGD will not be appropriate for this purpose and practices will likely want to use the Written Instructions provided by Specialist Pharmacy Service (SPS)

We would like to highlight the following clauses in the enhanced service for this activity: –

9.19. Practices may vaccinate those Patients in paragraph 9.2.10 to meet their practice requirement to offer, as part of the Practice’s employer responsibilities, where the Patient is either included in the Practice’s list of registered patients or is an unregistered patient or whose name is included on another primary medical services practice’s list of registered patients but has chosen to receive their influenza vaccination from the Practice.

9.20. Where a Practice administers an influenza vaccination in accordance with paragraph 9.19 the Practice will not be eligible for any payment in accordance with paragraph 11. Practices are not eligible for the reimbursement for the cost of the influenza vaccine administered to eligible frontline patient-facing staff and shall not claim for reimbursement of vaccine costs or personal administration fees relevant to these vaccinations.

The specification also advises the following for those staff who are not on the practice list of registered patients: –

9.21.2. the Practice must retain a record of the vaccination and where the Patient’s name does not appear on their own Practice’s list of registered patients, remind the Patient that they should inform the practice on whose list of registered patients on which their name appears, that they have received the vaccination from the Practice. This Practice record shall include the details at paragraph 10.2.

10.2. Practices must adhere to defined standards of record keeping ensuring that the influenza vaccination event is recorded in the medical record of the Patient on the same day that it is administered and shall include:

10.2.1. any refusal of an offer of an influenza vaccination; and

10.2.2. where an offer of influenza vaccination was accepted:

(a) details of the informed consent to the influenza vaccination (including persons that have consented on the Patient’s behalf and that person’s relationship to the Patient must also be recorded);

(b) the batch number, expiry date and title of the vaccine;

(c) the date of administration of the influenza vaccination;

(d) when two or more vaccines are administered in close succession the route of administration and the injection site of each vaccine;

(e) any contra-indication to the influenza vaccination or immunisation;

(f) any adverse reactions to the influenza vaccination; and

(g) record within the Patient record any influenza vaccinations that have been administered using centrally supplied stock if this stock has been supplied.

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10.Useful Websites / Resources

  1. Annual Flu letter & Statement of amendment to the annual flu letter for 2023 to 2024
  2. NHSE Accelerated Winter Vaccination Programme letter 8.23
  3. NHSE Letter – Autumn/Winter 2023-24 flu and COVID-19 seasonal campaign
  4. Flu vaccines 2023-2024 season
  5. Annual Flu Programme plan
  6. Flu vaccination: letter template for at risk patients and carers
  7. Flu vaccination: letter template for children aged 2 and 3 years
  8. The national flu immunisation programme for 2022/23 slide-set
  9. NHSE Enhanced Service Specifications (Adults) 23/24
  10. NHSE Enhanced Service Specification (Children) 23/24
  11. Enhanced Service 23/24 Additional Guidance on recording of influenza vaccination events, payments and collaboration.
  12. Enhanced service seasonal influenza vaccination collaboration agreement
  13. PCN Grouping Financial and Payment Guidance
  14. NHSE Covid-19 Enhanced Service Specification 23/24
  15. The Green Book – Chapter 19 Influenza
  16. UKHSA Flu vaccination programme 23/24: information for healthcare practitioners
  17. Flu vaccination for children: leaflets and posters
  18. UKHSA Patient Resource – Who should have the Flu vaccination and Why
  19. UKHSA -Flu immunisation training recommendations
  20. Wessex LMCs training
  21. e-lfh – Flu Immunisation training
  22. Influenza vaccines: ovalbumin content
  23. Flu vaccination for children: leaflets and posters
  24. Flu vaccine for children: best practice guide for GPs
  25. SPS Specialist Pharmacy Service – The First Stop for Professional Medicines Advice
  26. SPS Written Instruction for the administration of seasonal ‘flu vaccination to staff
  27. Flu vaccination: easy read flu resources for those with learning disabilities
  28. Flu vaccinations: supporting people with learning disabilities
  29. Learning Disabilities – Reasonable adjustments
  30. Various excellent resources for Flu and LD Patients – With thanks to Leeds LD Service
  31. NHS the flu Vaccine overview – includes who should and should not have it
  32. Vaccines and porcine gelatine Leaflet describing how and why porcine gelatine is used in vaccines for immunisation programmes.
  33. British Islamic Medical Association – Flu Guidance 2023
  34. Muslim Council of Britain – Info and resources from 20/21 but much is still relevant and helpful to this year’s campaign

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Last Reviewed Date
14/12/2023