On 20 November 2020, the Department of Health and Social Care announced that community pharmacy contractors and general practices will be able to vaccinate 50- to 64-year-olds against flu from Tuesday 1 December 2020.
In order to improve access to NHS flu vaccination for eligible patients, NHS England and NHS Improvement has commissioned an advanced service for community pharmacies to provide flu vaccinations since 2015. The aims of the service are:
- to sustain and maximise uptake of flu vaccine in at risk groups by continuing to build the capacity of community pharmacies as an alternative to general practice
- to provide more opportunities and improve convenience for eligible patients to access flu vaccinations.
Summary of Changes for 2020/21 and Getting Started
Summary of Key Changes for 2020/21
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Key Next Steps for Contractors
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Groups Included in this Advanced Service
| Eligible Groups | Further Details |
|---|---|
| All people aged 65 years or over | Including those becoming age 65 years by 31 March 2021. |
| People aged from 18 years to less than 65 years of age with one or more serious medical condition(s) outlined below: | |
| Chronic (long-term) respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis | Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission. COPD including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). |
| Chronic heart disease, such as heart failure | Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. |
| Chronic kidney disease at stage three, four or five | Chronic kidney disease at stage three, four or five, chronic kidney failure, nephrotic syndrome, kidney transplantation. |
| Chronic liver disease | Cirrhosis, biliary atresia, chronic hepatitis. |
Chronic neurological disease, such as Parkinson’s disease or motor neurone disease or Learning disability Diabetes | 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, based on individual assessment, to clinically vulnerable individuals including those with cerebral palsy, learning disabilities, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability. Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet-controlled diabetes. |
| Immunosuppression, a weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment) | Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, bone marrow transplant, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder). Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day. 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. |
| Splenic dysfunction or asplenia | This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction. |
| Morbid obesity | Adults with a body mass index ≥40kg/m2 |
| Pregnant women (including those women who become pregnant during the flu season) | Pregnant women aged 18 or over at any stage of pregnancy (first, second or third trimesters). |
| Household contacts of those on the NHS Shielded Patient List | People who are household contacts, aged 18 and over, specifically individuals who expect to share living accommodation on most days over the winter and, therefore, for whom continuing close contact is unavoidable. |
| People living in long-stay residential care homes or other long-stay care facilities | Vaccination is recommended for people aged 18 or over living in long-stay residential care homes or other long-stay care facilities 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. For the pharmacy service this only applies to those aged 18 or over. |
| Carers | People aged 18 or over who are in receipt of a carer’s allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill. |
| Household contacts of immunocompromised individuals | People who are household contacts, aged 18 and over, of immunocompromised individuals, specifically individuals who expect to share living accommodation on most days over the winter and, therefore, for whom continuing close contact is unavoidable. |
| Social care workers | Health and social care staff, employed by a registered residential care/nursing home or registered domiciliary care provider, who are directly involved in the care of vulnerable patients/clients who are at increased risk from exposure to influenza. Vulnerable means those patients/clients in a clinical risk group for flu or who are aged 65 years and over. |
| Hospice workers | Health and care staff, employed by a voluntary managed hospice provider, who are directly involved in the care of vulnerable patients/clients who are at increased risk from exposure to influenza. Vulnerable means those patients/clients in a clinical risk group for flu or who are aged 65 years and over. |
| Workers employed through Direct Payments and/or Personal Health Budgets to deliver domiciliary care | Health and social care workers employed through Direct Payments and/or Personal Health Budgets to deliver domiciliary care to patients and service users. |
| All people aged 50–64 years of age who do not fall within another eligible group | People aged 50 to 64 years of age. Notification of the phased eligibility of individuals in this cohort will be formally announced later in the flu season. A copy of this announcement will be available at: gov.uk/government/publications/national-flu-immunisation-programme-plan These patients are not eligible to be vaccinated under this service until that announcement has been made. |
Service Specification
The service is effective from 1 September and runs to 31 March, but focus should be given to vaccinating eligible patients between 1 September and 31 January each year. Eligible patients should be vaccinated as soon as the vaccine is available.
Widespread immunisation may continue until December in order to achieve maximum impact, but where possible, should be completed before flu starts to circulate in the community.
However, flu can circulate considerably later than this and pharmacists should apply clinical judgement to assess the needs of individual patients who are eligible for vaccination under this service to receive immunisation beyond 31 January. This should take into account the level of flu-like illness in the community3 and that immune response following immunisation may take up to 14 days to achieve.
The pharmacy contractor must have a SOP in place for this service, which includes procedures to ensure cold chain integrity.
Each patient being administered a vaccine should be given a copy of the manufacturer’s patient information leaflet about the vaccine or be directed to a web-based version of the leaflet.
Prior to vaccination, consent must be sought from each patient. This consent should cover the administration of the vaccine as well as advising the patient of information sharing that will take place for the appropriate recording of the vaccination in their GP practice record. The patient should also be informed that information relating to their vaccination may be shared with NHS England and NHS Improvement. Patient consent should be recorded in the pharmacy’s clinical record for the service.
The pharmacy contractor will ensure that a notification of the vaccination is sent to the patient’s GP practice on the same day the vaccine is administered or on the following working day.
Where a patient presents with an adverse drug reaction following the initial vaccination and the pharmacist believes this is of clinical significance, such that the patient’s GP practice should be informed, this information should be shared with the GP practice as soon as possible.
Training and Premises Requirements
In order to provide the service, pharmacies must have a consultation room. Vaccinations can be offered in any area of the pharmacy where suitable facilities are available and patient confidentiality is able to be respected. However, the vaccination must take place in the consultation room wherever the patient expresses this preference.
Vaccinations under this advanced service will usually be carried out on the pharmacy premises, but they can also be undertaken in other suitable locations, such as in the patient’s home, a long-stay care home, a long-stay residential facility or community venues.
Where vaccinations are undertaken off the pharmacy premises, the pharmacy contractor must: ensure that vaccinators have professional indemnity that covers off-site vaccinations; continue to adhere to all professional standards relating to vaccinations; follow appropriate cold-chain storage measures; ensure that the setting used to administer the vaccinations is appropriate (including ensuring patient confidentiality as appropriate); appropriately dispose of any clinical waste or personal protective equipment used during the vaccination process. Additionally, where vaccinations are undertaken in the patient’s own home (including a care home), contractors must ensure that vaccinators have a valid DBS certificate.