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Lloyds restarts flu service after clarifying vaccination for over-65s

Lloydspharmacy has restarted its NHS flu service after clarifying that the quadrivalent vaccine (QIV) should not be given to patients over 65 years.

The multiple suspended its flu service yesterday (September 19) across all its branches in England and Wales “until further notice”, after it identified a “misinterpretation” of the NHS patient group direction (PGD).

Lloydspharmacy confirmed to C+D today that it restarted the service “this morning, after providing clarification on the circumstances under which a QIV should be administered to someone aged 65 and over”.

Pharmacies “misinterpreting” the service

In an email to “all pharmacy colleagues”, Lloydspharmacy’s operations team explained it had suspended the service because “we became aware some teams were misinterpreting the NHS PGD – especially with regard to availability of adjuvanted trivalent vaccine (aTIV) stock”.

Independent pharmacies have previously raised concerns with C+D about the limited supplies of the aTIV vaccine Fluad – the only vaccine NHS England has recommended for over-65-year-olds.

But Lloydspharmacy’s operations team said pharmacy teams should only offer [Fluad] to patients over 65.

“You will see that we have decided not to offer the QIV to patients who are 65 years of age and above regardless of the availability of Fluad.”

Pharmacy teams who “feel there is an immediate need to provide QIV” should contact the multiple’s professional standards team, it added in the email.

Other providers face “similar challenges”

Lloydspharmacy claimed that other flu service providers have experienced “similar challenges” and it is “pleased that our prompt action has highlighted this issue before it became widespread”.

The multiple is liaising with NHS England and Public Health England on the topic, it added. “Our strong stance in temporarily suspending our NHS service has been welcomed for putting patient safety first.”

The Pharmaceutical Services Negotiating Committee (PSNC) told C+D today that Lloydspharmacy had suspended the service “to clarify the details of this year’s flu vaccination programme with their staff”.

The negotiator highlighted its summary of aTIV guidance, with advice on “exceptional circumstances” for QIV use in over-65s, which it released on Monday (September 17) following “many queries from contractors about ordering and appropriate use of aTIV”.

Read a timeline of the issues relating to supplying Fluad this season here.

Advice on vaccinating patients aged 65 years and over

Make sure you have clinical justification

“No vaccine other than Fluad should be administered at this point in the season – except for patients with an egg allergy. Where despite this advice, a contractor seeks reimbursement for vaccine other than the recommended vaccine choice, NHS England may make enquiries to understand how the evidence of clinical efficacy of [Fluad] and QIV was considered and how the clinical judgement to use the relevant vaccines was reached.

“Where an appropriate clinical justification cannot be provided, NHS England may seek to take action against a contractor for breach of the terms of service for failing to provide the service and exercise their professional judgement consistent with standards generally accepted in the pharmaceutical profession.”

What should I do if I have administered QIV to a patient over 65?

“QIV is licensed in this age group and should provide protection against flu. For this reason, and also because the safety and effectiveness of administering aTIV shortly after QIV has not been established, no further vaccination is recommended this flu season for an individual who has inadvertently received QIV. The patient should be offered reassurance, the local screening and immunisation team should be informed and systems reviewed to prevent this happening again.”

Source: PSNC

What issues have you had with the flu vaccine this year?

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