People aged 50-64 and primary care staff will no longer be eligible for a free flu jab in the 2022/23 season, NHS England and NHS Improvement (NHSE&I) wrote in a letter published on Wednesday (March 2).

As a result, community pharmacies will only be reimbursed for vaccines administered to those aged 65 years and over and at-risk adults aged 18-64.

According to data collated by the Pharmaceutical Services Negotiating Committee (PSNC), as of today (March 4), the 50-64-year-old cohort made up 46% of the patients vaccinated in community pharmacies in the 2021/22 season.

Contractors swiftly took to social media to slam NHSE&I’s decision.

  

“A few days' extra notice would have made a huge difference”

 

While contractors were aware that eligibility for free flu jabs would eventually return to “pre-pandemic” conditions, they argued that NHSE&I could have clarified its expectations for the next flu season well in advance, before pharmacies placed their final flu orders with wholesalers.

Ashley Cohen, managing director at Pharm-Assist (Healthcare) in Leeds, told C+D that contractors tend to place these orders early – between September and February – to secure stock before the start of each flu season and are “basically second guessing well in advance what vaccines are going to be used next year”.

While contractors have been able to “tweak” their orders after placing them in previous years, this year wholesalers "categorically” told contractors they must place their orders “in full amounts”, Mr Cohen claimed.

When the letter announcing a narrower pool of patients eligible for free vaccines circulated earlier this week, Mr Cohen said it felt “like the NHS actually wants you to fail”.

Pharmacist Adeel Sarwar from the Roundhay Pharmacy in Leeds said he understands COVID-19-related issues can evolve rapidly. “But a few days' extra notice would have made a huge difference for us,” he argued.

Mr Sarwar’s vaccine supplier gave the pharmacy “until the end of February to make any changes to [their] order”, he claimed. It was therefore “horrible” that NHSE&I’s letter didn't arrive until it was too late.

 

Potential for vaccines to go to waste

 

Meanwhile Nat Mitchell, pharmacist and director of JWW Allison in Cockermouth, Cumbria, told C+D that he had “no problems about [NHSE&I] changing the guidance”.

The “the timing of it”, however, “feels almost like it was done as soon as the orders [were] closed”, he added.

Mr Mitchell said he had “made requests to reduce [the pharmacy's] order” and was "waiting to hear what [the suppliers would] say”.

“If suppliers deem that the new guidance isn’t sufficient to allow us to reduce our orders without penalty, then we risk being severely out of pocket, with lots of vaccine going to waste,” he added.

 

Expectations to exceed last season’s uptake

 

NHSE&I specified that pharmacies should aim to achieve “at least the uptake levels of 2021/22 for each cohort” in the upcoming flu season in its letter earlier this week.

Pharm-Assist pharmacies administered 2,200 vaccines this past flu season, “which was fantastic”, Mr Cohen said.

He ordered 5,000 vaccines this year and will “struggle” to achieve this target, he said.

“I was almost thinking about doing more because we’ve been pushed to do more,” he added.

Meanwhile, Mr Sarwar ordered 500 vaccines, having administered 300 during the most recent flu season.

“Doing the vaccines as patients’ demand dictated” over the 2021/2022 flu season meant “we had to step up to the mark, as we kept running out and we ordered more and more and more throughout the season”, he said.

 

Will the high uptake persist?

 

NHSE&I’s decision “will massively affect our service going forward”, Mr Mitchell predicted.

He estimated that 40% of the flu vaccines Allisons Chemist administered in the most recent flu season went to 50–64-year-olds.

“From past experience, I’d estimate that about 20% of those patients would’ve previously had one privately,” he continued.

“A few more may choose to have a private jab this autumn after being introduced to flu jabs during the pandemic, but [that will be] nothing like the numbers we have administered on the NHS service,” Mr Mitchell added.

Sheffield-based Armstrong’s pharmacy owner Chris Armstrong told C+D: “With this news, it is very likely we will do 30-50% fewer vaccinations than the current season.”

NHSE&I’s announcement has also left contractors like Mr Cohen wondering “whether excess vaccines can be reimbursed” next flu season.

“I’ve now committed to 5,000 vaccines”, he continued, “so what I’ve now got to try and do is find 5,000 arms to put them in”.

“Otherwise, I could be £35,000 down,” he said. “It’s a kick in the teeth.”

“We’re already financially strained”, Mr Sarwar echoed, “and now we’re going to be left with thousands of pounds worth of stock that we’re not going to be able to use on the NHS cohorts”.

“We can provide that same vaccine to private paying patients,” he acknowledged. “But private demand isn’t as big as the NHS demand, which is free at the point of use”.

This story was updated to reflect that the cohort no longer eligible for a free flu jab in 2022/23 includes those aged 50-64, not those aged 50-65 as previously stated.