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Flu jab priority groups won't be ‘patient-friendly’, pharmacists warn

PSNC: The two vaccines for the main patient groups will increase the flu service's effectiveness
PSNC: The two vaccines for the main patient groups will increase the flu service's effectiveness

Guidance to prioritise older patients for flu vaccination will be difficult for pharmacies to deliver in a “patient-friendly way”, community pharmacists have warned.

In national guidance issued jointly by NHS England, the Pharmaceutical Services Negotiating Committee (PSNC) and the British Medical Association, pharmacy teams and general practices are advised to take a “three-phased prioritisation approach” to vaccinating patients aged over 65.

The guidance states that for the 2018-19 flu vaccination season, the adjuvanted trivalent influenza vaccine – the Fluad vaccine, manufactured by Seqirus – should be offered to all patients aged 65 and over.

Priority should be given to patients aged over 75 years or those in a care home, followed by those aged 65-74 years in a clinical risk group, then other patients aged between 65 and 74 (see below).

Challenges “need to be planned for”

But PSNC also said “where the appropriate vaccine is available, and an eligible patient presents at the pharmacy seeking vaccination, they should be vaccinated at that point”.

PSNC director of NHS services, Alastair Buxton, said: “The use of specific vaccines for the two main patient groups should ensure the impact for patients and the NHS of the 2018-19 vaccination service is greater than in recent years.

“The phased delivery of [the trivalent vaccine] will however present logistical challenges which need to be planned for,” he added.

Community pharmacists warned that the guidance, coupled with rationed deliveries of the Fluad vaccine – which England said in a letter published this month (August 2) will be limited to pharmacies in tranches of 40% in September, 20% in October, and 40% in November – would make this year’s pharmacy flu service difficult to deliver.

Rekha Shah, immunisation local pharmaceutical committee (LPC) lead for London, said the real advantage of pharmacy flu vaccination was that it was largely a walk-in service.

“LPCs across the country will need to provide additional guidance to pharmacies to supplement [the guidance and] ensure there is no confusion and each pharmacy team knows what they need to do,” she told C+D.

“There are bound to be many practical issues that need to be addressed and managed by pharmacy teams, with stock arriving in a phased manner, and patient demand growing as people realise they may be turned away this year.

“Those that are in the lower priority [groups] might have to be left until sometime in November, or even as late as December, and the risk is that they leave it and don’t get the jab at all.”

“Hard to see how it will work”

Nat Mitchell, pharmacist and director of JWW Allison & Sons Ltd in Cockermouth, Cumbria, said phased deliveries would cause his pharmacy a lot of problems, as last year they had already done “60 to 70%” of their vaccinations by the end of October.

“It is hard to see how it will work,” he told C+D. “Last year we had done 800 [flu vaccinations] by the end of September. It is going to be very hard to explain what’s happening to patients.”

Pharmacists who offer a walk-in service face a big financial risk in having the right amount of vaccine at the right time, he added.

Hitesh Patel, chief officer at City and Hackney LPC, said: “This is going to be really difficult for our contractors. I really cannot see a patient-friendly way of carrying out this guidance.”

However, Sadik Al-Hassan, pharmacist manager at Well Pharmacy in Kingswood, Bristol, said pharmacists would heed the advice not to turn away eligible patients and rise to the challenge.

“The biggest risk I could see would be if phasing puts off some pharmacies from pursuing [trivalent] vaccinations in favour of quadrivalent only,” he said.

What does PSNC advise pharmacies to do?

The guidance sets out a three-phased prioritisation approach to vaccinating patients aged 65 years and over:

  • First priority should be given to those aged 75 years and over or those in a care home
  • Second priority should be given to those aged 65-74 years in a clinical risk group
  • Third priority should be given to those aged 65-74 years not in a clinical risk group.

Community pharmacy teams should use this information to inform the provision of vaccines from September to November 2018, but where the appropriate vaccine is available, and an eligible patient presents at the pharmacy seeking vaccination, they should be vaccinated at that point.

If the recommended vaccine is not available, the patient should be asked to return when vaccine will be available.

Source: PSNC

What effect will priority groups have on your pharmacy's flu service?

A Hussain, Senior Management

To be honest in reality we'll all just have to ignore the first part of the guidance and follow the second part, where we just do what we usually do.

How High?, Community pharmacist

So as we've been advised not to turn anyone who is eligible away we will simply vaccinate on demand, run out of stock, vaccinate some more on demand when the second phase arrives, run out out of stock, vaccinate some more when the the third delivery arrives and then run out of stock. 

It's going to be hit and miss in the extreme but essentially business as usual.

A few patients will obviously miss out but I'm sure that NHS England will say it went jolly well and all the main targetted groups were covered. 

I'm more concerned that the BMA think it's a good plan, especially as 2 local surgeries phoned me last year to complain that I was "vaccinating their patients" and to "stop immediately". 

I for one am really looking forward to all the other customers complaining that their script is "taking longer than ever" and "I'm never coming back here again" etc then posting on NHS choices about how poor we are are at the one thing they actually want us to do. 


Adam Hall, Community pharmacist

Different vaccines for different groups of patients being delivered in a phasing which contractors cannot control? NHS England couldn't organise a ****-up in a brewery!

Brian AUSTEN, Administration & Support

Sounds like there is going to be an almighty cock-up due to lack of sensible planning by NHS England. Don't they understand that the 40%/20%/40% quotas will mean that some pharmacies will run out quickly and have to turn patients away. They may not come back. Then NHS England will say we cannot understand why flu vaccination uptake is below target! 

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