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.