Flu Vaccination Service

The Department of Health and Social Care (DHSC), the UK Health Security Agency (UKHSA) and NHS England continue to seek to improve on the uptake rates that occurred in the 2023/24 flu season. Data from UKHSA confirmed that no group included in the adult cohorts achieved the national vaccine uptake ambitions of equivalent or higher uptake in the 2023/24 season than in 2022/23 season.

Data from 1st September 2023 to 29th February 2024 in England, indicates that the NHS vaccination services had vaccinated:

• 77.8% of those aged 65 years and over, compared to 79.9% in 2022/23. This again exceeded the World Health Organization uptake ambition of 75%;
• 41.4% of those in the under 65 years in one or more clinical risk groups, compared to 43.7% in 2022/23; and
• 32.1% of pregnant women, compared to 35% in 2022/23. This was the lowest on record for this cohort since the 2011/12 season.

The Government continues to wants the influenza programme for 2024/25 to demonstrate a 100% offer and aim to equal or improve on the 2023/24 uptake particularly in clinical risk groups and pregnant women.

The potential for co-circulation of influenza, COVID-19 and other respiratory viruses could add significant pressures in the NHS. This co-circulation could add to or prolong the overall period for which respiratory viruses circulate in sequence. Vaccination, therefore, helps the health and social care system manage winter pressures by helping to reduce demand for GP consultations and likelihood of hospitalisation.

Pharmacy owners do not have a fixed patient list from which to undertake call and recall  activities, however, pharmacy owners are encouraged to proactively offer influenza vaccination to any patient they identify as being eligible to receive it should the patient present in the pharmacy for any reason.

Immunisation is one of the most successful and cost-effective health protection interventions and is a cornerstone of public health. High immunisation rates are key to preventing the spread of infectious disease, complications and possible early death among individuals and protecting the population’s health through both individual and herd immunity.

The impact of COVID-19 on the NHS and social care continues to be felt. Those most at risk from flu are also most vulnerable to COVID-19, so, while the NHS is taking steps to prepare for an autumn COVID-19 vaccine booster campaign, flu vaccination continues to be one of the most effective interventions the NHS has to reduce pressure on the health and social care system this winter.

The aim of the seasonal influenza vaccination programme is to protect those who are most at risk of serious illness or death should they develop influenza, by offering protection against the most prevalent strains of influenza virus. Due to the combined risk from flu and COVID-19, as a sector, we must continue to do all we can to help protect those at risk of serious illness or death from the complications of influenza this winter.

Key documents

Service specification for the flu vaccination Advanced Service 2024/25 (version 2, published 2nd July 2024)
The service specification describes the requirements for provision of the service and it is essential reading for all pharmacists providing the service.

National Patient Group Direction 2024/25
The national Patient Group Direction (PGD) provides one legal mechanism for administration of flu vaccine under the service. Email england.communitypharmacy@nhs.net if you have questions about the PGD.

National protocol for inactivated influenza vaccine 2024/25
This protocol provides another legal mechanism for administration of flu vaccine under the service by appropriately trained persons in accordance with regulation 247A of the Human Medicines Regulations 2012. Email immunisation@ukhsa.gov.uk if you have questions about the national protocol.

The protocol allows provision of flu vaccinations to people aged from 6 months to under 65 years in a clinical risk group, but the pharmacy service is only for eligible patients aged 18 years and older.

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Start date of the service

Based on evidence that flu vaccine’s effectiveness can wane over time in adults, the Joint Committee on Vaccination and Immunisation (JCVI) advised moving the start of the programme for most adults to the beginning of October. This is on the understanding, that the majority of the vaccinations will be completed by the end of November, closer to the time that the flu season commonly starts.

As a result, the Annual flu letter confirmed, from 1st September 2024, pharmacies will only be able to vaccinate pregnant women, as they are the exception to the advice.

From October 2024, vaccination of the other adult cohorts will commence. This means that the following timings will apply to the commencement of the service in 2024/25, for pharmacies and general practices:

Start date	Eligible cohort
From 1st September 2024	Pregnant women
From 3rd October 2024	All other eligible adult patients

Pharmacy owners must not commence the administration of vaccinations under the Advanced service prior to the appropriate commencement dates for the appliable patient cohorts. Payment to all providers, will only be made for flu vaccinations administered from the service commencement date onwards.

Following the service commencement date, the specification notes that pharmacy owners should maximise administration of vaccine by 30th November 2024.

Read more about this change to the service requirements

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Eligible cohorts

The annual flu vaccination programme letter for the 2024/25 season confirms the eligible cohorts for the 2024/25 season and the vaccines which will be reimbursable under the Advanced Service.

The service covers those patients most at risk from influenza aged 18 years and older, with the eligible patient cohorts also being listed in Annex A of the service specification.

Vaccinators are not authorised to administer flu vaccines to other patient groups as part of the Flu Vaccination Service. If a vaccine is administered to patients in other groups, the pharmacy owner will not be paid for that vaccination and the administration will have been undertaken outside the authority of the legal mechanisms (national PGD / national protocol).

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Reimbursed vaccines

Originally, there was to be no change to the recommended vaccines that would be reimbursed for adults in the 2024/25 programme. However, on 12th June 2024, a statement of amendment to the Annual Flu letter was published.

Read the statement of amendment

This was issued, following the news from Sanofi that recombinant quadrivalent influenza vaccine (QIVr) would not be available for the 2024/25 flu vaccination programme.

The amendments to the Annual Flu letter include a new flu vaccine which can be used for the first time – high-dose quadrivalent influenza vaccine (QIV-HD) – which is only licensed for those aged 60 years and over.

Within the Annual Flu letter, the advice regarding when second line vaccines can be used has been strengthened.

The annual flu vaccination programme letter for the 2024/25 season states that use of second line vaccines should only be considered when every attempt to use first line recommended vaccines has been exhausted – evidence of this may be requested by NHS England before reimbursement is agreed.

This section contains additional information and resources to support pharmacy owners and their teams to provide the Flu Vaccination Service.

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The national Patient Group Direction
The administration of a flu vaccine – a Prescription Only Medicine (POM) – as part of the Flu Vaccination Service is legally authorised by a national PGD (or alternatively, the national protocol – see the next section).

The national PGD for the Flu Vaccination Service has been developed and clinically approved by UKHSA. NHS England has authorised its use by an appropriately trained practitioner to provide the Advanced service.

The practitioners who can legally supply and administer under the PGD are listed in the Qualifications and professional registration section of the PGD and this mirrors the groups of practitioners authorised to supply or administer medication via a PGD under current legislation. That group of professionals now includes pharmacy technicians. Any listed practitioners must only provide the service under the supervision of a pharmacist, trained in vaccinations (including a clear understanding of this service).

The PGD cannot be used to authorise administration of flu vaccines under any other NHS or private services.

Appropriately trained practitioners, who will administer flu vaccines under the authority of the national PGD must:

• Download a copy of the latest version of the PGD from the NHS England website;
• Read the PGD and ensure they fully understand its content, including the eligible patient groups, the inclusion and exclusion criteria and the record keeping requirements; and
• Print off a copy of the PGD and complete the Practitioner declaration to confirm they have read and understood the content of the PGD and that they are willing and competent to work to it within their professional code of conduct – if there is more than one practitioner in the community pharmacy or working with the community pharmacy who will be providing the Flu Vaccination Service, one copy of the PGD can be printed and all practitioners can complete the practitioner declaration on this one copy.

The Authorising Manager declaration must then be completed. The Authorising Manager’s role is to confirm the practitioner(s):

• Is/are aware of the service specification and requirements for provision of the service;
• Have demonstrated their competence to provide the service; and
• Has/have the organisation’s approval to provide the service.

In certain circumstances, for example, a community pharmacy where the pharmacist who will administer vaccines is also the superintendent pharmacist or pharmacy owner, it may be necessary for the authorising manager to be the same person as the practitioner, though this situation should be avoided wherever possible.

These steps must be completed before an individual practitioner is authorised to administer flu vaccines as part of the service.

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The national protocol

A national protocol is a legal mechanism for the supply or administration of POMs, which was put in place following amendment of the Human Medicines Regulations during the COVID-19 pandemic. They were originally only intended to be used during a pandemic, but that approach has now been amended, so they can continue to be used outside of pandemic periods.

The protocol allows those who are registered healthcare professionals who cannot operate under a PGD, and those who are not registered healthcare professionals, in the context of the Flu Vaccination Service, to safely administer a licensed influenza vaccine. The protocols for vaccines are developed by UKHSA and are very similar to a PGD.

The protocol provides the flexibility to define the training and competence requirements of vaccinators. It also allows the process of administration to be split into its component parts, i.e. clinical assessment and consent, preparation of the vaccine (not required for flu vaccine) and administration of the vaccine. This allows wider use of workforce skill mix to support the provision of the vaccination service. All these stages can be done by one competent person (the registered healthcare professional), but these tasks can also be split with each person trained and authorised to complete their specific task as defined in the protocol. The clinical assessment and consent process must be undertaken by a registered healthcare professional.

The choice of whether to operate under a protocol is the decision of the pharmacy owner. Pharmacy owners using the national protocol are responsible for ensuring:

• Those persons involved in the service or elements of the service are trained and competent to safely provide the activity they are employed to provide under the protocol;
• As a minimum, competence requirements stipulated in the protocol under Characteristics of staff must be adhered to;
• They and registered healthcare professionals have adequate and appropriate indemnity cover;
• Persons must be authorised by name to work under the protocol;
• The staff characteristics for the activity being undertaken are met;
• Practitioners make a declaration of competence and are authorised in writing. This can be done by completing Section 4 of the protocol or maintaining an equivalent electronic record;
• A clinical supervisor, who must be a pharmacist, must be present and take overall responsibility for provision of vaccination under the protocol at all times and be identifiable to service users; and
• Any time the protocol is used, the name of the clinical supervisor taking responsibility and all the people working under different stages of the protocol must be recorded for the session.

The clinical supervisor has ultimate responsibility for safe care being provided under the terms of the protocol. Staff working under the protocol may be supported by additional registered healthcare professionals, but the clinical supervisor retains overall responsibility. Staff working to the protocol must know who the clinical supervisor is at any time and only proceed with their
authority. The clinical supervisor may withdraw this authority for all members of staff or individual members of staff at any time and has authority to stop and start service provision under the protocol as necessary. Every member of staff has a responsibility to, and should, report immediately to the clinical supervisor any concerns they have about working under the protocol in general or about a specific individual, process, issue or event.

Appropriately trained practitioners or staff, who will be authorised to work under the authority of the national protocol must:

• Download a copy of the latest version of the national protocol from the NHS England website;
• Read the protocol and ensure they fully understand its content and the appropriate stages that they are expected to be able to provide; and
• Print off a copy of the protocol and complete the Practitioner/staff declaration to confirm they have read and understood the content of the protocol and that they are willing and competent to work to it under the supervision of a pharmacist. If there is more than one practitioner/staff member in the community pharmacy or working with the community pharmacy who will be providing the Flu Vaccination Service using the protocol, one copy of the protocol can be printed and all practitioners/staff can complete the practitioner/staff declaration on this one copy.

The Authorising registered healthcare professional declaration must then be completed. The individual taking on this role must be familiar with the competence required by all aspects of the protocol. The role is to confirm the practitioner(s) and staff:

• Is/are aware of the service specification and requirements for provision of the service;
• Has demonstrated their competence for the role and completed the necessary documentation; and
• Has/have the organisation’s approval to provide the service.

In certain circumstances, for example, a community pharmacy where the pharmacist who will administer vaccines is also the clinical supervisor and the authorising registered healthcare professional, it may be necessary for them to make a self-declaration of competency.

These steps must be completed before an individual practitioner or staff member is authorised to administer flu vaccines as part of the service. Pharmacy owners using this protocol should retain copies, along with the details of those authorised to work under it, for 10 years after the protocol expires.

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Joint guidance and briefing documents

National flu immunisation programme letter 2024/25 (the Annual Flu letter) (updated 12th March 2024)

Statement of amendment to the Annual Flu letter (published 12th June 2024)

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UK Health Security Agency (UKHSA) guidance and briefing documents

UKHSA flu programme website hub

Influenza vaccines marketed in the UK  Influenza vaccines marketed in the UK for 2024/25, including ovalbumin content

Protocol for ordering, storing and handling vaccines

Vaccine incident guidance: responding to errors in vaccine storage, handling and administration

Flu vaccination programme: information for healthcare practitioners

Flu vaccines poster: 2024 to 2025 flu season (15th August 2024)

Flu immunisation for social care staff

Immunisation against infectious disease: the green book– Chapter 19 Influenza

Vaccine Update

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Other resources

Anaphylaxis action card – Personalise this card and keep it by the phone to guide staff on calling an ambulance if a patient has an anaphylactic reaction to a vaccine.

Anaphylactic guidelines and algorithm poster (Resuscitation Council UK)(May 2021)

NICE – Guideline 103, Flu vaccination: increasing uptake (August 2018)

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Flu vaccinations for pharmacy staff

As has been the case for several years, in the Annual Flu letter, the Department of Health and Social Care, UKHSA and NHS England advise that all frontline health and social care workers should receive a flu vaccination this season. They state this should be provided by their employer, to meet their responsibility to protect their staff and patients and ensure the overall safe running of services.

There are several conditions that are specified in the Directions which pharmacy owners must comply with prior to provision of the service. These include:

1. Pharmacy owners must be satisfactorily providing all Essential Services and be compliant with the clinical governance requirements of the Community Pharmacy Contractual Framework (CPCF).
2. Staff who will provide the service must be competent to provide the service (see section on training requirements and resources for further details).
3. Pharmacy owners must have an SOP in place for provision of the service, having regard to the requirements of the national PGD, the national protocol and service specification of which all pharmacy staff involved in provision of the service are aware, and which covers the following points as a minimum:
   • • the provision of the service to patients and the roles of different staff members;
     • the ongoing conditions under which the service needs to be provided (specified in the service specification);
     • cold chain integrity;
     • needle stick injuries;
     • the identification and management of adverse reactions;
     • the handling, removal and safe disposal of any clinical waste related to the provision of the service; and
     • if the pharmacy owner is to provide the service out of the pharmacy, e.g. in a care home or patient’s own home, the SOP must also detail provision of the service and the role of staff members in that location.
4. The pharmacy 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. The consultation room must meet the applicable requirements of the Pharmaceutical Services Regulations.

These requirements do not prevent the presence of other persons where the patient requests or consents to this. For example, where the practitioner uses a chaperone, or wishes to include a trainee pharmacist in the consultation as part of their training, this would be allowed if the patient consents. Similarly, the patient may prefer that they are accompanied by another person during the consultation.

Provision of the service in the consultation room is the traditional model of delivery but there are other models to support flexible provision of the service. To support these flexible provisions, pharmacy owners will need to think through several considerations. A list of these is provided in our support guide.

Vaccinations under this Advanced service can also be undertaken in other suitable locations, such as in the patient’s home, a care home, a long-stay residential facility or community venues (e.g. community centres).

Vaccinations should be administered under the supervision of a pharmacist, trained in vaccinations (including a clear understanding of this service). A record should be maintained of who that person is at each premises at any given time. Additionally, where vaccinations are undertaken in the patient’s own home (including a care home), pharmacy owners must ensure that vaccinators have a valid Disclosure and Barring Service (DBS) certificate.

Where vaccinations are undertaken off the pharmacy premises, the pharmacy owner must continue to adhere to professional standards; follow appropriate cold-chain storage measures; ensure that the setting used to administer the vaccinations is appropriate (including ensuring patient confidentiality as appropriate); and appropriately dispose of any clinical waste or personal protective equipment (PPE) used during the vaccination process.

A checklist to help pharmacy owners and their teams to prepare for and to provide the service can be found below.

Download checklist for the NHS Flu Vaccination Service

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National Booking Service (NBS)

NBS will be opened for all participating sites to post COVID-19 and flu appointments from Monday 16th September 2024. It will be open for bookings from the public from Monday 23rd September 2024.

The last available appointment date on NBS will be Friday 20th December 2024 for both flu and COVID-19.

All pharmacy staff involved in the provision of the service should receive appropriate training relevant to the role they will undertake and pharmacy owners are required to demonstrate that all staff providing the service in their pharmacy have the skills needed to do so.

The content of vaccination training

The National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners sets the standards and lists the essential topics which should be incorporated into immunisation training for registered healthcare practitioners.

Pharmacists and other vaccinators who will administer flu vaccines must have completed practical training in vaccination that meets these requirements.

There are several organisations offering training and support for the provision of flu vaccination services and contact details can be found below.

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The frequency of training

Pharmacists and other vaccinators providing the service need to attend face-to-face training for both injection technique and basic life support training periodically.

Pharmacy owners and vaccinators will need to consider when it would be appropriate to attend refresher training or if ongoing competence of an individual vaccinator can be evidenced, without the need for face-to-face training.

An individual’s continued competence may be influenced by their prior experience vaccinating patients, including the overall number of vaccines administered and the regularity with which they administer vaccines.

The National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners recommend that immunisers should keep a portfolio of completed competency checklists, knowledge test score sheets, reflective logs, completion of e-learning course certificates and certificates of attendance at immunisation training courses and updates.

This will provide vaccinators with a means to be able to show evidence of completion of training and achievement of competence to both current and future employers. It will also provide useful evidence of continuing professional development for professional revalidation.

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Annual update training

Vaccinators are expected to undertake annual update training, to ensure their knowledge stays up to date with changes in practice and guidance.

This may involve self-directed learning, using relevant references sources, such as the Green Book and the annual flu letter. It may also include online training which is available from a range of providers.

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Assessment of vaccinator competency

The Declaration of Competence (DoC) approach, using the Vaccination Services DoC (hosted on the Centre for Pharmacy Postgraduate Education website) is one  way which pharmacy professional providing the service can demonstrate their competence to the pharmacy owner.

Alternatively, the competence of any vaccinators (including pharmacists and pharmacy technicians) can be assured using the UKHSA Flu vaccinator competency assessment tool. This can be used as a self-assessment tool, an assessment tool for use with a supervisor or both depending on the previous experience of the vaccinator.

The recommendations that accompany the assessment tool advise that all new flu vaccinators should complete the competency assessment for formal assessment and sign-off of their clinical competency. Any flu vaccinators returning to vaccination after a prolonged interval should also complete flu-specific training and the flu-specific competency assessment. As the circumstances and training needs for individual practitioners returning to vaccination will vary, there is no defined time interval for ‘prolonged’, but vaccinators and their supervisors need to be assured of their competence before they deliver this year’s programme.

Staff who are not vaccinators but are involved in administrative elements of vaccine provision, as defined within the national protocol, must be trained and competent to safely carry out the activity they are employed to provide. The competence requirements stipulated in the protocol under Characteristics of staff should be used to assist with assessing staff.

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Training resources

e-Learning for Healthcare Flu Immunisation online course This interactive flu immunisation e-learning programme, written by UKHSA and NHS England’s eLearning for Healthcare, is available for anyone involved in providing the flu vaccination programme.

Some LPCs arrange local training for their pharmacy owners; contact your LPC to see if they are organising any training.

There are a number of organisations that provide vaccination training and those that we have been made aware of are listed below for information. Listing on this page does not constitute endorsement of the course or provider by Community Pharmacy England.

AAH Pharmaceuticals (Account required)

Alliance Healthcare – Skills in Healthcare

Allied Health Training

Avicenna

Buttercups Training Ltd

Cambrian Alliance

Charles Bloe Training Ltd

ECG Training

Health Academy – The Flu Hub

Health and Safety Group

Immunisations UK

National Pharmacy Association

Numark (Members only)

Pharmacy Foundations

Rx Advisor Ltd

Sonar Informatics

Voyager Medical

This section provides some of the practical requirements related to provision of the Flu Vaccination Service.

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Patient consent

As with the provision of any pharmacy service, the patient must consent to being vaccinated.

The General Pharmaceutical Council’s Guidance on Consent provides information on consent for pharmacists and their teams.

Prior to vaccination, consent must be sought from each patient for the administration of the vaccine.  The patient should also be advised of the information sharing that will take place for the appropriate recording of the vaccination in their GP practice medical record and information that will be shared with NHS England and the NHS Business Services Authority (NHSBSA) as part of post-payment verification.

Patient consent can be obtained verbally and should be recorded in the pharmacy’s clinical record for the service.

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Service records, IT support and sharing of data

NHS England regional teams arrange IT support for the service; contact your LPC to find out about the system which is provided in your area.

These NHS England provided systems must be used to maintain the clinical records for the service; a paper based record keeping system is no longer allowed for this service.

Pharmacy owners must ensure the vaccination is recorded on the same day that it is administered unless exceptional circumstances apply. Where the IT system is unavailable due to exceptional circumstances beyond the control of the pharmacy owner, then the record of vaccination must be added to the system as soon as possible after it becomes available again.

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To support business continuity provisions in the event of IT issues only

Where the IT system is unavailable due to exceptional circumstances beyond the control of the pharmacy owner, then the record of vaccination must be added to the system as soon as possible after it becomes available again. The following record form may be used to maintain provision of the service in such circumstances.

Flu Vaccination Service record form (Microsoft Word)

Flu Vaccination Service record form

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Co-administration of the vaccine

JCVI confirmed that the ComFluCOV trial indicates that co-administration of the influenza and COVID-19 vaccines is generally well tolerated with no reduction in immune response to either vaccine. Therefore, the two vaccines may be co-administered where operationally practical.

Based on advice from the COVID-19 vaccination programme – Information for healthcare practitioners, where co-administration does occur, patients should be informed about the likely timing of potential adverse events relating to each vaccine. Where more than one vaccine is given at the same time, they should preferably be given in different limbs. Where this is not possible, they should be given at least 2.5cm apart and the site at which each vaccine was given should be clearly documented in the patient’s records.

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Storage of vaccines

Vaccines should be stored in line with the requirements set out by their manufacturer in the Summary of Product Characteristics.

In 2014, Public Health England issued guidance on the protocol for ordering, storing and handling vaccines for all healthcare providers involved in vaccinations, including community pharmacies.

All refrigerators in which vaccines are stored must have a maximum / minimum thermometer. Readings must be taken and recorded from the thermometer on all working days.

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Information for patients

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.

UKHSA leaflets to promote the service are also available and these can be downloaded and printed or patients be directed to a web-based version of the leaflets. Links to these can be found in the Promoting the service to patients section below.

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Clinical waste

Pharmacy owners are required to make arrangements for the removal and safe disposal of any clinical waste and PPE related to the provision of this service. This includes vaccinations carried out in long-stay residential care homes, other long-stay care facilities, off-site or in a patient’s home.

Pharmacy owners must also ensure that staff are appropriately trained and made aware of the risks associated with the handling and disposal of clinical waste and that correct procedures are used to minimise those risks. A needle stick injury procedure must be in place.

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Provision of data to NHS England

Claims for payment for the service will be made to the NHS Business Services Authority (NHSBSA) (see section on Funding and claiming payment for further details) and they will subsequently share data on service provision with NHS England.

The clinical records system being used, will submit data on service provisions into the NHSBSA’s Manage Your Service (MYS) portal via an application programming interface (API). Information from the clinical record detailed in the service specification will be shared with NHS England and NHSBSA for the purpose of post payment verification.

When pharmacy teams provide the service, notifying the patient’s GP practice is an important service requirement.

Data recorded in the NHS-assured IT system regarding a patient’s vaccination will be shared with the patient’s GP practice automatically. Where a problem occurs with this notification system, the pharmacy owner must ensure a copy of the vaccination notification is sent or emailed (via NHSmail) to the GP practice.

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.

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Dealing with local issues related to the service

Sometimes issues with the service may arise between GP practices and community pharmacies; in this situation pharmacy owners may wish to seek support and advice from their LPC.

Occasionally we receive reports of GP practices issuing information to their patients that unfairly or inaccurately represents the community pharmacy service. If this occurs, we advise pharmacy owners to raise the issue with the GP practice concerned. If that does not resolve the issue, pharmacy owners should raise the matter with the local NHS England team and their LPC.

There is a tendency for these examples to get circulated via social media and other routes, which creates a bigger issue out of one incident than may be warranted and it also potentially inspires others to copy the approach. We recommend that LPCs and pharmacy teams avoid sharing such matters via social media, as it will not help long term community pharmacy/GP relationships; incidents should be dealt with locally wherever possible.

Vaccinating in the pharmacy, but not in the consultation room

Pharmacy owners can provide the service in an alternative location in the pharmacy, as long as it can be undertaken in a way which maintains patient safety and confidentiality.

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Off-site provision

Flu vaccinations can also be provided to patients in their own homes (including care homes) or at other off-site locations.

The sites could include marquees outside the pharmacy premises; local village, town or community halls; church halls, temples or mosques; adapted mobile units such as buses or vans; sports halls / stadiums.

People providing flu vaccinations in a patient’s own home or a care home must have a valid Enhanced Disclosure and Barring Service (DBS) certificate. Pharmacy owners needing to arrange this should refer to the DBS checking website for details.

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Care homes

Pharmacy owners can offer to vaccinate eligible patients who are living in long-stay residential care homes, or other long-stay care facilities as well as the care home staff who are directly involved in the care of these patients.

There is no requirement for pharmacy owners to have notified the patient’s general practice in advance of vaccination when providing flu vaccinations at a care home. However, pharmacy owners should bear in mind that Primary Care Networks, as part of their COVID-19 vaccinations plans, have been encouraged to co-administer vaccines where possible. As is the case for provision of flu vaccinations in the pharmacy, pharmacy owners who undertake vaccinations in care homes, must ensure that data regarding a patient’s vaccination is recorded on the point of care system the same day that it is administered; this will then be shared with the patient’s GP practice automatically.

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Additional guidance

Guidance for pharmacists delivering a seasonal influenza vaccination service to care homes This guidance was developed by the Suffolk CCGs’ Safeguarding Team and West Suffolk CCG Medicines Management Team.

Decision-making flowchart for decision-makers in hospitals and care homes Guidance for health and social care staff who are caring for, or treating, a person who lacks the relevant mental capacity. This provides help to decision-makers in hospitals and care homes to make decisions in relation to adults who lack the relevant mental capacity to consent to their care and treatment.

Assessing Mental Capacity and Gaining Consent This guidance was developed by the Suffolk CCGs’ Safeguarding Team and West Suffolk CCG Medicines Management Team.

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Additional points for all off-site provision

Support

Vaccinators should consider being accompanied by a trained pharmacy support staff member when providing flu vaccinations off-site. The primary role of the support staff member is to assist in the event of an emergency, but they could also undertake administrative tasks and, where necessary, act as a chaperone.

Clinical waste

Pharmacy owners must ensure that they meet the requirements of the Waste (England and Wales) (Amendment) Regulations 2012 in terms of transferring pharmaceutical waste from the site of vaccination back to the pharmacy premises for subsequent safe disposal.

Maintaining the cold chain

Vaccinators must ensure that the cold chain storage of the vaccines is maintained. Vaccines should be taken from the pharmacy fridge and placed into an appropriate validated cool box (which will maintain the vaccines at a temperature between 2˚C and 8˚C) just before travel to the off-site location.

The vaccines should be kept in their packaging and should be insulated from the cooling system within the cool box, e.g. using bubble wrap, to avoid the risk of freezing. Any unused vaccines should be returned to the pharmacy fridge within eight hours of first removal.

Professional standards

When considering any provision of flu vaccination services outside the pharmacy, pharmacy owners and their pharmacists are reminded that all the usual professional standards apply in whatever setting the service is provided. Any planning or risk assessments need to keep these standards central to considerations of how to provide the service, as they will offer a useful framework to help decision making.

If pharmacy owners decide to develop their own marketing materials to promote the service they must ensure they comply with the requirements of the Terms of Service relating to promotion of services funded by the NHS.

If pharmacy owners choose to use the NHS identity on their marketing materials they must follow the primary care guidelines for use of the NHS identity.

An A-Z style guide of words and phrases about health and the NHS, which aims to make content aimed at patients easy to understand, is available on the NHS website. The NHS website team try to use words on their website that people use themselves when they talk about their problems and when they search for information on the internet. Community pharmacy teams may wish to refer to the guide when producing their own health content or communication materials.

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Community Pharmacy England resources

Letters

Flu vaccination letter for patients (Word)
This letter invites eligible patients to have their NHS flu jab.

Letter or email from pharmacy owners to local care providers (Word)
This letter informs local care providers that community pharmacies can vaccinate care home and domiciliary care workers.

Evidence of employment letter (Word)
Pharmacy owners and LPCs can share this template letter with employers of care home and domiciliary care workers which can be used as proof of eligibility for vaccination. The letter is to be used on the employer’s letterhead.

Posters and counter top notice

Poster for the public on flu vac timing changes

Flu vaccination service poster general

Flu vaccination service poster care workers poster

Flu vaccination service poster care workers poster (printer friendly)

Flu vaccination service poster carers

Flu vaccination service poster carers (printer friendly)

Flu vaccination service poster long term conditions

Flu vaccination service poster long term conditions (printer friendly)

Flyers

Small flu vaccination flyer(Word)
These double-sided flyers can be personalised and attached to dispensing bags to alert patients to the availability of the service.

Small carer flu vaccination flyers
These double-sided flyers can be attached to prescription bags and be used as a conversation starter to encourage carers to have a flu vaccination.

Social media

Social media tiles

Suggested flu vaccine tweets 2023

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UKHSA resources

Leaflets

UKHSA easy read flu leaflet

The below listed leaflets are also available in Albanian, Arabic, Bengali, Bulgarian, Chinese (simplified), Cantonese (traditional, Cantonese), Estonian, Farsi, French, Greek, Gujarati, Hindi, Latvian, Lithuanian, Panjabi, Pashto, Polish, Portuguese, Romanian, Romany, Russian, Somali, Spanish, Tagalog, Tigrinya, Turkish, Twi, Ukrainian, Urdu, Yiddish and Yoruba via the below links.

UKHSA patient leaflet – Flu vaccination: who should have it this winter and why

UKHSA flu leaflet for pregnant women

Copies of these leaflets can be ordered from the Health Publications Order point or by phoning 0300 123 1002 and quoting the reference numbers on the back pages of the leaflets.

Flu immunisation for social care staff
Leaflets for social care staff and providers to support the annual flu programme.

Posters

UKHSA easy read flu poster

A quick links poster with QR codes to the Pregnancy: how to help protect you and your baby and the COVID-19 vaccination: a guide on pregnancy and breastfeeding leaflets (2021)

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Identifying carers eligible for a flu vaccination

We have previously worked with Carers Trust to produce resources to assist pharmacy teams in identifying carers who may be eligible for a flu vaccination.

Small carer flu vaccination flyers
These double-sided flyers can be attached to prescription bags and be used as a conversation starter to encourage carers to have a flu vaccination.

Further information on how pharmacy teams can support carers can be found on our  Carer Friendly pharmacy page.

In addition, Carers Trust has produced ‘ten signs that tell community pharmacy teams that someone may be a carer’. These are listed in the box below:

Carers are often the people who: Drop off and collect prescriptions for another person. Collect medications for someone who has a condition (e.g. dementia) which suggests that they wouldn’t be able to get by on their own. Buy incontinence products or other items associated with ill health, frailty or disability. Ask for advice about someone else’s medication, health condition or disability rather than their own. Sit in on a Discharge Medicines Service consultation and give the impression that they are the main ‘manager’ of the patient’s medicines. May seem to be in a hurry to get back home because they don’t want to leave someone on their own for very long. Visit the pharmacy with someone who appears to need their support. May look tired, depressed or anxious when the person they usually accompany isn’t with them. Take delivery of medicines from the pharmacy delivery driver. Regularly buy over-the-counter medicines for another person.

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Flu vaccinations for people with learning disabilities

People with learning disabilities are eligible to receive a flu vaccination under the service, as learning disabilities are categorised as a neurological condition.

Around 1 in 3 deaths of people with a learning disability are caused by respiratory problems and the number of respiratory related deaths increases during winter. Having the vaccination can help avoid preventable deaths for people with a learning disability during this period.

A person with learning disabilities will have:

• a significantly reduced ability to understand new or complex information and to learn new skills (impaired intelligence); and

• a reduced ability to cope independently (impaired social functioning).

This will have started before adulthood, with a lasting effect on development. This does not include conditions like dyslexia, which cause a specific difficulty with one type of skill but not a wider intellectual impairment.

People with learning disabilities are less likely to get flu if the people around them are also vaccinated; carers and care workers are eligible to receive a flu vaccination under the service.

UKHSA have easy read flu resources, which are aimed at people who have, or care for someone with a learning disability.

Suggested actions to improve flu vaccination uptake amongst people with learning disabilities:

• Ensure you continue to talk to people in general about getting a flu jab so people with learning disabilities are aware that they can get a flu vaccination from the pharmacy;

• Let carers of people with a learning disability know that they are also entitled to an NHS flu vaccination to protect the person they are caring for;

• Ensure the eligibility criteria you have displayed (on your website or in the pharmacy) for the service or any patient materials, include learning disabilities as an eligible group;

• Consider the information you display in your pharmacy to promote the service to this eligible group of patients – can it be easily read and understood by all your patients?

• Consider undertaking some learning to enhance your understanding around people with learning disabilities; the Centre for Pharmacy Postgraduate Education has a distance learning course available.

• If a person has a learning disability, annotate their PMR to indicate their eligibility for an NHS flu vaccine so you can talk to them about being vaccinated when the service commences again in the autumn.

• Understand your responsibilities under the Mental Capacity Act to ensure appropriate consent is captured or where necessary, an appropriate capacity assessment can be carried out.

Other resources

People with learning disabilities and the flu injection Easy-read information with information for people with learning disabilities, their family, carers and paid supporters (National Development Team for Inclusion).

NHS England short video on flu vaccination for people with a learning disability and autistic people The video covers why it is important eligible people have a flu vaccination, who is eligible for a free vaccine, reasonable adjustments, consent and decision making. A parent of a 16-year-old with a learning disability describes how primary care can support families to make sure their relatives can have their vaccination.

The flu jab for people with learning disabilities YouTube video showing a patient with learning disabilities having a flu vaccination (NHS England).

Pharmacy and people with learning disabilities: making reasonable adjustments to services Guidance on how to make reasonable adjustments to help support people with learning disabilities in using pharmacy services.

Assessing Mental Capacity and Gaining Consent
A flowchart to support assessing mental capacity and gaining consent (Suffolk CCGs’ Safeguarding Team and West Suffolk CCG Medicines Management Team).

Funding

In 2024/25, pharmacy owners will be paid £9.58 for each vaccine administered; this fee is funded from NHS vaccination budgets, not from the Community Pharmacy Contractual Framework global sum.

Read our view on the funding for the service

Pharmacy owners will also be reimbursed for the vaccine cost at the basic price (list price) of the individual vaccine administered and an allowance at the applicable VAT rate will also be paid.

Basic prices can be confirmed using the NHS Business Services Authority’s DM+D browser.

Claiming payment

The NHS-assured IT system which pharmacy owners and their teams use to make a clinical record for the service will also populate a claim for payment, via an API (Application Programming Interface),  within the NHSBSA’s Manage Your Service (MYS) portal.

The transfer of data via the API happens throughout the month, as data is entered into the IT system. The service provisions will then be available to view in MYS from the 1st of the following month. For example, service provisions in September will be available to view in MYS on 1st October. Contractors will then need to log into the MYS platform to check that the data matches the details in their IT system, and they will then need to submit their claim for payment.

Pharmacy owners must claim payment within one month of, and no later than three months from the claim period for the chargeable activity provided. Claims which relate to work completed more than three months after the claim period in question will not be paid and the pharmacy owner will not receive any payment for the administration of those vaccinations.

Payments to pharmacy owners will be made monthly as part of their normal payment schedule.

Payment will only be made for flu vaccinations administered from the service commencement date onwards.

Visit the Flu Vaccination Service Frequently Asked Questions page for FAQs on the service requirements.

Download the slides from the digital guide

This section contains information and advice for LPCs on the Flu Vaccination Service.

LPCs may want to consider:

• supporting pharmacy owners, for example, through regular communications about service updates and by highlighting training options and other resources;

• hosting a training event locally;

• patient communications to highlight the service, for example, LPCs may wish to organise an event with local press when the service launches; and

• what meetings with local stakeholders might be helpful to ensure that as many patients are possible receive NHS flu vaccinations.

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Flu Vaccination Service promotional toolkit

Part 1: Promoting to politicians and the public

LPC invitation to MPs – visit a local pharmacy for your flu vaccine
This template invitation can be used by LPCs to invite an MP to visit their local pharmacy for a flu vaccine.

Press release for MPs – Flu 2023
This template press release can be used when MPs visit pharmacies, either to be briefed by the local pharmacy team or to receive an NHS flu vaccination if they are eligible.

Press release for LPCs – 2023/24 Flu season
The template press release can be used to highlight the record number of flu vaccinations that community pharmacies have provided in 2023/24.

Flu Vaccination Service tweets

Flu Vaccination Service social media tiles

A how-to-guide to organising an MP flu vaccination visit
This provides a guide on how to organise an MP flu vaccination visit.

Community Pharmacy England Briefing 050/15: Template radio scripts to promote national pharmacy flu vaccination service
The LPC may also wish to consider working with a local radio station to produce some adverts. This Community Pharmacy England Briefing was issued when the national service first began, but the template scripts are still relevant.

Part 2: Reaching out to local charities and care provider support organisations

Promoting the service to local charity support groups will help increase their members’ awareness of the importance of having a flu vaccination and that the NHS Flu Vaccination Service is widely available in community pharmacies. The following resources have been created to help LPCs.

• A list of suggested national charity support groups – coming soon
• Email/letter to send to local charity support groups (Word)
• PowerPoint presentation for patient groups which can be modified to suit the needs of your event – coming soon

Promoting the service to umbrella local care provider support organisations and other stakeholders will help increase awareness that care/nursing home, domiciliary care and hospice care workers can now have a flu vaccination in a community pharmacy. The following resources have been created to help LPCs.

• Email/letter to umbrella local care provider support organisations (Word)
• Email/letter to stakeholders (Directors of public health, Local Medical Committees, etc) (Word)

Visit the Flu Vaccination – Statistics page for statistics on the 2023/24 service and statistics on previous Flu Vaccination Services.

Pharmacy set up

Checklist for the NHS Flu Vaccination Service (Microsoft Word)

Checklist for the NHS Flu Vaccination Service

Anaphylaxis action card

Anaphylactic guidelines and algorithm poster (Resuscitation Council UK) (May 2021)

Flu vaccines poster: 2024 to 2025 flu season (15th August 2024)

Letters

Flu vaccination letter for patients (Word)
This letter invites eligible patients to have their NHS flu jab.

Letter or email from pharmacy owners to local care providers (Word)
This letter informs local care providers that community pharmacies can vaccinate care home and domiciliary care workers.

Evidence of employment letter (Word)
Pharmacy owners and LPCs can share this template letter with employers of care home and domiciliary care workers which can be used as proof of eligibility for vaccination. The letter is to be used on the employer’s letterhead.

Posters and counter top notice

Poster for the public on flu vac timing changes

Flu vaccination service poster general

Flu vaccination service poster care workers poster

Flu vaccination service poster care workers poster (printer friendly)

Flu vaccination service poster carers

Flu vaccination service poster carers (printer friendly)

Flu vaccination service poster long term conditions

Flu vaccination service poster long term conditions (printer friendly)

Flyers

Small flu vaccination flyer (Word)

Small carer flu vaccination flyers

Social media

Social media tiles

Suggested flu vaccine tweets 2023

Business continuity support only

Flu Vaccination Service record form (Microsoft Word)

Flu Vaccination Service record form