Flu Vaccination Service
Published on: 22nd July 2015 | Updated on: 2nd October 2023
Community pharmacy has been providing flu vaccinations under a nationally commissioned service since September 2015.
Each year from September through to March the NHS runs a seasonal flu vaccination campaign aiming to vaccinate all patients who are at risk of developing more serious complications from the virus. The accessibility of pharmacies, their extended opening hours and the option to walk in without an appointment have proved popular with patients seeking vaccinations.
Update: Autumn (C-19 & flu) vaccination programme brought forward
Following guidance from the UK Health Security Agency (UKHSA), the Government has asked NHS England to bring forward the start of the COVID-19 autumn/winter booster programme to commence on 11th September 2023. Wherever possible, patients should be offered flu and COVID-19 vaccination at the same time. Flu vaccinations can and should therefore, be offered to eligible patients in September.
Click on a heading below for more information
Only a small number of amendments have been made to the service specification this season. The key changes are:
- The eligible patient cohorts have been amended to reflect those previously announced, i.e. the removal of the 50-64 years old, not at-risk cohort.
- Pharmacy owners must use an NHS-assured point of care IT system (e.g. Sonar Informatics and PharmOutcomes) to make their clinical records for the service and to submit payment claims to the NHSBSA’s Manage Your Service platform (automatically via an application programming interface).
The vast majority of pharmacy teams have been using such a system, provided by their NHSE regional team, over the last few years and they will continue to be made available to pharmacy owners by the regions.
- The commencement date for the service will be announced by NHSE in their Primary Care Bulletin – see further information on this in the next section.
Start date of the service
This year, in a significant change from previous years, NHS England said it will announce the commencement date and authorise the vaccination of patients eligible for the Flu Vaccination Service in the Primary Care Bulletin. Prior to that date, pharmacy owners must not commence the administration of vaccinations under the Advanced service.
This change to the service specification was not agreed by us, as there was insufficient advance notice of this to pharmacy owners, but NHS England insisted on its inclusion.
Once NHS England told us they expected the service would not start until October, we collated evidence to share with NHS England which demonstrated the significant adverse impact such a delay to the start of the service would have on pharmacy owners, their teams and patients.
Once NHS England’s plans were made public, we started a public lobbying campaign to seek to get the policy changed. This included writing to Ministers and asking MPs to raise our concerns with the Department of Health and Social Care.
On 10th August 2023, NHS England announced that while the flu vaccination service will officially commence in October, pharmacy owners will be able to go ahead and vaccinate any patients who have already booked September appointments and be paid for those.
On 30th August 2023, following guidance from the UKHSA, the Government asked NHS England to bring forward the start of the autumn/winter 2023-24 flu and COVID-19 booster programmes to commence on 11th September 2023. NHS England has subsequently confirmed this via a system letter sent to all pharmacy owners on 30th August 2023 and also via the Primary Care Bulletin on 1st September 2023.
NHS England’s latest letter to systems, community pharmacies and general practices says flu vaccinations (and COVID-19 vaccinations) can commence:
- for care home residents and care home staff and those who are house bound from 11th September 2023;
- for all other eligible patient cohorts, vaccination can commence via Local Booking Systems (LBS) from 11th September 2023; and
- from 18th September 2023, LBS will be complemented by the National Booking System (NBS) which will become available to allow eligible patient cohorts to book a COVID-19 or flu vaccination online (using NHS.uk), via the NHS App or by calling 119.
Wherever possible, patients should be offered flu vaccination at the same time as their COVID-19 vaccination.
This change in the timings for the vaccination programme supersedes the previous information NHS England issued to pharmacy owners on the provision of flu vaccinations starting in October (unless firm commitments and appointments have already been made). Flu vaccinations can and should be offered to eligible patients in September.
The annual flu vaccination programme letter for the 2023/24 season confirms the eligible cohorts for the 2023/24 season and the vaccines which will be reimbursable under the Community Pharmacy Seasonal Influenza Vaccination Advanced Service.
The Government has confirmed that 50 to 64 year olds not at clinical risk are not included as a cohort for this coming season.
Although there has been no change to the recommended vaccines that will be reimbursed for adults in the 2023/24 programme, the advice regarding when second line vaccines can be used has been strengthen.
The annual flu vaccination programme letter for the 2023/24 season states that second line vaccines should only be used 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.
For those aged 18 to 64 years in eligible clinical risk groups, the letter advises that while egg-grown quadrivalent influenza vaccine (QIVe) remains a second line vaccine, there is a potential advantage to using flu vaccines which do not use eggs in the manufacturing process (cell-culture or recombinant). Due to this, the recommended first line vaccines avoid the possible impact of “egg-adaptation” on the effectiveness of flu vaccines, particularly against A(H3N2) strains.
Service specification for the flu vaccination Advanced Service 2023/24 (published 4th August 2023)
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 2023/24
The national Patient Group Direction (PGD) provides one legal mechanism for administration of flu vaccine under the service. Email ENGLAND.email@example.com if you have questions about the PGD.
National protocol for inactivated influenza vaccine 2023/24
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 firstname.lastname@example.org if you have questions about the PGD.
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.
Amendments to the Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2013
The Secretary of State Directions provide the legal basis for the provision of the service.
Community Pharmacy England Briefing 024/23: Guidance on the 2023/24 Seasonal Influenza Vaccination Advanced Service
Our Briefing provides guidance for pharmacy owners and their teams on the 2023/24 NHS Seasonal Influenza Vaccination Advanced Service.
This section contains additional information and resources to support pharmacy owners and their teams to provide the Flu Vaccination Service. This section will be updated as further resources are published by various bodies.
Joint guidance and briefing documents
National flu immunisation programme letter 2023/24 (updated 3rd July 2023)
UK Health Security Agency (UKHSA) guidance and briefing documents
Flu vaccines: 2023 to 2024 flu season (8th August 2023)
Influenza vaccines marketed in the UK Influenza vaccines marketed in the UK for 2023/24, including ovalbumin content (27th March 2023)
Protocol for ordering, storing and handling vaccines (2nd April 2014)
Flu vaccination programme: information for healthcare practitioners (20th September 2022)
Flu vaccines poster: 2023 to 2024 flu season (8th August 2023)
Flu immunisation for social care staff (30th September 2022)
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.
NICE – Guideline 103, Flu vaccination: increasing uptake (August 2018)
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.
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.
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.
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.
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 pharmacists providing the service can demonstrate their competence to the pharmacy owner.
Alternatively, the competence of any vaccinators (including pharmacists) 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.
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.
Numark (Members only)
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.
IT support for the service 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 or another NHS-assured IT system of the pharmacy owner’s choice 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.
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)
When pharmacy teams provide the service, notifying the patient’s GP practice is an important service requirement.
This is firstly because it is important that the patient’s GP has a full record of vaccinations their patients have received, but also because the UK Health Security Agency’s (UKHSA) systems use GP records to assess the total number of people who have been vaccinated against flu each year.
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.
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.
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 certificate.
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.
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.
Additional points for all off-site provision
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.
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.
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.
Community Pharmacy England resources
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 emploment 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
Flu vaccination service poster care workers poster (print friendly) (PDF)
Flu vaccination service poster carers (print friendly) (PDF)
Flu vaccination service poster long term conditions (print friendly) (PDF)
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 (PDF)
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.
UKHSA easy read flu leaflet (2023)
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.
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 (Sept 2023)
Leaflets for social care staff and providers to support the annual flu programme.
UKHSA easy read flu poster (2023)
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)
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 (PDF)
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:
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.
People with learning disabilities and the flu injection (PDF) 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 (PDF) A flowchart to support assessing mental capacity and gaining consent (Suffolk CCGs’ Safeguarding Team and West Suffolk CCG Medicines Management Team).
In 2023/24, 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.
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.
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.
Visit the Flu Vaccination Service Frequently Asked Questions page for FAQs on the service requirements.
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.
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.
A how-to-guide to organising an MP flu vaccination visit
This provides a guide on how to organis 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.
Visit the Flu Vaccination – Statistics page for statistics on the 2023/24 service and statistics on previous Flu Vaccination Services.