Flu Vaccination – FAQs

Q. Can distance selling pharmacies provide the Flu Vaccination Service?
Yes. A distance selling pharmacy (DSP) may provide Advanced Services, if any Essential Service which forms part of the Advanced Service is not provided to persons present at the premises. The DSP must fully meet the requirements for the provision of the Flu Vaccination Service, which includes the consultation room requirements.

Q. What insurance should you have for the Flu Vaccination Service?
Advice should be sought from your insurance provider.

Q. How do pharmacy owners inform NHS England that they intend to provide the Advanced service?
There is no requirement to notify NHS England that you intend to provide the service.

Q. Where can I obtain statistics from previous years on the national pharmacy Flu Vaccination Service?
Information on how many vaccinations have been provided under the national pharmacy Flu Vaccination Service in previous years can be found on the Flu Vaccination – Statistics page.

Q. I was an essential small pharmacy, but I now have a replacement LPS contract. Will I be able to provide the Flu Vaccination Service?
All the services to be provided by an LPS pharmacy owner must be agreed between NHS England/the Integrated Care Board (ICB) and the pharmacy and be included in the LPS contract. As the very substantial benefits of pharmacies providing the Flu Vaccination Service are recognised by NHS England, Community Pharmacy England recommend that LPS pharmacy owners contact their local NHS England team/ICB to propose a contract variation, to include a Flu Vaccination Service.  The location of the ‘essential small pharmacy’ LPS premises often in areas where there are no other healthcare providers could provide a very convenient service for the public who would otherwise be hard to reach.

Q. My pharmacy doesn’t have a consultation room; can I provide the Flu Vaccination Service?
No. Having a consultation room is a prerequisite for provision of the Flu Vaccination Service. 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 comply with the requirements in the Terms of Service.

Q. We are a distance selling pharmacy without a consultation room; can I provide the Flu Vaccination Service to patients in their own homes?
No. Pharmacy owners must have a consultation room that meets the requirements of the Terms of Service, even if they intend to vaccinate off-site only.

Q. Does a pharmacy owner have to make a ‘prescription register’ entry for each administration of vaccine under the national PGD or the National Protocol?
No. The records required to be maintained by the PGD or National Protocol, made on the date of administration meet the requirements to make records in the Human Medicines Regulations.

Q. Do pharmacists, pharmacy technicians (and other individuals authorised to work under the PGD) have to sign a copy of the national PGD?
Yes, pharmacists, pharmacy technicians (and other individuals authorised to work under the PGD) must sign a copy of the PGD to indicate that they understand the PGD requirements and agree to work under those requirements.

Q. Can the PGD be signed remotely (electronic signature) by the authorising manager, for example, from the pharmacies’ head office for all their pharmacies?
Yes. It is possible for the PGD to be signed remotely (electronic signature); however, the authorising manager still needs to be able to confirm the pharmacist, pharmacy technicians (and other individuals authorised to work under the PGD):

• are aware of the service specification and requirements for provision of the service;

• have completed the Declaration of Competence self-assessment framework and has printed and signed the statement of declaration (pharmacist only)  or the Flu vaccinator competency assessment tool; and

• has the organisation’s approval to provide the service.

Q. Should a copy of the signed PGD be kept at the pharmacy for each pharmacist, pharmacy technician (or other individuals authorised to work under the PGD) providing the service at the pharmacy?
Yes. The PGD states that a copy of the PGD with the completed practitioner authorisation sheet should be retained and available at the pharmacy premises as a record of those practitioners authorised to work under the PGD.

Q. Does a pharmacy owner need to keep evidence of vaccinator competency for all individuals that deliver the Flu Vaccination Service?
Yes. The service specification states that pharmacy owners must keep evidence of competency relating to any staff that they employ/engage to deliver the service.

Q. What is the legal basis for the administration of flu vaccinations in the Flu Vaccination Service?
A national PGD and a national protocol provide the legal authority for administering the vaccine.

Q. Can pharmacy staff other than a pharmacist administer the vaccine?
Yes. Under the authority of the national PGD and the associated regulatory requirements flu vaccinations can be provided by any practitioner listed in the Qualifications and professional registration section of the PGD, which mirrors the groups of practitioners authorised to supply or administer medication via a PGD under current legislation. Any listed practitioners must only provide the service under the supervision of a pharmacist, trained in vaccinations (including a clear understanding of this service).

Under the authority of the national protocol, 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, can administer a licensed influenza vaccine, provided they are trained and competent to do so. The clinical assessment and consent process must be undertaken by a registered healthcare professional as defined within the protocol.

Q. Can a nurse administer the vaccine as part of the service?
Yes. Under the authority of the PGD or the national protocol. Nurses must only provide the service under the supervision of a pharmacist, trained in vaccinations (including a clear understanding of this service).

Q. Can a pharmacy technician administer the vaccine?
Yes. Under the authority of the PGD or the national protocol. Pharmacy technicians must only provide the service under the supervision of a pharmacist, trained in vaccinations (including a clear understanding of this service).

Q. Can pharmacy technicians supervise NHS vaccination services in a community pharmacy?
No. There has been no change to the clinical supervision requirements for the National Protocol, which is in keeping with other registered healthcare professionals legally able to operate under PGD but not act as a clinical supervisor, such as physiotherapists, Occupational Therapists and paramedics.

Q. Can pharmacy technicians provide clinical suitability assessments of patients who are due a vaccine under the national protocol?
Yes. By design of being included as a professional in the registered healthcare group of professions that can vaccinate using PGDs, pharmacy technicians in the UK can now operate under Stages one to four of the protocol, including assessment and consent under stage 1.

Q. Can a pharmacist providing the service and qualified as an independent prescriber prescribe the vaccine for patients, rather than using the national PGD?
No. The Advanced Service only uses the national PGD or the national protocol to authorise administration of the vaccine.

Q. Does the national PGD authorise administration of the vaccine for other patients not covered by the NHS eligibility criteria (i.e. as a private service)?
No. If pharmacies wish to provide a private Flu Vaccination Service in addition to the Advanced Service, they need to ensure that another suitable PGD is in place to allow provision of a private service.

Q. Do pharmacists, pharmacy technicians (or other individuals authorised to work under the PGD) have to send a copy of the signed PGD to NHS England or another organisation?
No. The signed PGD should be retained in the pharmacy where the pharmacist, pharmacy technician (or other individuals authorised to work under the PGD) is administering vaccines.

Q. Can a pharmacy company with multiple pharmacies nominate one authorising manager for all pharmacists (and other individuals authorised to work under the PGD) signing the PGD, for example, the superintendent pharmacist?
Yes, as it is for the pharmacy owner to determine who should be an authorising manager within their organisation.

Q. Who should complete the authorising manager declaration section on the PGD?
It is for the pharmacy owner to determine who should be an authorising manager within their organisation. The authorising manager’s role is to confirm that individuals providing the service:

• are aware of the service specification and requirements for provision of the service;

• Have completed the appropriate Declaration of Competence self-assessment framework and has printed and signed the statement of declaration (for pharmacists only) or the Flu vaccinator competency assessment tool; and

• Has 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.

Q. What are the knowledge and skills required in order to provide a vaccination service?
The National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners set out the knowledge and skills that healthcare professionals undertaking vaccination services need to have. NHS England has determined that individuals providing the Flu Vaccination Service need to attend face-to-face training for both injection technique and basic life support training periodically.

Pharmacy owners and vaccinators 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 standards 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.

Q. Where can I undertake training to provide vaccination services?
A range of organisations provide training on vaccination. Some LPCs have arranged training, so you may want to check with your LPC about the availability of local training. A list of training providers is also available on the Community Pharmacy England website.

Q. I completed face-to-face training covering injection technique and basic life support last year, but I have been told that unless I vaccinated over a specific number of patients last year I will need to re-do the training again this year. Does this apply to the NHS Advanced Flu Vaccination Service?
No, there is no training requirement linked to the vaccination of a specific number of patients within the NHS Advanced Flu Vaccination Service.

If you are providing private flu vaccinations (not as part of the NHS Advanced Flu Vaccination Service) there may be minimum activity requirements for your training to be valid; this should be verified with the private PGD provider.

Q. I completed face-to-face training for both injection technique and basic life support two years ago; do I need to complete face-to-face training again this year?
Face-to-face training should be completed periodically (previously face-to-face training for both injection technique and basic life support was required every three years).

This requirement means that individuals need to consider their competence and any additional requirements set by their employer to inform a decision on when completion of face-to face training is appropriate.

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

A vaccinator is personally responsible for keeping their knowledge and skills up to date and relevant to their roles and responsibilities. The vaccinator should reflect on their current competencies and decide whether further learning is required.

Q. I completed face-to-face injection technique and basic life support training last year. Do I need to complete online refresher training this year?
There is no requirement in the service specification to complete online refresher training, but the National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners expect vaccinators to undertake annual update training to ensure their knowledge stays up to date with changes in practice and guidance.

Individuals should undertake this training prior to commencing provision of the service each year, to ensure they have up-to-date knowledge in relation to the provision of flu vaccinations in that year and any related matters, such as current guidance on infection control. This update training can be undertaken in a variety of ways, including self-directed learning and use of relevant references sources, such as the Green Book and the annual flu letter. Training can also include the use of online training materials which are available from a range of providers.

Q. There is free flu training available for healthcare professionals on www.e-lfh.org.uk; if I study it and pass the assessments, does it count as annual update training?
It is up to individuals to determine how they wish to do annual update training that meets their needs. This could include, for example, completing a CPPE learning pack, completing online training and assessments, reading relevant books/articles or watching videos.

Q. Is there any other training I should consider?
As well as training specifically on vaccination provision, pharmacy owners and individuals should consider training for themselves or their team on topics such as consultation skills or first aid, or even marketing or time management, as these may better equip them to provide the service. The core vaccination training will cover matters such as management of allergic reactions and the patient consultation.

Individuals may also wish to consider training to support their awareness and understanding of their responsibilities under the Mental Capacity Act. Support with this topic can be found on the Social Care Institute of Excellence website where there are a range of training resources.

Q. How will pharmacy owners determine that their vaccinators have the necessary knowledge and skills to provide the service?
Options for assessing this include completion of the Vaccination services Declaration of Competence (DoC) (for pharmacists and pharmacy technicians only) or the UKHSA Flu vaccinator competency assessment tool. The latter tool 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.

Q. Once a pharmacist or pharmacy technician has completed the DoC self-assessment framework and has printed and signed the statement of declaration, is the DoC process complete?
Once both documents have been completed and signed, the pharmacist or pharmacy technician will be able to demonstrate to the pharmacy owner that they are working for that they have the necessary knowledge and skills to provide the service. However, it is important to complete step 5 of the DoC process ‘Update your CPPE learning record’. This step confirms that the statement of declaration for Vaccination services has been signed.

Q. Since the requirement for face-to-face training for both injection technique and basic life support now needs to be completed periodically (previously this training was required every three years), will the DoC requirement also change so the requirements can be synchronised?
No. The DoC process remains unchanged; this needs to be completed every two years.

Q. If I am a pharmacy professional with a registered address in Wales or Scotland, but I will be working in an English community pharmacy providing the service, how can I access the DoC on the CPPE website?
Pharmacy professionals who work in England but live in Scotland or Wales can make a request to CPPE for their practice location to be changed on their database (telephone 0161 778 4000 or email info@cppe.ac.uk). This will allow the pharmacist access to learning and assessments plus the DoC. Every six months CPPE will automatically check if they still practise in England.

Q. The Vaccination services DoC provides a list of recommended learning and assessments; should all of these be completed?
This is a decision that needs to be made by the individual pharmacy professional. A pharmacy professional is personally responsible for keeping their knowledge and skills up to date and relevant to their roles and responsibilities. Working through the DoC system provides a pharmacy professional with the opportunity to reflect on their current competencies and identify and meet their learning and assessment needs.

The list of recommended learning and assessments will help pharmacy professionals to fill any gaps in their knowledge or competence to provide the Flu Vaccination Service.

Q. If a pharmacist has completed an independent prescribing course, does this mean they meet the Consultation Skills for Pharmacy Practice: Practice Standards for England, and can complete the core competency section in the Vaccination services DoC?
The wording in the core competency within DoC states that pharmacy professionals should be actively working towards the Practice Standards. This is because developing consultation skills is an ongoing process throughout the career of every pharmacy professional. The independent prescribing course will have provided a pharmacist with an element of training on consultation skills to support them in working towards the Practice Standards; however, it would be down to the individual pharmacist to download the Consultation Skills for Pharmacy Practice: Practice Standards for England to see whether they feel the training they have undertaken has sufficiently supported them or whether further learning would be beneficial. If a pharmacist feels they meet the standards and have a good understanding of consultation skills due to the learning they have undertaken, they should attempt the consultation skills e-assessment, which will help assess their skills in this area and provide reassurance of competency.

Q. Is it a requirement to have accessed, but not necessarily completed the Consultation Skills for Pharmacy Practice: e-assessment to be able to provide the Advanced Flu Vaccination Service?
Pharmacy professionals, are not required to have completed the Consultation Skills for Pharmacy Practice: e-assessment before completing the Vaccination services DoC; they are required to meet or be actively working towards the Consultation Skills for Pharmacy Practice Standards for England.

If you confirm that you are actively working towards the standards, you are declaring that you are undertaking the relevant learning and CPD to meet the standards. It is expected that you will have accessed the standards and associated learning to meet this requirement and that you will complete the assessment within 12 months of signing the DoC statement.

As a pharmacy professional, you should continuously seek to develop your consultation skills throughout your career and, therefore, this topic should regularly feature in your CPD plan. To access the assessment, go to the CPPE website. If you have not yet completed the assessment, you should be able to provide evidence of the consultation skills learning you have undertaken.

Q. I completed the DoC two years ago. Do I need to complete it again?
Yes if this is your chosen method to confirm your competency. The DoC framework and statement of declaration need to be completed every two years. Alternatively, competence can be assessed in another way, such as by using the UKHSA Flu vaccination competency assessment tool.

Q. Who does the recommendation for a period of supervised clinical practice apply to?
The document states that those new to immunisation should receive comprehensive foundation immunisation training, either through a face to face taught course or a blended approach of both e-learning and a face to face taught course. New immunisers should also have a period of supervised practice and support with a registered healthcare practitioner who is experienced, up to date and competent in immunisation.

Q. Does the recommendation for a period of supervised clinical practice apply to pharmacists who have previously been trained to vaccinate?
If you have vaccinated patients in the past and consider yourself to be an experienced vaccinator, supervised practice would only be required if you feel it would benefit your professional practice, for example, if a long duration of time has passed since you last vaccinated patients.

Q. I am a pharmacy professional who is commencing immunisation training for the first time, so I can provide the Flu Vaccination Advanced Service. What are the steps I need to take?
If you are a new vaccinator we recommend the following steps:

• Complete your core training (face-to-face and any other learning directed by your training provider);

• Complete the Vaccination Services DoC on the CPPE website or the UKHSA Flu vaccinator competency assessment tool;

• Undertake a period of supervised practice with a registered healthcare practitioner who is experienced, up to date and competent in immunisation; then

• Should any additional training need be identified during your supervised practice, undertake further training and then review your chosen competency tool.

Q. What is the idea behind undertaking a period of supervised practice?
In addition to acquiring knowledge through a theoretical taught course, practitioners need to develop clinical skills in immunisation and apply their knowledge in practice. A period of supervised practice will allow acquisition and observation of clinical skills and application of knowledge to practice when the practitioner is new to immunisation.

Q. What happens during a period of supervised practice?
Before starting to give immunisations, it is recommended that all new immunisers should spend time with an experienced registered practitioner, such as an experienced pharmacist immuniser, who has undertaken training that meets the national minimum standards and is experienced in advising about immunisation and giving vaccines. The new immuniser should have the opportunity in these sessions to observe and discuss relevant issues with the experienced practitioner.

Those new to their role in immunisation should also demonstrate an appropriate standard of practice to their supervisor. This supervised practice should be structured and robust and follow a clear, comprehensive checklist so each step of the consultation is considered. A competency checklist such as that included in Appendix A of the National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners should be used for formal assessment and sign-off of the practitioner’s clinical competency in immunisation. A copy of the completed checklist should be retained in the practitioner’s personnel file.

Q. How long should a period of supervised clinical practice be?
UKHSA advise that there is no agreement or evidence as to how many times supervised practice should occur, but both the supervisor and new practitioner need to feel confident that the practitioner has the necessary skills and knowledge to advise on and/or administer vaccines. If the practitioner administers a range of different vaccines to patients of different ages, their supervisor should ensure this is considered and they should be given the opportunity to observe and be assessed on this range.

Q. Are there any qualifications which apply to the experienced healthcare practitioner
The supervisor does not require a formal teaching and assessing qualification but should be competent in immunisation and can make an assessment of a new immuniser’s knowledge and skills. One of the supervisor’s key roles is to go through the assessment document with the new immuniser and assure themselves that the new immuniser has the appropriate level of knowledge and skill to undertake their role in immunisation.

Q. Can another pharmacist act as the experienced healthcare practitioner within a period of supervised clinical practice?
Yes, if the pharmacist is competent in immunisation and can assess a new immuniser’s knowledge and skills.

Q. How can a period of supervised clinical practice be arranged?
There are several ways a supervision session could be arranged, for example:

• At the point of arranging face-to-face immunisation training, trainees could enquire whether the training provider could arrange such a session;

• New immunisers could speak to the pharmacy owner they work for to enquire whether they could arrange a supervised session with an experienced immuniser, within the same organisation; or

• New immunisers could contact local pharmacist colleagues, who are experienced immunisers, and ask them whether they would be willing to supervise a session within their pharmacy.

Q. I want to develop my own promotional materials for the Flu Vaccination Service, am I allowed to do this?
Yes; however, pharmacy owners must ensure they comply with the requirements of the Terms of Service relating to promotion of services funded by the NHS and if the NHS logo is used in materials related to the service, this must comply with the guidelines for use of the NHS identity by community pharmacies.

The Flu Vaccination page on our website provides links to resources from Community Pharmacy England, UK Health Security Agency and other organisations which pharmacy owners can use if they do not want to develop their own materials.

Q. Can a pharmacy owner provide a patient with any kind of free gift if they have a vaccination under the Advanced Service?
No. The Terms of Service state that a pharmacy must not offer any gift or reward to any person as an inducement to receive any Advanced Service.

Q. If a patient was previously eligible for a flu vaccine but is currently no longer in a risk group, can they still receive a vaccine?
Some patients may have been eligible for a vaccine under the Flu Vaccination Service during previous flu seasons whilst in an at-risk group but may no longer be in that group. Examples could include women who were pregnant during the last flu season but are no longer pregnant or patients who were taking regular inhaled steroids during last flu season but are no longer taking them.

Providing these patients are not in any other risk group as detailed in the service specification, they would not be eligible for a flu vaccination this year under the Flu Vaccination Service.

Q. At what stage of pregnancy should pregnant women be offered the flu vaccine?
All pregnant women should be offered an inactivated influenza vaccine whilst pregnant, regardless of their stage of pregnancy. Studies have demonstrated that pregnant women can safely receive influenza vaccine during pregnancy and that infants also receive some protection from maternal antibodies because of their mother having the vaccination whilst pregnant.

Q. Can the flu vaccine be given to women who are breastfeeding?
Yes. The flu vaccine can be given to breastfeeding women; however, ‘breastfeeding women’ is not an eligible group for the Flu Vaccination Service. Breastfeeding women would only be entitled to a free flu vaccination if they fall into an eligible group listed in the service specification.

Q. Can a homeless person have an NHS flu vaccination?
A homeless person can have an NHS flu vaccination if they fall into one of the eligible groups for the Flu Vaccination Service. Pharmacy owners should also consider the following:

• The homeless person would need to come into the pharmacy, or come to an agreed off-site location that has been assessed by the pharmacy owner as suitable to provide the pharmaceutical service for their vaccine;

• No fixed abode (NFA) can be entered on the record form/IT system in the patient’s address section;

• If a homeless person is registered with a GP practice, notification would need to be sent to the GP practice if appropriate providing as much identifying information as the pharmacy can provide to allow the GP practice to match the information to the relevant person (some areas have specific homeless patient services to allow GP registration and some encourage registration at any GP practice); and

• If a homeless person is not registered with a GP practice, the service can still be provided to the person. Pharmacy staff could encourage the person to register with a practice and explain how to do this.

Q. A patient has requested a flu vaccination, but they seem generally unwell; can they receive the vaccine?
Vaccination may be postponed in those who are acutely unwell until they have fully recovered. This is to avoid confusing the differential diagnosis of any acute illness by wrongly attributing any signs or symptoms to the adverse effects of the vaccine.

Q. Can immunosuppressed patients have the flu vaccine?
Yes, the inactivated influenza vaccine can be safely given to immunosuppressed individuals though they may have a sub-optimal response to the vaccine. Individuals may be immunosuppressed because of a medical condition or because of medical therapy that they are taking. As these patients are at risk of increased morbidity and mortality if they develop influenza, they should be offered the vaccine. Immunosuppression may continue for several months following completion of treatment. If there is any uncertainty regarding an individual’s level of immunosuppression, further advice should be taken from their consultant.

Q. Can patients taking steroids have the inactivated flu vaccine?
Yes, patients taking steroids can be safely vaccinated with inactivated flu vaccine. As systemic steroids at a dose equivalent to prednisolone 20mg or more per day are considered to be immunosuppressive, patients taking steroids are at risk of serious illness if they develop flu and so should be vaccinated. Patients that are receiving high-dose steroids may be immunosuppressed for at least three months after cessation of treatment.

Q. When should patients having chemotherapy have their flu vaccine?
Patients receiving chemotherapy should receive their vaccine at the earliest opportunity. For individuals due to commence immunosuppressive treatments, inactivated vaccines should ideally be administered at least two weeks before commencement. In some cases, this will not be possible and therefore vaccination may be carried out at any time.

Q. If an individual has had confirmed influenza recently and they are in an at-risk group should they still have the vaccine?
Yes, anyone eligible to receive the vaccine should still have it even if they have had confirmed influenza, either recently or in the past. Having the vaccine will help to protect against other circulating strains. The inactivated flu vaccine can be given at any time following recovery providing there are no contraindications to vaccination.

Q. I am unsure whether a patient is eligible to receive a vaccine under the Flu Vaccination Service because their condition is not specifically mentioned as being part of an eligible group in the service specification. What is the best way to proceed?
Pharmacists will need to make a clinical decision as to whether an individual patient falls into an eligible group based on the information in the service specification and consider that eligible groups offered the flu vaccination are those that are most at risk of the complications of flu.  If a pharmacist is unsure if a patient is eligible for an NHS flu vaccination, the patient should be referred to their GP practice.

Q. Can children receive a flu vaccination under the Flu Vaccination Service?
No. The community pharmacy Flu Vaccination Service is for patients aged 18 years and over who fall into an eligible group; it does not cover children.

Q. Should pharmacy teams check with the patient’s GP practice if the patient has already had a flu vaccination?
In most cases the patient will be able to verify if they have received a flu vaccination at their GP practice; however, if the patient is unsure, relevant care records should be checked or the GP practice should be contacted to confirm whether they have already been vaccinated or not to prevent the risk of the patient being vaccinated twice. This is especially important for patients who fall into vulnerable groups such as those with dementia who may not remember if they have been vaccinated or not.

Q. Can children (2-17 years) be vaccinated under the national service if they are allergic to Fluenz Tetra nasal vaccine?
No.

Q. Should pharmacy teams verify the eligibility of patients requesting flu vaccination under the service?
In many circumstances pharmacy teams will know the patients who are requesting vaccination under the service and they will therefore be able to determine whether a patient falls within an eligible group as a result of the knowledge of the patient and their patient medication record. There will, however, be circumstances where the patient is not known to the pharmacy team. In that case it will be necessary for the pharmacist to talk to the patient and to use their professional judgement to determine whether the patient falls within an eligible group.

Q. Are all people with asthma (aged 18 years or over) eligible for an NHS flu vaccination under the national Flu Vaccination Service?
No. People with asthma are entitled to an NHS flu vaccination if they have asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission as stated in the service specification. Therefore, patients who are only prescribed a short-acting β2 agonist to manage their asthma are not entitled to an NHS flu vaccination unless they fall into another eligible group.

Q. Are pharmacy team members an eligible group for flu vaccination within the Advanced Service?
No. Employers may wish to offer pharmacy staff flu vaccinations as part of their occupational health arrangements, but this cannot be undertaken as part of the Advanced Service. If a pharmacy team member is eligible for an NHS flu vaccination and falls into one of the eligible patient groups for the Advanced Service, they would be able to use the service at the pharmacy.

Q. What should I do if a patient requests a vaccination, but they are not eligible under the Advanced Service?
If a patient is not eligible for vaccination under the Advanced Service, but they are eligible for an NHS vaccination (for example, a child in a clinical risk group), they should be referred to their GP practice. If a patient is not eligible for vaccination at NHS expense by any healthcare provider, the patient could be offered a private vaccination service if the pharmacy has appropriate arrangements in place to provide such a service.

Q. Can a patient who lives in one of the other home countries, for example, Wales or Scotland, have an NHS flu vaccine at a pharmacy in England?
Yes. There are no geographical restrictions placed on the provision of the service to eligible NHS patients.

Q. Is a patient with epilepsy eligible for an NHS flu vaccination under the national Flu Vaccination Service?
No. Epilepsy is not considered a high-risk group for flu; therefore, patients with epilepsy are not entitled to an NHS flu vaccination unless they fall into another eligible group.

Q. Do patients with HIV need to stop their antiretroviral treatment for two weeks after immunisation and not be immunised until 48 hours after stopping the antivirals?
No. The HIV Pharmacy Association of the UK has advised that there is no interaction between the influenza vaccine and antiretrovirals used to treat or prevent HIV infection and recommend that it is safe to give patients on antiretroviral therapy the influenza vaccine without compromising either the vaccine or the patient’s HIV treatment.

Q. Are all workers working within registered care home and domiciliary care organisations eligible to receive the Flu Vaccination Advanced Service?
No. Only those workers directly involved in the care of vulnerable patients/clients are eligible. A worker that has no direct contact with a patient/client is not eligible. For example, a member of the catering staff that prepares food for patient/clients would not be considered eligible.

Q. If a person presenting is a social care worker but is also eligible to receive the Flu Vaccination Advanced Service at the community pharmacy because they are part of an ‘at-risk’ group, under which risk category should they be recorded?
The person presenting should be recorded under their ‘at-risk’ group for their eligibility for the Flu Vaccination Advanced Service.

Q. If a patient has a bleeding disorder or is taking oral anticoagulants, do I need to take any special precautions when giving them their flu vaccine?
Information on providing a flu vaccination to a patient who has a bleeding disorder or is taking oral anticoagulants is contained in the PGD.

Q. Can patients with neurological deterioration receive a flu vaccination?
The presence of a neurological condition is not a contraindication to immunisation, but if there is evidence of current neurological deterioration, deferral of vaccination may be considered to avoid incorrect attribution of any change in the underlying condition. The risk of deferring the vaccine should be balanced against the risk of flu and vaccination should be promptly given once the diagnosis and/or the expected course of the condition becomes clear.

This precaution does not apply to individuals with a chronic neurological condition who should be offered vaccine.

Q. Are frontline health and social care workers entitled to both COVID-19 and NHS flu vaccinations as part of the autumn/winter 2024/25 vaccination programme?
All frontline health and social care workers and staff working in care homes for older adults can have an NHS COVID-19 vaccination as part of the autumn/winter 2024/25 vaccination programme.

Under the Flu vaccination Advanced service, an NHS flu vaccination can only be provided to frontline workers in a social care setting without an employer-led occupational health scheme. This cohort, includes those working for a registered residential care or nursing home, registered domiciliary care providers, voluntary managed hospice providers and those that are employed by people who receive direct payments (personal budgets) or Personal Health budgets, such as Personal Assistants.

All other frontline health care workers, including community pharmacy staff, other clinical and non-clinical staff and those working in a social care setting with an employer led occupational health scheme, who have contact with patients, should be offered a flu vaccine from 3rd October 2024 as part of their employers’ policy for the prevention of the transmission of flu. This is part of the employer’s occupational health commitment to meet their responsibility to protect their staff and patients and ensure the overall safe running of services and it is not part of the NHS flu vaccination service.

Social care workers directly working with people clinically vulnerable to flu should also have the flu vaccine provided by their employer where employer schemes are in place.

Q. Which care home and domiciliary care workers are eligible for the Flu Vaccination Service?
Health and social care staff who are eligible for the Flu Vaccination Service are those aged 18 years and over, employed by a registered residential care/nursing home, registered domiciliary care provider or a voluntary managed hospice provider who are directly involved in the care of vulnerable patients/clients who are at increased risk from exposure to influenza. Vulnerable means those patients/clients in a clinical risk group for flu or aged 65 years and over (including those becoming age 65 years by 31st March 2025), are eligible to be vaccinated by community pharmacies.

Q. Is there a definition of carers who are eligible for the Flu Vaccination Service?
The Carer’s Trust defines a carer as anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support. Unpaid carers may or may not be receiving Carer’s Allowance.

A paid carer is someone that is employed to care for a patient and support their individual needs. Paid carers can work in a variety of settings, including residential homes, nursing homes or at home with the patient.

Health and social care workers employed through Direct Payments (personal budgets) and/or Personal Health Budgets, such as Personal Assistants, to deliver domiciliary care to patients and service users are also eligible for a flu vaccination.

Q. Does a social care worker need to provide evidence that they work within a relevant organisation?
No, that is not required, but if evidence can be provided, it may help speed up the process when they present in the pharmacy. We have provided a template that pharmacies can give to local care provider organisations, for them to add to their letterhead and provide to staff.

Q. How do I verify eligibility for vaccination for the newer cohorts?
Household contacts of immunocompromised individuals should usually be confirmed as living at the same address as the immuno-compromised individual. Eligible individuals are expected to share living accommodation with an immuno-compromised person on most days over the winter, and so continuing close contact in this case would be unavoidable.

Social care workers employed through direct payment (personal budgets) and/or personal health budgets, such as personal assistants, to deliver domiciliary care to patients and service users can present a letter agreed by the Government and provided and signed by their employer confirming their eligibility for vaccination.

Other eligible social care workers have been advised that there is no requirement to present ID to receive a vaccination. Social care employers have been advised to provide staff with a letter they can present stating they are a social care worker, which will help show eligibility to providers, but this is not a requirement.

However, at all times, the provider of the flu service should use their own judgement to assess if the patient is eligible if no formal proof is available.

Q. Are people aged 64 years who turn 65 by 31st March 2025 eligible for an NHS flu vaccination?
Yes.

Q. Can I administer flu vaccinations at an individual patient’s home?
Yes. This is permitted where it is requested by the patient.

Q. Do I need to obtain consent from the local NHS England team before vaccinating a patient in their own home?
No.

Q. A patient has requested a flu vaccination in their own home; do I need to let the patient’s GP practice know before I vaccinate the patient?
No.

Q. Do I need to obtain consent from the local NHS England team before vaccinating a patient in a care home or care facility?
No.

Q. A care home has requested flu vaccinations for their residents; do I need to let the patients’ GP practices know before I vaccinate the patients?
No.

Q. Can community pharmacies provide vaccinations to social care workers or hospice workers at their place of work?
Yes.

Q. Can we provide other services to patients in their homes at the same time as the Flu Vaccination Service?
This may be possible, but pharmacy owners must ensure they follow the requirements in the service specification for each service they intend to carry out.

Q. Is there an additional payment for vaccinations administered off-site?
No.

Q. Can I administer flu vaccinations at premises other than the pharmacy?
Yes.

Q. Would people living in supported accommodation such as sheltered accommodation fall into the ‘people living in long-stay residential care homes or other long-stay care facilities’?
No. People living in supported accommodation such as sheltered accommodation would not fall under the eligible group ‘people living in long-stay residential care homes or other long-stay care facilities’.

Q. Can patients living in sheltered accommodation receive an off-site flu vaccination?
Yes, if the patient falls into one of the eligible groups as listed in the service specification, they can receive an off-site vaccination if they live in sheltered accommodation as this is their place of residence.

Q. Can I administer flu vaccinations at a person’s place of work?
Yes. Provided patients fall under one of the eligible groups.

Q. Are health and social care staff working in sheltered housing accommodation, for example, warden-controlled flats, eligible to receive the Flu Vaccination Service?
No. Sheltered housing providers are not regulated by the Care Quality Commission (CQC) and are therefore not required to be registered, so their staff do not fall within the definition set out in the service specification. However, if a registered domiciliary care provider has staff that attend sheltered housing accommodation to support patients, then these staff will be eligible for the Flu Vaccination Service.

Q. Are health and social care staff working in extra-care housing (also called assisted living) eligible to receive the Flu Vaccination Service?
Yes. Unlike sheltered housing, extra care housing is regulated by the CQC. Therefore, if staff are directly involved in the care of vulnerable patients/clients who are at increased risk from exposure to influenza these staff would be eligible for the Flu Vaccination Service.

Extra-care housing (also called assisted living) offers more support than sheltered housing but still allows clients to live independently. Clients live in a self-contained flat, with their own front door, but meals may be provided. Personal care and support services are generally available on-site 24 hours a day. Some extra care housing is available to buy or rent privately and some is available from the local council following a needs assessment. This type of housing isn’t available in all areas.

Q. I only have stock of QIVe; can I vaccinate people aged 18 to under 65 years with QIVe?
The NHS guidance and the legal frameworks require pharmacy owners to offer QIVc to people aged 18 to 64 years and for those aged 60 to 64 years to offer QIVc or High-dose quadrivalent influenza vaccine (QIV-HD). Only when every attempt to use QIVc or in the case of 60 to 64 years also QIV-HD, has been exhausted, can QIVe be considered. Evidence of this may be requested by NHS England before reimbursement is agreed.

Q. I only have stock of QIVc available; can I vaccinate people aged 65 years or older with QIVc?                                          The NHS guidance and the legal frameworks require pharmacy owners to offer aQIV or a QIV-HD vaccination to people aged 65 years and over. An alternative second line vaccine should only be used if there is no first line vaccine available to order and every attempt to use first line recommended vaccines has been exhausted – evidence of this may be requested by NHS England before reimbursement is agreed.

In November 2024, NHS England published guidance, via their Primary Care Bulletin, highlighting that the High-dose quadrivalent influenza vaccine (QIV-HD), a first line vaccine for the 65 years and over cohort, as advised in the amendment to the annual flu letter, is available to order from Sanofi. NHS England has advised that where first line vaccines are temporarily unavailable, pharmacy owners may need to consider rearranging clinics or signposting people to alternative providers until they have a first line vaccine available.

It is recommended that aQIV is offered ‘off label’ to those who become 65 years before 31st March 2025.

Q. Will my pharmacy need to be registered with the CQC to provide the service?
No. The CQC does not regulate community pharmacies in relation to the provision of pharmaceutical services (including administration of vaccines); that is the role of the General Pharmaceutical Council.

Q. What should I do if a patient has inadvertently been given a second dose of inactivated flu vaccine?
It is not harmful to have extra doses of the inactivated flu vaccine. Any adverse reaction to an extra dose is likely to be similar to those commonly seen after a scheduled dose of flu vaccine such as local redness/pain at the injection site, malaise etc. The patient should be offered reassurance and your patient safety incident reporting and review procedure should be followed.

Q. Do you need to expel the air bubble in a pre-filled syringe before administering the flu vaccine?
No, you shouldn’t get rid of the air bubble unless specifically stated in the vaccine’s SPC. To try to expel it risks accidently expelling some of the vaccine and therefore not giving the patient the full dose. The air bubble is also there for a reason – the air injected into the muscle forms an airlock preventing the medication seeping out along the needle tract into subcutaneous tissue and onto the skin. The small bolus of air injected following administration of the vaccine clears the needle and prevents a localised reaction to the vaccination.

Q. What should I do if there is a power failure to the fridge containing the flu vaccines?
You should refer to the Vaccine incident guidancedocument and the vaccine product’s Summary of Product Characteristics. Further advice could be obtained from your local screening and immunisation team.

Q. Can a pharmacy buy vaccines direct from the manufacturer?
Yes.

Q. Do patients who are not exempt from prescription charges have to pay a prescription charge for the flu vaccination that is administered as part of the service?
No.

Q. Is it mandatory for a pharmacy to have a Standard Operating Procedure (SOP) for the service?
Yes.

Q. Do we need to have a needle stick injury procedure?
Yes.

Q. Do pharmacy owners have to arrange their own clinical waste disposal service to dispose of waste resulting from the Flu Vaccination Service?
Yes.

Q. What would normally be contained in an anaphylaxis pack?
The Green Book states that an anaphylaxis pack normally contains two ampoules of adrenaline (epinephrine) 1:1000, four 23G needles and four graduated 1ml syringes, and Laerdal or equivalent masks suitable for children and adults. The mask for children would only be required if the pharmacy is providing a vaccination service to children; the Advanced Service does not include the vaccination of children.

Q. Can I use an adrenaline auto-injector to treat anaphylaxis?
The Green Book states that auto-injectors for self-administration of adrenaline should not be used as a substitute for a proper anaphylaxis pack (see above). However, if an adrenaline auto-injector is the only available adrenaline preparation when treating anaphylaxis, health care providers should use it.

Q. If a pharmacist or pharmacy technician administers adrenaline in an emergency to treat anaphylaxis, is a PGD required to authorise the administration?
No.  Regulation 238 of the Human Medicines Regulations 2012 allows adrenaline to be administered by anyone for the purpose of saving life in an emergency.

Q. How long should a patient be observed for following administration of the flu vaccination to ensure they do not have an anaphylaxis reaction?
The Green Book states in the Anaphylaxis section in Chapter 8 Vaccine safety and the management of adverse events following immunisation(Page 57-58) ‘Onset of anaphylaxis is rapid, typically within minutes, and its clinical course is unpredictable with variable severity and clinical features.

Practical and clinical guidance for vaccine administration from the Royal College of Nursing (RCN) – Observation times after administering a vaccine states, the majority of reactions will occur within two minutes and some occur hours later. The advice from the RCN is that there is no need to keep patients waiting unless this is specifically indicated in the summary of product characteristics for a particular vaccine.

Q. What should I do if a patient requests or is eligible for another vaccination, for example, a pneumococcal vaccine?
Unless the pharmacy is commissioned at a local level to provide additional vaccinations, the patient should be referred to their GP practice.

Q. What are the storage requirements for vaccines?
Vaccines should be stored in line with the requirements set out by their manufacturer in the Summary of Product Characteristics. The former National Patient Safety Agency issued an alert in 2010 giving guidance on vaccine cold storage for all healthcare providers, including community pharmacies.

Q. What records should I make if a patient has an adverse reaction to a vaccine?
A record of any adverse reaction from a flu vaccine and any treatment administered or advised should be made by the pharmacy. Where the adverse reaction is deemed to be clinically significant by the pharmacist, this information may also be shared with the patient’s GP practice. Pharmacists are reminded to report all serious suspected ADRs, even if the effect is well recognised, and all suspected ADRs linked to new medicines and vaccines to the Medicines and Healthcare products Regulatory Agency (MHRA) via the Yellow Card scheme. New medicines and vaccines that are under additional monitoring are indicated by an inverted black triangle symbol (▼) displayed in their package, leaflet and summary of product characteristics.

Pharmacy professionals can report suspected side effects to the MHRA via:

• the Yellow Card website; or

• the free Yellow Card app, downloadable from the Apple App Store or Google Play Store.

Q. Must patient consent be recorded in writing?
No. Patient consent can be obtained verbally and should be recorded in the pharmacy’s clinical record for the service. A signed consent record is not required.

Some patients may be unable to provide verbal or written consent, but this is not synonymous with lacking capacity. The individual just needs to be able to communicate their decision clearly and this decision should then be captured in the pharmacy’s clinical record for the service.

Q. Can I vaccinate a person who seems unable to understand consent?
Where there is a concern that a patient may not have the capacity to provide informed consent, pharmacists should ensure that an appropriate mental capacity assessment is conducted. A process to support pharmacists meet their responsibility under the Mental Capacity Act (MCA) and provide appropriate care for their patient is available here.

Q. Does the patient’s GP practice always need to be informed of the vaccination administered to their patient?
Yes.

Q. A local GP practice is communicating incorrect information to their patients about the community pharmacy Flu Vaccination Service. What should I do?
Talk to the practice manager at the GP practice to raise your concerns and try to get them to correct any misleading information that is being provided to patients. You should also let your LPC know about the matter and agree with them whether they or you will notify the regional NHS England team.