Adult 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 2024/25 flu season.

During the 2024/25 season, for the first time adult groups (excluding pregnant women) were eligible for vaccination from 3rd October, rather than 1st September as in previous seasons. Therefore, data from UKHSA for those aged 65 years and over, and those aged under 65 years in clinical risk groups, is not comparable with previous seasons. As in previous seasons, pregnant women were eligible from 1st September.

Data from 1st September 2024 to 28th February 2025 in England, indicates that the NHS vaccination service vaccinated:

• 74.9% of those aged 65 years and over, compared to 77.8% in 2023/24;
• 40% of those in the under 65 years in one or more clinical risk groups, compared to 41.4% in 2023/24; and
• 35% of pregnant women, compared to 32.1% in 2023/24.

The Government continues to want the influenza programme for 2025/26 to demonstrate a 100% offer and aim to equal or improve on the 2024/25 uptake for each eligible group.

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/winter 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 aims of this Advanced service are:

• To sustain and maximise uptake of seasonal influenza vaccine in at risk groups by continuing to build the capacity of community pharmacies as an alternative to general practice attendance;
• To protect those who are most at risk of serious illness or death should they develop seasonal influenza, by offering protection against the most prevalent strains of the seasonal influenza virus through administration of seasonal influenza vaccination to eligible patients; and
• To provide more opportunities and improve convenience for eligible patients to access seasonal influenza vaccinations.

Service specification

Service specification for the Adult Flu Vaccination Advanced Service 2025/26  (published 21st July 2025)
The service specification describes the requirements for provision of the service and it is essential reading for all vaccinators providing the service.

---

NHS England’s Seasonal Vaccinations Site Campaigns Guide Autumn/Winter 2025-26

NHS England’s site campaigns guide collates key information on the adult and child flu vaccination services and the COVID-19 vaccination service:

NHS England’s Seasonal Vaccinations Site Campaigns Guide Autumn/Winter 2025-26 (FutureNHS collaboration platform)
If you do not have access to the FutureNHS platform, you can register directly on the site using an NHSmail email address.

---

Patient Group Direction

A national TEMPLATE Patient Group Direction (PGD) has been used by NHS England regional teams to create the PGD authorised for use within their region.

Copies of the regional PGDs can be found via the links below. These regional PGDs provide one of the two legal mechanisms for administration of flu vaccine under the service; pharmacy owners need to use the locally authorised PGD for the region in which their pharmacy is located.

• East of England – NHS England — East of England » Patient group directions
• London – NHS England — London » Immunisations
• Midlands – NHS England — Midlands » Patient Group Directions
• North East and Yorkshire – NHS England — North East and Yorkshire » Patient Group Directions Yorkshire and the Humber
• North West – NHS England – North West Inactivated Influenza Vaccine v14.0 PGD_FINAL
• South East – NHS England — South East » South East Patient Group Direction
• South West – NHS England — South West » NHS England South West – Patient Group Direction

The practitioners who can legally administer under the PGD will be listed in the Qualifications and professional registration section of the PGD and this will mirror the groups of practitioners authorised to supply or administer medication via a PGD under current legislation. Any listed practitioners must provide the service under the oversight of the Responsible Pharmacist at the pharmacy.

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 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 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.

Any questions on the PGD should be emailed to immunisation@ukhsa.gov.uk.

---

National protocol

National protocol for inactivated influenza vaccine 2025/26 (published 28th July 2025)
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.

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, doctor or nurse, 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 GOV.uk 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 the clinical supervisor. 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.

Any questions on the National protocol should be emailed to immunisation@ukhsa.gov.uk.

---

Service Directions and Determination

Service Directions

---

Service start date and duration

The timings for the service are set out in the Annual flu letter:

• From 1st September 2025, pharmacies will be able to vaccinate pregnant women; and
• From 1st October 2025, vaccination of the other adult cohorts can commence.

Payment to all providers, will only be made for flu vaccinations administered from the service commencement date onwards. NHS England asks that following the service commencement date, pharmacy owners should maximise administration of flu vaccines by 30th November 2025.

The service will close on 31st March 2026.

---

Eligible patients

The Annual flu letter confirms the eligible cohorts for the 2025/26 season.

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.

Pharmacy owners are not authorised to administer flu vaccines to other patient groups as part of the Adult 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 (PGD/national protocol).

---

Vaccines for use in the service

The Annual flu letter confirms the vaccines to be used in the service.

To receive payment for the Flu Vaccination Service and reimbursement of flu vaccine pharmacy owners will need to use the specific flu vaccines outlined in the annual flu letter for the appropriate cohort and administer vaccines in line with the announced and authorised patient cohort. NHS England will actively recover any payments made for the incorrect vaccine administered.

Ahead of the flu season first line vaccines should always be ordered for a given patient cohort.

Once the vaccination campaign has started, if pharmacy owners need additional stock, second line vaccines should only be ordered if first line options are not available to order. Clinics should be planned using the recommended first line vaccine.

Where a pharmacy owner does not have a first line vaccine in stock, patients should be directed to an alternative provider who has stock of a first line vaccine or be asked to rebook when the new stock is available.

Vaccination with a second line vaccine should only be considered on an exceptional basis where there is a valid reason why the patient may not return for a further appointment. Pharmacy owners should aim to minimise the need for this by procuring adequate stock before the Flu Vaccination Service starts.

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

• Pharmacy owners must be satisfactorily providing all Essential Services and be compliant with the clinical governance requirements of the Community Pharmacy Contractual Framework (CPCF).
• Staff who will provide the service must be competent to provide the service (see section on training requirements and resources for further details).
• Staff who provide the service must have a Disclosure and Barring Service (DBS) certificate if they intend to provide the service in patients’ homes.

Other requirements or matters that pharmacy owners should consider before providing the service are detailed below.

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

Download the pharmacy owner checklist for the NHS Adult Flu Vaccination Service

Pharmacy professional checklist

Download the vaccinator implementation checklist for the NHS Adult Flu Vaccination Service
This checklist provides suggested actions that vaccinators need to undertake to prepare to provide the service.

---

Standard operating procedure (SOP)

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, and which covers the following points as a minimum:

• The provision of the service to patients and the roles of different staff members, including the training required for staff members;
• The ongoing conditions under which the service needs to be provided (set out 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.

---

Premises requirement

The pharmacy must have a consultation room in which to provide the service, which meets the requirements of the Terms of Service.

The vaccination must take place in the consultation room wherever the patient or their carer expresses this preference.

Vaccinations can also be offered in any area of the pharmacy where suitable facilities are available, infection prevention and control standards can be maintained and patient confidentiality and dignity are able to be respected.

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.

Pharmacy owners must appropriately dispose of any clinical waste or personal protective equipment (PPE) used during the vaccination process and will therefore need to ensure they have contracted for a suitable clinical waste disposal service for their pharmacy premises.

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); see the Provision of the service off the pharmacy premises section below.

---

Professional oversight

The Responsible Pharmacist at the registered pharmacy premises is professionally responsible for overseeing this service.

If the Responsible Pharmacist is unable to provide sufficient oversight, for example due to workload or where vaccinations are undertaken off the pharmacy premises, an on-site pharmacist or pharmacy technician responsible for the delivery of the service must be linked and work closely with the Responsible Pharmacist and Superintendent Pharmacist through an appropriate governance framework to ensure appropriate oversight of the 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.

---

National Booking Service (NBS)

If a pharmacy owner would like to take up the offer of use of the NBS, they were asked to complete an NBS flu form by 11th August to receive login details before 18th August 2025. Later applications (open until 9th March 2026) will receive their login details within 10 working days.

To register, pharmacy owners will need to provide their pharmacy ODS code (F code), and the name and NHSmail email addresses of two pharmacy representatives who will be given access to NBS. Following registration, the representatives will be sent login details, training details and further information.

NBS opened for all participating sites to post flu (and COVID-19) appointments from 18th August 2025  and it opens for bookings from the public from 1st September 2025 for vaccinations from 1st October 2025.

The last available appointment date on NBS will be 31st March 2026 for both flu and COVID-19 vaccinations.

Read more about NBS in NHS England’s site campaigns guide:

NHS England’s Seasonal Vaccinations Site Campaigns Guide Autumn/Winter 2025-26 (FutureNHS collaboration platform)
If you do not have access to the FutureNHS platform, you can register directly on the site using an NHSmail email address.

Any queries on NBS should be emailed to england.vacspolicyandcontracts@nhs.net.

---

NHS Profile Manager

Pharmacy owners should make sure that when they start to provide the Adult Flu Vaccination Service that they update NHS Profile Manager to show that they are a provider of the service.

This will ensure that the Find a pharmacy that offers free flu vaccination tool on the NHS website will be able to direct people to your pharmacy, as well as showing as a service that you deliver on your pharmacy’s NHS website profile.

---

Provision of the service off the pharmacy premises

Vaccinations can also be undertaken in other suitable locations, such as in the patient’s home, or community venues (e.g. community centres).

Pharmacy owners must obtain consent from the NHS England regional vaccinations team if they wish to carry out vaccinations at a location off the pharmacy premises.

The local approval process will be communicated by your NHS England regional vaccination team and further information should be available via your Local Pharmaceutical Committee.

In addition to getting permission from NHS England, there are various matters that a pharmacy owner will need to consider ahead of any provision of the service off the pharmacy premises, including:

Professional oversight: Where vaccinations are undertaken off the pharmacy premises, pharmacy owners must ensure there is an on-site pharmacist or pharmacy technician responsible for the delivery of the service (or delivering the vaccination service themselves) and who will ensure provision of the service is in line with the requirements of the service specification.

Setting used for vaccination: pharmacy owners must ensure that the setting used to administer the vaccinations is appropriate, including ensuring patient confidentiality and dignity.

Support staff: vaccinators should consider being accompanied by a trained pharmacy support staff member. The primary role of the support staff member would be 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 appropriately dispose of any clinical waste or personal protective equipment (PPE) used during the vaccination process. That should include ensuring they meet the requirements of waste disposal legislation in relation to 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 must ensure they continue to comply with all professional standards.

Any planning or risk assessments undertaken ahead of off-site provision 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.

Indemnity insurance: pharmacy owners must ensure their professional indemnity cover applies to provision of the service off the pharmacy premises.

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

Staff providing the service and administering vaccines will need to be authorised to operate under the PGD (or national protocol if being used). That means the service will generally be provided by pharmacists and pharmacy technicians within community pharmacies, but other registered healthcare professionals able to operate under a PGD may also administer vaccines using that legal route. As described above, use of the national protocol allows greater use of skill mix in the provision of the service.

Any 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 and knowledge needed to do so, including working within the relevant systems and processes set out by the pharmacy owner and understanding how to report concerns, should any be identified.

---

The content of vaccination training

Vaccinators providing the service must have undertaken appropriate training in line with the National minimum standards and core curriculum for vaccination training.

This document describes the training that should be given to all practitioners engaging in any aspect of immunisation so that they are able to confidently, competently and effectively promote and administer vaccinations.

The document was updated in June 2025 and replaces the previous training standards for registered healthcare practitioners and healthcare support workers.

Pharmacists, pharmacy technicians and other vaccinators who will administer flu vaccines must have completed practical training in vaccination that meets the requirements set out in the document.

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, pharmacy technicians and other vaccinators providing the service need to attend face-to-face refresher training periodically.

This refresher training should help to ensure consistency of practice, provide peer support and allow discussion of any clinical issues that are arising in practice.

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.

---

Understanding the relevant clinical guidance

The service specification requires that the pharmacy owner ensures vaccinators have read and understood the clinical guidance available in relation to the service and that they have a process in place to check any updates to these documents.

The key sources of clinical guidance in relation to this service will be:

Immunisation against infectious disease: the green book (Chapter 19 Influenza)

National Patient Group Direction 2025/26

National protocol for inactivated influenza vaccine 2025/26

---

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 National minimum standards and core curriculum for vaccination training recommends 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.

Pharmacy owners must ensure that vaccinators are competent to provide the service and they must keep evidence of competency relating to any staff that they employ or engage to provide the service.

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 professionals providing the service can demonstrate their competence to the pharmacy owner.

Alternatively, the competence of any vaccinators can be assured using the National minimum standards and core curriculum for vaccination training competency assessment tool in appendix A of the guidance.

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 appropriate update training and the appropriate vaccination 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 provide the service.

---

Training resources

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

---

Training providers

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

CB Training

ECG Training

Health Academy – The Flu Hub

Health and Safety Group

Immunisations UK

National Pharmacy Association (Registration required)

Numark (Members only)

Pharmacy Foundations

Rx Advisor

Voyager Medical

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

---

Community Pharmacy England resources

We have developed additional resources which pharmacy owners can use to assist with their understanding, implementation and provision of this service to patients. 

Implementation guidance

Pharmacy owner checklist for the NHS Adult Flu Vaccination Service
A checklist to help pharmacy owners to prepare for and to provide the service. 

Vaccinator implementation checklist for the NHS Adult Flu Vaccination Service
This checklist provides suggested actions that vaccinators need to undertake to prepare to provide the service.

---

Joint guidance and briefing documents

National flu immunisation programme letter 2025/26 (the Annual Flu letter) (updated 13th February 2025)

Update to the Annual flu letter (published on 28th July 2025)

---

NHS England resources

Seasonal Vaccinations Site Campaign Guide AW2025 / 2026 (1st September 2025) (Future NHS log-in required)

---

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 2025/26, including ovalbumin content (6th June 2025)

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 immunisation for social care staff

Immunisation against infectious disease: the green book (Chapter 19 Influenza)

UKHSA Vaccine Update bulletin (including flu special edition (1st September 2025))

---

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)

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

---

Patient consent

As with the provision of any pharmacy service, prior to vaccination, informed verbal consent must be sought from the patient for the administration of the vaccine.

Informed consent should be recorded in the pharmacy’s clinical record.

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

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 and the UK Health Security Agency for managing and monitoring vaccination programmes. Data that has been pseudonymised may be used for evaluation and research purposes.

---

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 and , where applicable, their carers should be informed about the likely timing of potential adverse events relating to each vaccine. If the vaccines are not given together, they can be administered at any interval.

If  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.

---

Flu vaccinations for pharmacy staff

As has been the case for many years, in the Annual Flu letter, DHSC, UKHSA and NHS England advise that all frontline health and social care workers should receive a flu vaccination this season. However, this should be provided (i.e. funded) by their employer, to meet their occupational health responsibility to protect their staff and patients and ensure the overall safe running of services.

---

Service records, IT support and sharing of data

Pharmacy owners must use an NHS-assured Point of Care System to record the administration of vaccinations.

For the 2025/26 flu vaccination season, NHS England has agreed to fund the cost of the Point of Care System through a new community pharmacy Point of Care (PoC) IT Supplier Contractual Framework. This allows pharmacy owners to choose which PoC system they use to make their clinical records for the Flu Vaccination Service (and COVID-19 Vaccination Service) during the Autumn/Winter 2025/26 campaign.

IT system suppliers held webinars at the end of July/beginning of August to allow pharmacy owners and team members involved with IT system supplier decisions or who are interested in considering whether to switch IT suppliers with information about their systems and what they offer.

View recordings of the webinars (FutureNHS collaboration platform)
If you do not have access to the FutureNHS platform, you can register directly on the site using an NHSmail email address.

Read more about the NHS-assured Point of Care Systems for recording vaccinations

General requirements related to record keeping:

• Pharmacy owners must maintain appropriate electronic records to ensure effective ongoing service delivery. Records must be managed in line with the Records Management Code of Practice for Health and Social Care.
• Pharmacy owners must ensure that the vaccination event is recorded on the same day that it is administered unless exceptional circumstances apply.
• Pharmacy owners must ensure vaccination records are complete and include all of the required fields about the patient.
• Pharmacy owners must ensure that any staff recording the administration of the vaccination have received relevant training to be able to update records appropriately and accurately.
• Where the Point of Care system is unavailable due to exceptional circumstances beyond the control of the pharmacy owner, then the record of vaccination events must be added to the it as soon as possible after the system becomes available again.
• Where a record of a vaccination needs amending or has not been created on the point of care system, the pharmacy owner is responsible for undertaking the amendment or creation as soon as reasonably possible following notification from the patient or another healthcare professional that the record is not complete or correct.

Use of Point of Care IT systems:

• There must be robust user and access management processes to ensure high levels of security in relation to staff access to the point of care system. That should include frequent updates to system access levels to add users who join the pharmacy team or remove accounts where staff leave or do not have shifts scheduled at the pharmacy.
• Only one point of care system can be used to record vaccinations in any calendar month except where it is necessary to make amendments to previously recorded vaccination events or where this has been agreed with NHS England during the transition to a new point of care system.

Retention of records:

• Records must be managed in line with the Records Management Code of Practice for Health and Social Care.
• The necessary records required for reimbursement must be kept for a period of three years to demonstrate the service was delivered in accordance with the service specification, and to assist with PPV activities. These records must be provided by a pharmacy owners when requested by the NHSBSA Provider Assurance Team.
• Pharmacy owners should ensure that clinical records for the service are retained for the appropriate period. This retention period may be beyond the specified period for PPV purposes and should be in line with both the requirements for the record type and the age of the person being vaccinated. You can find links to further guidance on this topic on our Data handling, record keeping and disposal webpage.

Sharing of data:

• Data recorded via the Point of Care System regarding the patient’s vaccination will be shared with the patient’s registered general practice (where this is known) automatically on the day of provision or on the following working day. This will be sent as a structured message in real-time by the point of care system.
• If the structured message system is not available or fails, the pharmacy contractor must ensure a copy of the vaccination notification is sent or emailed via NHSmail to the patient’s registered general practice as soon as reasonably possible.
• Some of the data recorded in the Point of Care System will be shared via an application programming interface (API) with the NHSBSA’s MYS platform as part of normal payment arrangements.
• Pharmacy owners must promptly comply with any reasonable request for information from NHS England (or an organisation acting on their behalf) relating to this service.
• Personal data recorded in Point of Care Systems will flow to NHS England for managing and monitoring vaccination programmes; it will also be shared with the UKHSA under a Data Sharing Agreement.
• Data that has been pseudonymised may be used by the NHS for evaluation and research purposes.

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.

Adult Flu Vaccination Service record form (Microsoft Word)

Adult Flu Vaccination Service record form

---

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 and appropriate action taken in a timely manner when readings are outside the recommended temperature.

---

Information for patients/carers

Each patient  being administered a vaccine (or their carer) 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.

---

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 where vaccinations are carried out 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.

---

Communicating and working with GP practices

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

Data recorded via the point of care IT system regarding the patient’s vaccination will be shared with the patient’s registered general practice automatically on the day of provision or on the following working day. This will be sent as a structured message in real-time by the point of care system.

If the structured message system is not available or fails, the pharmacy owner must ensure a copy of the vaccination notification is sent or emailed (via NHSmail) to the patient’s registered general practice as soon as reasonably possible.

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 and a Yellow Card report submitted.

---

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 ICB primary care contracting team and their LPC.

Sometimes examples of such information get circulated via social media and other routes, which can create a larger issue from a single 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.

---

Dealing with incidents arising from the provision of the service

If an incident occurs in relation to the service, pharmacy owners are required to report any patient safety incidents in line with the Clinical Governance Approved Particulars for pharmacies.

Where necessary, the pharmacy owner is also expected to follow UKHSA’s Vaccine incident guidance: responding to errors in vaccine storage, handling and administration.

---

Withdrawal from provision of the service

Pharmacy owners must ensure they update NBS and NHS Profile Manager if they wish to stop providing the service.

Community Pharmacy England resources

We have developed a range of materials which pharmacy owners can use to promote the availability of this service to patients. 

Our shared folder (link below) allows you to download the latest versions of the following resources: 

• Posters for display (both ready to use and editable versions); 

• Suggested social media graphics and messages; 

• Letters to eligible patients and local care providers; 

• Flyers for attaching to prescription bags; 

• Template local press releases; 

• Radio scripts; and 

• Materials to support hosting an MP pharmacy flu jab visit. 

Download here: Flu Vaccination Service promotional materials 

---

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 (the leaflet describes the vaccines, including the flu vaccine, that are recommended during pregnancy) and the COVID-19 vaccination: a guide on pregnancy and breastfeeding leaflets (2021)

---

Developing your own marketing materials

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.

---

Identifying carers 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.

We have previously worked with Carers Trust and they 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 medicines 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 medicines, 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.

---

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 has 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.

Funding

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.

Read about our view on the service fee for 2025/26

---

Claiming payment

The point of care 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 within the NHSBSA’s 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 October will be available to view in MYS on 1st November. Pharmacy owners will need to log into the MYS portal 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. The exception to this is where the submission of a claim was delayed by IT issues outside the pharmacy owner’s control (such as issues with the NHS approved API system used by the pharmacy owner or with the MYS portal). Such claims will be accepted outside the usual grace period within 12 months of the date by which the claim should have been submitted. This is subject to the NHSBSA receiving evidence of the IT issue, and only if investigation finds that the evidence demonstrates that the IT issue was outside the control of the pharmacy owner, and it delayed the claim submission.

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.

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.

---

Community Pharmacy England resources to assist LPCs with promoting for the service will be available soon.

Visit the Flu Vaccination – Statistics page for statistics on the service.

At Community Pharmacy England, we are always keen to hear from pharmacy owners and their teams about how the provision of national pharmacy services is going, be that niggles with the way services are commissioned, a success story you want to share or something else.

Please click on the link below to share a success story where you have helped achieve a good outcome for a patient following a consultation for a national pharmacy service or to provide feedback on one of the services.

Provide feedback on national pharmacy services