In the 2017/18 season 77% (8981) of pharmacy contractors in England signed up for the NHS service last year and delivered 1,344,462 flu vaccinations to eligible groups and was worth over £12million in fees to the sector. There was an average of 150 vaccinations per pharmacy, 33% up on 2016/17, with six pharmacies doing more than 1000 and many also providing private flu vaccinations under a separate PGD to non-eligible groups and local employers.
This increased the reach of the whole NHS flu vaccination programme, however overall performance still falls below government targets for at risk groups and over 65s. Community pharmacies are well placed to have a significant impact on the health and wellbeing of the communities they serve through the delivery of an accessible, high quality flu vaccination service.
Start planning now
Start planning now to ensure that implementation and delivery is optimised for the benefit of your community and your future professional business. This is what mainly differentiates those pharmacies which deliver more that the average number of vaccinations from those who deliver less. You can find your performance data and that of the pharmacies and providers in your area on PharmData.
The key steps to a successful service are:
1. Engage your team
Delivering an effective service is a team effort so it is important that everyone understands why it is important to you, your pharmacy, your community and them. Involve the team early in the planning process so that they can help to shape the plan, take on responsibilities and feel ownership. This requires putting aside time together, asking questions and actively listening. Once everyone in the team is on-board, build the plan together and agree who does what and by when, being clear about expectations.
It is also important at this stage to engage the wider healthcare team, e.g. local GP practices. The sooner you have that conversation the less likely there is to be conflict. You have the opportunity to work together to target eligible groups that they struggle to reach – complete, not compete.
2. Understand the service requirements
The service specification and directions for the 2018/19 service have been released with some additions to eligible groups and the opportunity to vaccinate patients in their own homes. There are also some changes to the paperwork and an improved service fee. You should ensure that you and your team understand what is involved and we recommend that you read the PSNC Flu Briefing for the latest information. In some areas your Local Pharmaceutical Committee (LPC) may have negotiated some additional elements for the service such as other eligible groups or additional vaccines, e.g. pneumococcus, so check with your LPC now.
NHS England has issued guidance on the 2018/19 service with pharmacies advised that due to rationed deliveries, they should take a “three-phased prioritisation approach” to vaccinating patients aged over 65. This will require careful planning for recruitment and delivery. The guidance states that the adjuvanted trivalent vaccine (aTIV) should be offered to all patients aged 65 and over. Priority should be given to patients aged over 75 years or those in a care home, followed by those aged 65-74 years in a clinical risk group, then other patients aged between 65 and 74.
Patients in the eligible at risk groups between 18-65 years should receive the quadrivalent vaccine (QIV).
Pharmacies are advised that where the appropriate vaccine is available, and an eligible patient presents at the pharmacy seeking vaccination, they should be vaccinated at that point. The new service specification also allows for vaccination in a patient’s own home.
Public Health England has also issued guidance on vaccine administration and released their latest Vaccine Update newsletter.
3. Develop your team
All pharmacy staff involved in the provision of the Flu Vaccination Service should receive appropriate training relevant to the role they will undertake.
The National Minimum Standards for Immunisation Training and the associated Core Curriculum for Immunisation Training set out the knowledge and skills that healthcare professionals undertaking vaccination services need to have and pharmacists must have completed practical training in vaccination that meets these requirements. The requirement for face-to-face training has been extended to every three years and a Declaration of Competence (DoC) for vaccination which should be reviewed every two years is available on the CPPE website.
The whole team needs to know the basics of the flu service – who is eligible for the NHS service and who you might consider for a private service outside of this, what the important steps in the protocol are and who can and should do what. Many pharmacies have further developed their team members using our Flu Champion course and our Championing Health cards to support the implementation, promotion and recruitment into the service leaving the pharmacist free to complete the clinical elements, this has resulted in increased uptake.
4. Review your premises
The GPhC standards and the NHS flu service specification are clear about requirements for provision of this clinical service. However, it is important that the whole pharmacy reflects a professional environment, including the consultation room, and meets all clinical and information governance requirements.
5. Promote the service
- We mentioned earlier the importance of building collaborative working relationships with local GP practices so that you can work together towards a common goal. Explore how you can give patients flexibility, choice and a better experience to achieve a higher uptake during this flu season.
- Ask your team to start promoting the flu service during the late summer in every contact they have with a customer – simply mentioning the service and asking ‘Have you had or booked your flu jab yet?’ will raise awareness and promote what you do.
- Set up a flu campaign in your pharmacy using materials provided by NHS England and Public Health England, the 2018/19 leaflet is available here. There may also be materials available from your vaccine manufacturer. Make sure that you also run the campaign out in your community to reach people you would not otherwise see.
- Make contact with local groups such as carers and self-help groups for people with conditions which are eligible for the NHS service.
- Promote through your website and social media to make your patients and customers aware of what you have to offer.
- Analyse your PMR database for those you vaccinated last year and those in eligible groups then use bag stuffers, stickers and direct invitations (assuming you have their consent).
- Use other services such as MURs and NMS as an opportunity to check whether a patient has had their flu jab this year.
It is clear that there is much to be done to implement and deliver an effective flu vaccination service, but many pharmacies have seen both direct and indirect benefits from engaging the team, putting a clear plan in place, with assigned actions and timelines. Do remember to review progress regularly and celebrate success.
Some pharmacies have built on their successful flu vaccination service and leveraged the acquired skills to develop a profitable private vaccination business including occupational health services to local businesses, other condition protection vaccines and a travel health clinic. Look carefully at your local market opportunity and explore the private PGD and training options available to you.
One thing is certain, it won’t happen by itself so start planning now.
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