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Four-year olds moved out of GP flu vaccination programme

Morbidly obese patients added to at-risk groups

April 27th 2017

Tagged: Clinical guidance news

By Ailsa Colquhoun

Four-year-olds are to be removed from the childhood seasonal influenza enhanced service and transferred to the schools programme as part of a raft of changes to England’s vaccination and immunisation programmes.

The effect of this change is that these children will now be offered flu vaccination (live attenuated influenza vaccine (LAIV) in reception class, rather than through general practice. GPs are advised that no DES payment will be made if these children are vaccinated in general practice (unless the child is in an at risk group). The change also removes the requirement to use Child Health Information Systems (CHIS) for these children.

Another key change to the 2017-18 seasonal influenza programme for England is the inclusion of morbidly obese patients as an at-risk cohort. Payment for seasonal flu vaccination will be made at £9.80 per dose. JCVI has advised that “all other things being equal” offering the quadrivalent inactivated vaccine is preferable to the trivalent alternative.

Practices are reminded that it is a contractual requirement to record all influenza vaccinations on ImmForm.

In 2017/18, during the flu season running from September 1, 2017- March 31, 2018, immunisers should aim to achieve the following minimum vaccination rates:

  • 75 per cent in over-65s
  • 75 per cent in healthcare workers
  • 55 per cent in all clinical risk groups,
  • 40 per cent in children aged 2 – 8 years.

For all eligible populations apart from children, providers remain responsible for ordering vaccines directly from manufacturers. It is recommended that immunisers:

  • order vaccine from more than one supplier
  • order sufficient vaccine before the start of the season at least to cover the uptake aspirations for all their registered eligible patients, including those requiring low ovalbumin content vaccine.

When considering which vaccine to order and, in particular, the JCVI advice to consider “all things being equal” practices may wish to consider the premium cost of the quadrivalent vaccine, and the vaccine type offered by pharmacies and other competitive providers. Local primary care pharmacist teams may offer some guidance in this regard.

To support uptake of the flu vaccination service, a checklist has been published (see Appendix F).

GPs are advised to use ‘free’ communications channels to promote the vaccination message (such as the electronic booking system or patient newsletters). A range of template communication materials and leaflets will also be available for GP practices to use.

Other points to note

  • The community pharmacy seasonal influenza vaccination advanced service will continue in 2017-18 for eligible adults aged 18 years and over.
  • Antiviral medicines may be prescribed and supplied in primary care, only once authorisation is given by the chief medical and chief pharmaceutical officers.

Technical requirements for 2017/18 GMS contract changes will be available from NHS Employers.

Further information is also available in the National Flu Immunisation Programme plan and letter to healthcare professionals.

England: Childhood vaccination programme
The GMS 2017-18 childhood seasonal flu vaccination service specification for England begins on 1 September 2017 until 31 March 2018.

Practices who wish to participate in this service must sign up no later than 31 August 2017. A payment of £9.80 per dose is available.

All flu vaccines for children are purchased centrally by PHE. This includes vaccine for the national offer to all children aged 2 to 8 years old and for children in risk groups aged six months to under 18 years.

For children in risk groups under 18 years of age where Live Attenuated Influenza Vaccine (LAIV) is contraindicated, suitable inactivated influenza vaccines will be provided centrally and should be offered. LAIV and inactivated injectable vaccines can be ordered through the ImmForm website.

Ordering controls introduced last year on centrally purchased flu vaccine, in particular LAIV, are expected to be in place in 2017/18. Latest information on these controls will be available in Vaccine Update both prior to, and during the flu vaccination period. Practices are advised to read the March issue of Vaccine Update to understand the supply situation for vaccines purchased direct from the manufacturers (e.g. for travel and risk groups).

Other vaccination programmes
Practices are asked to note the following changes to other (non-flu) vaccination programmes:

  • Shingles (routine) – a change in patient eligibility to the date the patient turns 70 rather than on 1 September
  • Shingles (catch-up) – a change in patient eligibility to the date the patient turns 78 rather than on 1 September
  • MenACWY programmes – a reduction in the upper age limit from ‘up to 26th birthday’ to ‘up to 25th birthday’ (in line with the Green Book). [MenACWY for patients aged 18 year on 31 August 2017, MenACWY freshers and meningococcal completing dose (was previously meningococcal booster)]
  • Pertussis or pregnant women – a reduction in the eligibility of patients for vaccination from 20 weeks to 16 weeks.

The following programmes continue unchanged:

  • Hepatitis B (newborn babies)
  • HPV for adolescent girls
  • Measles mumps and rubella (aged 16 and over)
  • Meningococcal B
  • Pneumococcal polysaccharide
  • Rotavirus.

Download a summary of the new and amended programmes including payment details.

Wales
Flu vaccine ordering guidance for GPs in Wales (and vaccination targets for Wales) additionally advises that there will be approximately 2.5 per cent more people in Wales aged 65 years and older next season, equivalent to an overall increase of around 1.5 per cent in the eligible groups. This should be taken into consideration when ordering vaccine.

Scotland
Seasonal flu campaign information is not yet available. Please visit PSD for more information.

It is expected that the 2017-18 flu vaccination season in Scotland will run from Tuesday 1 August 2017 to Saturday 31 March, 2018.

The Scottish Vaccine Update issued by Health Protection Scotland provides current information and practical advice about immunisation policy, practice and vaccine supply in Scotland for dispensing GPs.

Collection of unused adult flu vaccines is underway. Details of how to arrange a return are available from Practitioner Services.

If you wish to subscribe to Scottish Vaccine Update mailing list please send an email including your name and email address.

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