Who is eligible?
The eligible cohorts you should be targeting are:
Flu - children
- Children aged 2 and 3 – via nasal spray ordered on ImmForm
- At -risk children aged between 6 months and 18 years. (Children aged 4 – 8 will usually be vaccinated at school)
Public Health England has produced a useful poster about which flu vaccine children should have, which you can access here.
Flu – adults
- Aged 65 and over on 31 March 2017
- Aged six months to 64 years (excluding patients aged two and three as of 31 August 2017) and defined as at-risk (see appendices in the guidance below for a list of at risk groups)
- Locum GPs
- Aged 65 and over
- Aged two to 64 years and defined as at-risk in the Green Book
Pneumococcal vaccination is not repeated annually, therefore only one dose is required, except for individuals with no spleen, splenic dysfunction or chronic renal disease who will require boosters at five-year intervals. Practices should contact their commissioner to reach local agreement on the re-vaccination of these patients.
- The national childhood flu immunisation programme: information for healthcare practitioners
- Download the national flu immunisation 2017/18 programme letter (which includes full details of at-risk groups)
- Guidance for heath professionals about the inactivated influenza vaccine
- Download the Winter 2017/18 Flu Plan
Set up searches on your clinical system to find all the eligible patients. Your CCG or clinical system supplier may do this for you as there are a lot of criteria for the flu searches.
Make sure that you have one list of eligible patients and that if doing multiple searches that each patient only appears once in the final combined search e.g. patient may appear in over 65 and in an at-risk search.
Alternatively, the technical guidance provides all the detail that needs to be in the searches – download the flu section of the guidance here.
When you have your list of eligible patients, run a search on housebound patients and make a list of those who cannot come into the surgery. In some areas the community nurses will do some of the flu jabs on housebound patients, particularly for those who are on their caseload. Make a plan early about how to divide the flu home visits.
Plan how you will set up clinics, consider booked appointments and walk in. Booked appointments make it easier to control the flow of patients, particularly if space is an issue at your practice.
Walk-in clinics can mean you can get large numbers done at one time. Ask for all hands on deck and have several nurses, HCAs and GPs present so that you can vaccinate relatively large numbers in a single session.
For a walk-in approach consider the patient flow from when they arrive at reception, then into the waiting room and consulting rooms. A ticket system is quite useful. Many of those eligible for the vaccination will not be very mobile, so think about chairs in corridors for those who can’t queue. Is there enough space for two people (one in each direction) to navigate the path you have selected? If not, the building could get very congested. Think about having some receptionists at key points to direct patients and to advise patients to take off coats and roll up sleeves, etc.
Combine with other campaigns
Think about what other campaigns you can run at the same time. Pneumococcal and shingles are two key ones. As you have the patient in the surgery, consider what other information or tests this patient cohort might need. Some suggestion ares:
- Checking mobile numbers and contact details
- Registering for patient online
- Nominating pharmacies for ETP
- Height, weight, BMI and smoking status
- Are they eligible for an NHS Healthcheck? If they are, suggest they make an appointment
- Invite relevant patients for a frailty review
HCAs can give the flu jab as long as they have been appropriately trained and do so under a PSD. Make sure you have a process for how to produce these and record this in the patient record.
Make sure that HCAs are confident in giving the flu jab and that reception know which patients can be booked in with HCAs and which patients need to see a nurse (children, those with an allergy and anyone who expresses a preference for a nurse).
All staff giving the flu jab should have up to date training with regard to the recognition and initial treatment of anaphylaxis.
These are some useful links
- National minimum standards and core curriculum for immunisation training of healthcare support workers
- Green Book guidance on PGDs and PSDs
- Public Health England has developed free online training for those delivering the flu programme.
- NHS Education for Scotland has produced a video on how to give the nasal spray to children
Make sure everyone knows which template to use. Consider both clinical and non clinical staff - if receptionists speak to patients and a patient declines the flu jab, they need to know what to do, either to enter that information themselves or to forward to a clinician to do so.
Decide how you will record PSDs onto the system and make sure the nurse or GP signing the PSD and the HCA giving the vaccine knows the process.
The eligible flu population is a large cohort so think about how best to communicate and also if there are any other key messages to communicate when doing the flu communication.
Text messages are quick and easy to merge in bulk to the searches generated above.
Letters can give a more complete explanation of why the flu vaccination is needed and you can include newsletters or other mailouts in the same communication.
Telephone calls, while more time consuming, can mean that you can catch and convince patients who may not be that keen to have the vaccination or capture the fact that they want to decline the flu jab.
Public Health England has prepared some useful resources to help with the campaign:
- Flu vaccination invitation template for children aged 2 to 3
- Invitation letter template for at-risk patients and their carers
- Easy-read invitation letter template for people with learning difficulties
- The flu vaccination: who should have it and why information leaflet
- Flu vaccination: easy read leaflet
- Protecting your child against flu leaflet
- Flu vaccination: easy read childhood nasal flu leaflet
- Five reasons to vaccinate your child against flu poster
You can also make use of materials from pharma companies to advertise the flu clinics at your surgery. Meanwhile NHS Employer's Flu Figher campaign, which is aimed at boosting uptake of flu jabs among frontline healthcare staff, also has useful advice to help promote the vaccination to carers.
Think about using the TV screen in the waiting room if you have one, and changing the welcome message on your phone system if your phone system has this facility.
Public Health England's best practice guidance for general practice, which you can download here, suggests contacting local nurseries and schools to help promote the child flu campaign.
Set up searches for how many flu vaccinations given and run searches after the first of the each month to get the numbers to check the automated extract on CQRS.
It is a good idea to double check with the nursing team that the number of flu jabs given that generated by the search matches the numbers in the vaccine fridges – sometimes clinicians can forget to enter these on the patient’s clinical records and each vaccine is worth £9.80.
You will also need to report activity information via ImmForm on a monthly basis.
Think about how flu vaccinations given by other organisations, for example a local pharmacy, are recorded because although practices will not be eligible for payment for these they will count towards the target.
The business rules for this year have yet to be published. You can find the 2016/17 business rules here.
Put flu on the practice meeting agendas from September and make sure everyone understands their role in helping the flu campaign run smoothly, monitor and communicate progress and congratulate those who are proactive in keeping the campaign going.
- Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member