Guide: Enhanced Services

Boost your seasonal flu vaccination income


There is a target for 100% of eligible patients to receive an invitation for flu vaccination. At a typical practice of 5,000 patients, achieving 100% coverage of all target patients would provide income of approximately £10,000. 

Who can have the vaccine on the NHS? 

NHS England has confirmed eligibility of the 2022/23 campaign as being:  

  • those aged 6 months to under 65 years in clinical risk groups, such as patients who are morbidly obese or with chronic respiratory disease (COPD or asthma requiring inhaled or oral steroids), chronic heart disease, chronic kidney disease, chronic liver disease, splenic dysfunction or asplenia, chronic neurological illness, diabetes, immunosuppression or learning disabilities. 
  • pregnant women 
  •  those aged 65 years and over in the flu season (defined as Sept 1 to March 31)
  • those aged 50 to 64 years old not in clinical risk groups (including those who turn 50 by 31 March 2023)
  • secondary school-aged children focusing on Years 7, 8 and 9. Any remaining vaccine will be offered to years 10 and 11, subject to vaccine availability
  • People in long-stay residential care homes  
  • carers  
  • close contacts of immunocompromised individuals  
  • frontline staff employed by the following types of social care providers without employer led occupational health schemes
  • locum GPs
  • a registered residential care or nursing home 
  • registered domiciliary care provider 
  • a voluntary managed hospice provider 
  • direct payment (personal budgets) or personal health budgets, such as personal assistants.

Primary school age children are also eligible for the NHS vaccine but are now being immunised by the school age immunisation service. Similarly, children aged 2 or 3 on August 31 are eligible but are covered by a separate enhanced services contract. 

Practices have been asked to start vaccinating the 50 to 64 year olds (not in clinical risk group) from 15 October 2022.

The complimentary NHS flu vaccination offered to primary care staff has not been extended for the 2022/23 season. So, vaccinations for this group, like other frontline healthcare staff, revert to being an employer’s occupational health responsibility. This includes GPs and their staff. 

Under the 1974 Health and Safety at Work Act employers are required to protect employees from risks associated with their work and this could include contracting influenza. Since GPs are not been able to provide occupational health services under the GMS contract (they have to offer it as a private service to employers), it means they cannot claim for an item of service fee or dispensing fee for vaccinating staff. As mentioned, this situation changed last year so practices didn’t suffer any monetary loss but has reverted to the pre-pandemic arrangement this year.  

That said, reimbursement can be claimed for members of your frontline patient-facing team who also fall within the eligibility criteria for an NHS jab due to age or clinical risk and are registered with their employing practice.

Meanwhile, locum GPs remain eligible for a an NHS jab from any practice whether they are registered there or not, for which surgeries can be reimbursed, says the 2022/23 Enhanced Service Specification for the flu vaccine programme.

Which vaccines are reimbursable? 

The flu campaign has become increasingly complicated because of the different types of vaccine used for different cohorts. It is important to ensure staff are familiar with the latest guidance and the right vaccine is given to the right patient. The vaccines that will are reimbursable as part of the programme are:  

For those 65 and over – aQIV or QIVr. (QIVc may be used if others are unavailable) 

For all in at-risk groups, including pregnant women, and those aged 18 to 64 – QIVc or QIVr.  (QIVe may be used if others are unavailable). 

For 50-64 year olds not in a clinical risk group – QIVe. (QIVc / QIVr can be offered where it’s not needed by the clinical at-risk groups and over-65s. Vulnerable cohorts take priority).

Target coverage has been increasing in recent years. The aim of the flu programme is to demonstrate a 100% offer and to achieve at least the uptake levels of 2021/22 for each cohort (see table below), and ideally exceed them.

Eligible cohort 2021 to 2022 flu vaccine uptake 
Aged 65 years and over 82.3% 
In clinical risk group 52.9% 
Pregnant women 37.9% 
Aged 50 to 64 years not in risk group  45.7% 
Aged 2 years old 48.7% 
Aged 3 years old 51.4% 
Frontline healthcare workers  60.5% 
Eligible school-aged children  51.5% 

Uptake has been confounded supply chain issues. This can be minimised by ordering ahead and sharing between different suppliers. 

It is possible to submit orders a year ahead but changing guidance has made this difficult in recent years. 

What is it worth to practices?  

The fee for administering a seasonal influenza vaccine is £10.06.  

The government isn’t procuring central stocks of vaccine for this year’s campaign, so the vaccine needs to be pre-ordered directly from the pharmaceutical company – this means practices can cut their costs if they negotiate decent discounts. This involves liaising with drugs reps as early as January for the following winter. Bulk buying can attract discounts and there are buyer groups, such as those run by LMCs, which can help. The vaccine reimbursement is claimed back from NHS prescription services (NHS Business Services Authority). With careful negotiation and swift claiming it is possible to get the reimbursement before paying the original invoice. 

How to claim and ensure payment

Practices must be signed up as delivering the service or ‘accepting a quality service’ on CQRS (Calculating Quality Reporting System) in order for payments to be made. These data are extracted via GPES (General Practice Extraction Service) run by NHS Digital.

Payments will be made monthly. Check the Open Exeter statement every month to ensure all the claims made correspond to monies received and make sure that any errors are chased up swiftly. Any problems should be addressed initially with the commissioner (which is the CCG if delegated co-commissioning or NHS England otherwise), and CQRS and GPES errors can also be pursued via NHS Digital.

How to maximise coverage

  • Run big conveyor-belt clinics to get people through fast and early (and beat the pharmacists).
  • Keep on top of address and telephone number changes to meet this target.
  • Book patients directly to clinics by phoning the target groups.
  • Leave messages on the right-hand side of prescriptions (many of these patients are on repeat prescriptions).
  • Put posters up in the waiting room from August onwards.
  • Change the greeting message on the practice phone to include a reminder.
  • Advertise in the local paper (in conjunction with other surgeries this may be cost effective).
  • Take the vaccine on home visits to known target patients (telephone ahead).
  • Don’t forget the less obvious groups. Good coding for pregnant women and cooperation with midwives helps, and make sure the under-18 at-risks are coded. Occupational coding for healthcare workers in the target groups may be useful.
  • Match appointments to vaccine availability and try and use it as fast as possible (it beats the pharmacists and clears space in the fridge).
  • Remember to code the refusers, as this helps with QOF targets, further boosting practice income.
Key Points  
  • With so many people eligible for vaccination it is worth changing the greeting message on the practice phone to include a reminder. As this can be co-administered with Covid vaccines it is worth linking the messaging. 
  • You order the vaccines directly from the pharmaceutical company. There will be no centrally procured vaccine in 2022/23. 
  • Practices can cut their costs by negotiating decent discounts.  

Authored by Dr John Allingham who is a GP in Leeds

Useful resources 

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