Boost your seasonal flu vaccination income

Published 3 August 2020

Please note this guide refers to the core 2020/21 seasonal flu DES – the newly expanded flu campaign due to COVID-19 includes additional cohorts, as detailed separately here.

This enhanced service requires GPs to vaccinate vulnerable groups of patients and certain health and social care staff.

At a typical practice of 5,000 patients, achieving 100% coverage of all target patients would provide an annual income of approximately £10,000.

Key points

  • Large numbers of patients are eligible so consider including a reminder in your practice telephone greeting message
  • There are nine main target groups, covering age, health status and occupation
  • You order the vaccines directly from the pharmaceutical company; cut costs by negotiating a discount.

This directed enhanced service requires GPs to vaccinate those aged 65 years and over, pregnant women, patients aged six months up to 65 years who are considered ‘at risk’, carers and locum GPs.

GP practices are also contracted separately to vaccinate two- and three-year-olds under the childhood flu vaccination enhanced service.

For 2020/21, the adjuvanted trivalent influenza vaccine (aTIV) is recommended for those aged 65 and over, while at-risk infants aged 6 months to 2 years should receive the egg-grown quadrivalent influenza vaccine (QIVe), at-risk 2-9-year-olds should be given the live attenuated influenza vaccine (LAIV) unless contraindicated, and a newer, cell-based quadrivalent vaccine – QIVc – is recommended in at-risk groups aged 9-18 years. (See box)

Vaccine ordering varies. It is possible to submit orders a year ahead but last-minute changes to vaccines in recent years have caught practices out.

The target groups for seasonal influenza vaccination are:

  • 65 years or over during the flu season.
  • Morbidly obese.
  • Patients with chronic respiratory disease (COPD or asthma requiring inhaled or oral steroids), chronic heart disease, chronic kidney disease, chronic liver disease, chronic neurological illness.
  • Patients with diabetes, immunosuppression or learning disabilities.
  • Pregnant women.
  • Residents in institutional care.
  • Those in receipt of carers allowance.
  • A health and social care worker in a registered home or agency or employee of a voluntary hospice.
  • Locum GPs (at the practice they are registered with as a patient).

See Annex B of the service specification for a full description of the eligible cohorts.

Note that under the expanded flu vaccination campaign for 2020/21, set up to protect those also vulnerable to COVID-19, the following groups will also be eligible for vaccination by GPs:

  • Household contacts of patients of the NHS Shielded Patient List
  • Health and social care workers employed under Direct Payments (personal budgets) and/or Personal Health Budgets – such as Personal Assistants.
  • From November (subject to vaccine availability) anyone aged 50-64 years

How much are practices paid?

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

NHS England/Improvement will reimburse the following vaccines in 2020/21:

• aTIV for those aged 65 years and over 

• QIVc for those aged 65 years and over (where aTIV is not available)

• QIVc and QIVe for at-risk adults aged 18 to less than 65 years (including pregnant women) and at-risk children aged 9 to 17 years for whom LAIV is unsuitable and where locally procured vaccine stock has been used. 

The LAIV for children should be ordered through ImmForm from centrally purchased supplies, with QIVe available to order for children in at risk groups aged less than 9 years old who are contraindicated to receive LAIV.

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).
  • 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 (phone ahead).
  • Don’t forget the less obvious groups. Good coding for pregnant women and co-operation with midwives helps, and make sure the under-18 at-risks are coded.
  • 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.

Dr John Allingham is medical secretary at Kent LMC

Vaccines recommend for 2020/21 Seasonal influenza vaccination programme (as defined in the annual flu letter)

Eligible groupsVaccineDosage
  At risk children aged from 6 months to less than 2 years     Offer standard QIVe  1 dose unless first influenza vaccination in which case a second dose is recommended at least 4 weeks after the first  
  At risk children aged 2 years to less than 9 years     Offer LAIV unless contraindicated, then offer QIVe     1 dose unless first influenza vaccination in which case a second dose is recommended at least 4 weeks after the first  
  At risk children aged 9 years to less than 18 years in clinical risk groups     Offer LAIV unless contraindicated then QIVc is recommended. If QIVc is unavailable, QIVe should be offered as an alternative.     1 dose  
  At risk adults 18-64 years (including pregnant women)  Offer QIVc or QIVe as an alternative to QIVc    1 dose  
  65 years and over    Offer aTIV or QIVc if aTIV is not available.  1 dose  

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