How to coordinate flu clinics with Covid-19 boosters

GP partner and PCN leader Dr David Coleman offers some practical advice on managing your flu vaccination clinics alongside the Covid-19 booster programme

It wasn’t so long ago that practices could reliably fall back on their time-honoured flu clinic systems. It worked the same as the previous year, nothing would really change (except the inactivated viruses contained within the vaccine itself) and we could just crack on.  

Sadly, things began to get more complex a few years ago when different vaccines where recommended for under 65s and over 65s.  This created challenges with orders and stock, which were exacerbated further as pharmacies started offering a larger number of flu jabs.

More recently, of course, the pandemic arrived and threw a whole sackful of spanners into the works. As the PHE National flu immunisation programme 2021 to 2022 letter reminds us, ‘last year saw the roll out of the biggest NHS influenza vaccination programme ever’.

This year, as well as being asked to deliver the same programme again, we now have the added dimension of Covid-19 boosters to contend with. It can be exhausting trying to keep up with developments, so here are some tips to consider as you approach the unenviable task of delivering these campaigns.

Who is eligible?

The first thing to be clear on is eligibility for each vaccine.

Flu:

• all children aged 2 to 15 (but not 16 years or older) on 31 August 2021
• those aged 6 months to under 50 years in clinical risk groups
• pregnant women
• those aged 50 years and over
• those in long-stay residential care homes
• carers
• close contacts of immunocompromised individuals
• frontline health and social care staff

Covid-19 booster:

• those living in residential care homes for older adults
• all adults aged 50 years or over
• frontline health and social care workers
• all those aged 16 to 49 years with underlying health conditions that put them at higher risk of severe COVID-19 (as set out in the green book), and adult carers
• adult household contacts of immunosuppressed individuals.

Note that all those eligible for Covid-19 boosters are also eligible for flu jabs.

The co-administration dilemma:

As you can see, there is a strong overlap here. Essentially all over 50s are eligible for both vaccines, as are elderly care home residents, 16-49 year old with underlying conditions, adult household contacts of immunosuppressed individuals, and health and social care staff.

The JCVI confirmed earlier this month that Covid-19 and influenza vaccines may be co-administered, which offers the kind of tempting efficiencies that primary care teams love to tap into.  But as the deputy chief medical officer Professor Jonathan Van-Tam warned, ‘it may not always be the case that it is possible to co-administer those two vaccines in every single patient’.

The practicalities are complex and we can’t expect to be told what to do in each and every case.

A patient may be eligible for both jabs, but not at the same time – the Covid booster needs to be given a minimum of six months after the second dose. Some fifty year olds, for example, may not have received their second dose until May, which means their booster won’t be due until November. In cases like this it, delaying the flu vaccination just to co-administer would increase the patient’s risk.

Some patients may be wary about one of the vaccines and a blanket co-administration offer may deter them from getting either.  Similarly, the fifteen-minute wait associated with the Covid booster may present a barrier to arranging an appointment, while dedicated flu clinics are often much slicker and more convenient.

There are also supply challenges – how to get sufficient flu vaccine stock from practices to PCN sites, how to track who has contributed what, and how to untangle the finances at the end of it all – as well as administrative ones, such as how to document the flu vaccines given and how to ensure the money flows back to the practices.  Some practices may interpret PCN sites giving flu vaccines as a threat to their income, so this should be sensitively worked out in advance – tricky when you consider the time frame.

Some practical tips

From my discussions and experience so far I would offer the following advice:

• Don’t delay either vaccine in the name of co-administration. The efficiency is tempting, but it is necessary to offer a range of options to maximise timely uptake. Practice based flu clinics are efficient and effective, not to mention local and accessible. I would arrange these as soon as you have vaccine stock rather than hold back in the hope of arranging a slick joint flu and Covid clinic.
• Ensure the PCN site has the capability to co-administer and that staff are trained. Each member practice could supply a small percentage of flu vaccine stock to facilitate this. Work with your CCG digital team to identify the best policy for documentation, for tracking vaccine stock on site, and for ensuring that practices are informed in a timely manner.
• Care homes should be a top priority. Co-administration makes perfect sense in this setting as most of these patients will have been first in line for Covid jabs in December and January so are already eligible. Indeed, practices have been told they should aim to give Covid boosters to all elderly care home residents and care home staff by 1 November. Arrange a roving team, secure stock of both vaccines, and sort out issues like consent in advance of the vaccination day. Ideally tap into the expertise that delivered these vaccines in the first phase.
• Make the most of visiting housebound patients. This group will be challenging when it comes to boosters, on account of the fifteen-minute waiting period with the Pfizer vaccine, which will be the predominant vaccine in the campaign. Consider using this period to co-administer a flu jab and collect face-to-face data required for QOF – such as blood pressure, smoking status, foot pulse checks for diabetics etc.
• Communicate your plans clearly with your patients. Use social media, practice websites, text messaging, and consider putting a message on your phone queuing system — there will potentially be lots of calls from patients seeking information. Try to get the info out to them before they call.

Dr David Coleman is a GP partner and PCN clinical director in South Yorkshire