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