Enhanced Services

Making the most of your flu vaccination service

Dr John Allingham explains how to run a profitable service with the minimum of hassle

The flu season is approaching. In recent years flu levels have been relatively low and the difficulties with different vaccines, delivery and supply issues made it a harder to hit targets and maximise profit. It’s especially important this year, with additional COVID-19 measures and cohorts, that practices start preparing to vaccinate as many people as possible to ensure a successful campaign.

1. Review your practice flu plan

It is always a good idea to bring key clinical and admin staff together for a debrief on what went well and what could have been improved in the previous flu season.

Get your team together to review your flu plan and look at your practice registers. For example, can the practice identify all pregnant women, who are particularly hard to track? The plan should also consider how you marketed your flu campaign, how you ran immunisation clinics, when and who carried them out and how the claims were processed so you can prepare for this year.

Also consider this as an action point for late January or early February next year when the last of the flu vaccine has been used. It is important to document it as learning degrades quickly.

For 2020/21 it is necessary to consider the changes imposed due to COVID-19. How can mass vaccination be delivered whilst maintaining social distancing? Can the practice operate a ‘drive through service’? Can you run clinics that operate at a slower pace but last longer?

2. Start early before local pharmacies get going

It is always good to kick off your campaign early, but particularly in England where you’re competing with the national community pharmacy scheme, which also targets at-risk patients.

The big advantage you have over pharmacies is that you are the holders of a registered list, and have the long-term disease registers as well as access to accurate demographics. By starting early you can ensure most of your patients are vaccinated before community pharmacies can start opportunistically picking up patients who attend to collect repeat prescriptions.

I would recommend starting with a marketing campaign to patients on the long-term disease registers, which ensures patients whose flu vaccines are worth QOF points do not get missed. These are the most lucrative because in addition to the payment of £10.06 per administered vaccine many of them also count towards points-scoring QOF targets.

It is a good idea to run the first clinic as soon after the vaccine is delivered as possible to get the ball rolling. Check with the pharmaceutical supplier and get a commitment to a guaranteed delivery date.

This year it may be worth co-operating with local pharmacies. There will be issues with COVID-19 social distancing and infection control measures that some community pharmacies may not meet. The uptake is likely to be high – the expanded flu campaign this year is aimed at reaching at least 75% uptake in all cohorts – and it may be easier to hit targets than usual.

3. Actively target patients

Use every trick in the book to remind and book clinic slots for the target groups. For example:

• Put reminders on the right-hand-side of prescriptions.

• Add an article about booking flu jabs in the surgery’s summer newsletter.

• The first clinic should be in late September. Put flu clinic reminder posters up and make sure the first flu clinic is on the computer system and ready for booking in August.

• Consult the patient participation group, which may be able to help raise awareness.

• Send text message reminders to any patients in target groups.

• In early September, allocate a member of staff to telephone patients and offer them appointments, starting with the QOF-target patients who are at most risk and the most profitable. Code those who refuse as the exemptions are needed to hit targets.

• Remind all clinical staff to prompt target patients when they attend or ring in. Make sure to code the verbal and written reminders. For QOF purposes, the rules have changed so that only two reminders must be sent before patients can be excepted, which now comes under ‘personalised care adjustment’. One reminder must be a written invite and the other can be a text message. It is worth sending additional text messages however, as generally they cost nothing and is worthwhile if a few extra patients turn up.

• Consider pooling resources with other practices to share the cost of placing a large advert in the local paper, reminding patients to book their flu vaccination. If you run it for two weeks in September just as the campaign is starting, you might hit a cohort who might have been missed elsewhere.

• It may be worth running a PCN level drive-through clinic.

4. Cast your net as widely as possible

By targeting all groups for which immunisation is recommended, the practice can maximise the degree of protection given and increase profits. Keep an eye on target figures as these are undergoing revision.

5. Make the best use of your stock

The vaccine should have been ordered earlier in the year. The quantity should be calculated according to how many were delivered last year, any changes in the practice list and how effective the marketing and delivery campaign was. An effective practice will look to increase the delivery each year.

Suppliers can be hard to negotiate with, but bulk buying with other practices can achieve bigger discounts. It is also good to buy from more than one supplier in case a supply fails.

It is also important to be on good terms with local colleagues so you can lend or borrow stock if demand peaks unexpectedly, for example if more patients turn up than expected.

Check your vaccine fridge before delivery and ensure that the plug cannot be accidentally taken out. Losing a fridge full of vaccine in the middle of the campaign can be very costly.

6. Run flu days

Many practices run Saturday morning clinics where hundreds or even thousands of patients can be vaccinated in one go. Our biggest practice in Kent has been known to vaccinate 2,000 to 3,000 patients in a single clinic. Clinics are popular with patients and staff who approach it as a light interlude in the normal day-to-day stress and quite a social event. COVID-19 will slow down the pace of these clinics but it may still be possible to do large numbers in a single session.

7. Target children differently

Practices are also paid to vaccinate two- and three-year-olds under the childhood seasonal flu programme, and this year, as with at-risk cohorts, are expected to achieve ‘at least’ 75% coverage. School-aged children are usually picked up by the school nursing service but those in years one and two (five and six-year-olds) can be vaccinated through local arrangements or as part of a catch-up programme.

For children aged 2-17 years old, the live attenuated influenza vaccine (LAIV) is still the recommended vaccine, unless contraindicated in which case they should receive the quadrivalent vaccine QIVe. These vaccines are supplied through ImmForm and thus do not incur a cost or supply issue to practices (but someone must remember to order it).

Children should be targeted in a different way to other at-risk patients. They will need more time for vaccine administration, for parents to be given explanations and to be treated in quiet private room rather than in a busy Saturday clinic. They are best targeted by letter.

8. Be aware of what local pharmacies are up to

Watch how community pharmacists are marketing their service. What are the adverts in their windows saying? When do they appear? Can you make sure you get in first? Community pharmacies must notify practices within 24 hours by paper, fax, e-mail or electronic data transfer if they have immunised their patients. It is important that practices code this information in order to hit targets, but remember not to accidentally claim the vaccination administration fee. Pharmacies not complying with this are in breach of the terms of their enhanced service and could be challenged.

9. Offer pneumonia and shingles vaccinations at the same time

Seasonal flu clinics also offer an opportunity to target the patients in need of the pneumococcal vaccine and the shingles vaccine. It takes a lot of organising to catch them in mass vaccination clinics but it is possible. In order to do this you will need to identify the patients in advance and send them to the clinician working from the room with the vaccine fridge in it – probably the nurse in the treatment room. Accept that they will work a little slower, so operate a ‘next please’ system for them rather than personally booked clinics.

The target group for the pneumonia jab is:

• Over-65s.

• The at-risk groups from age two to 64 in the Green Book – essentially the same list as the flu.

• Asplenic patients and those with chronic renal disease, who should be boosted every five years.

• Patients with cochlear implants or who have a CSF leak.

The shingles vaccination is more complicated but the intention is that you offer the shingles vaccine to those who have turned 70. Good systems and awareness in clinics offer an opportunity to increase coverage and claim two vaccine administration fees for one patient attendance.

10. Get your claims in early

The item of service fee of £10.06 and the vaccine reimbursement claims should be submitted as soon as possible, the day after the flu clinics if you’re organised enough.

This is an opportunity to help the practice cash flow. Efficient practices can, if our paymasters are equally well organised, be reimbursed for vaccine before the supplier’s invoice is due.

Dr John Allingham is medical secretary at Kent LMC

Indications for flu vaccination

• Age over 65
• COPD, asthma or any chronic respiratory disease
• Chronic heart disease
• Chronic kidney disease stages 3-5 plus nephrotic patients and those with renal transplants
• Chronic liver disease
• Chronic neurological disease including stroke and TIA
• Diabetes
• Splenic dysfunction
• Immunocompromised
• Pregnant women
• Age 2 to 11
• Patients in long-stay residential homes (excluding prisons and halls of residence)
• Those in receipt of carer’s allowance
• Household contacts of the immunocompromised
• Morbidly obese – BMI ≥40
• Locum GPs (employed GPs and contract holders should be vaccinated through occupational health arrangements)
• If clinically indicated (this is a bit of a catch-all but it is in the guidance).

Additional indications under the expanded campaign for 2020/21:
• Household contacts of those on the NHS Shielded Patient List
• Health and social care workers employed through Direct Payment (personal budgets) and/or personal Health Budgets, eg, Personal Assistants

• From November, all people aged 50 to 64 will also be eligible, subject to flu vaccine availability

Resources

The Green Book Chapter 19 Influenza 2019

References