Enhanced Services

Preparing for the flu campaign 2020/21

Director of Primary Care at Wessex LMCs Carole Cusack offers advice and tools for preparing for the expanded flu vaccination campaign this year

As we know, this year the delivery of the flu vaccination is going to have the added challenges of Covid-19. Not only have the targets increased to 75% for the usual cohorts (over 65 and those in an at-risk category) but new cohorts have been added, for example, household members of shielded patients, year 7 school children and also the 50-64 year olds not in an at risk group.

In addition, this year a target of 100% coverage has been placed for all health and social care staff including care home staff.

Deliveries and stock

Delivery of the various types of flu vaccine will commence on 2September and manufacturers will be notifying practices of their delivery dates. In most cases, there will be a phased delivery schedule which should mean there is no need for additional fridges.

NHS England / Public Health England has also procured a further 7.9 million doses to meet the additional numbers to be vaccinated, but have stated that practices and pharmacists should concentrate on vaccinating all the over 65s and at-risk groups using their existing vaccine stocks first. A decision will be made in November as to whether there is enough vaccine available to extend vaccination to 50-64 years olds and, if so, how that will be distributed.

Hospitals are also being requested to vaccinate inpatients although it is not yet clear where their stocks will come from.

Key Messages

Planning of the 2020/21 flu immunisation campaign is dependent on the size of the eligible population needing to be immunised, the available practice infrastructure (including staff and clinic set-up), the opportunities for local collaborative working and specific Covid-19 considerations at the time of vaccination.
Vaccination strategy is dependent on these co-dependent factors within the planning phase and include needs estimation, human resources and the vaccination timetable. It is these factors which determine the method(s) of vaccination delivery at practice and/or PCN level.
There is not one ‘correct’ delivery model as it is based on local factors. Outside clinics and additional estate have reduced Covid-19 transmission risks and allow less disruption to routine work but are logistically harder to deliver. Solutions need to be locally determined as they are locally delivered.
Due to social distancing and infection control measures, practices need to be able to immunise consistently and efficiently throughout the vaccination window, maximising all contact with the health system to reduce practice footfall. There needs to be a greater control and co-ordination of patient streams (considering priority groups) and clinic infrastructure.

Suggestions for Practices

Start considering the eligible populations, estate available and staff at a practice and scale level, using tools such as the flu-calculator (see below) to assist with planning.
Expect increased uptake, additional cohorts and that the campaign will take longer to deliver than past seasons. The cost of delivery will be higher, especially if practices need to deliver a predominant out-of-hours approach or use additional estate to reduce disruption to routine services. Practices also need to factor in ordering additional equipment, for example PPE.
Start considering the collaborative working opportunities with other GP practices and community teams (a focus should be domiciliary, Care Home and shielded populations, which need to interact with the health system differently).
Take into account the CQC requirements, particularly in respect of cold chain and infection control procedures depending upon which delivery method you choose. See box below for further information.
Indemnity is provided by the Clinical Negligence Scheme for General Practice for all activities provided under a GMS/PMS/APMS contract and it is the activity which is paramount rather than where it is undertaken. However, you must ensure that all staff are trained, competent and have the necessary capabilities to give the vaccination and this can include HCAs.

Identifying the cohorts and the call/recall system

In previous years practices have relied mainly on a local campaign with posters and notices plus some SMS text messaging and a small amount of opportunistic offering.

Given the increased targets, practices will need to be more proactive in reaching the at-risk groups, those who can be hard to reach and to prioritise those most at risk including those care homes for whom they have responsibility.

PHE will be undertaking a marketing campaign in October aimed at encouraging those most at risk to seek a flu vaccination as they are also the most vulnerable to covid-19.

Factors to consider when organising call/recall systems include:

Minimising waiting times and maintain social distancing when attending.
Providing patients with information in advance of their appointment and explain to patients what to expect. RCGP guidance on delivering mass immunisations during Covid-19 provides a check list on the key information to provide patients with in advance.
Recall patients who do not attend in line with contract requirements.
Social distancing innovations such as drive-through vaccinations and ‘car as waiting room’ models, if possible.
For those on the shielded patient list who are at high risk of Covid-19 – consider using domiciliary visits. However, the majority of shielded patients could be vaccinated in the surgery if you ensure this is carried out in a low-risk environment and potentially at the start of the day. Home visits should be reserved for the few where attending the surgery puts the individual at high risk.

Operational aspects of delivering the flu programme

Wessex LMCs has produced documents to aid and assist practices with operational aspects of delivering the seasonal flu vaccination programme for 2020/21. This includes a tool called ‘the Flu Calculator’ to assist practices.

The tool can be used to determine the eligible populations and infrastructure at a practice and PCN level to assist with planning of the flu campaign to determine the vaccination strategy.

The two template links below can be used as an aide memoire of arrangements for each flu clinic, should you so wish. They can be adapted to suit your set up to keep track of what is happening on each day, and perhaps useful for staff working on those days to have a copy. There is one for a practice-based clinic and another for drive to/thru. They also have a copy of the Flu Calculator embedded for ease of use.

Practice Location Flu Clinic

Drive To/Thru Flu Clinic

The flu calculator below includes the additional cohorts, but should only be used once confirmation of vaccine availability has been received.

Flu calculator – Full cohorts

CQC considerations for alternative models of delivery
The CQC has published details for providers who are thinking about and planning the ways in which they will deliver flu vaccinations for winter 2020/21. Models for delivery could look different to usual as a result of the coronavirus (COVID-19) pandemic and have given examples of registration requirements for various scenarios.
For the model/example that we understand many practices have been looking at is a ‘drive to’ delivery in a large car park. CQC advise that in such scenarios practices do not need to apply for different registration but do need to update their statement of purpose to inform the CQC they are running a ‘satellite’ clinic.
The advice states: ‘In premises which have not been used for the carrying on of a regulated activity (for example a car park). The location:
– is not listed in your conditions of registration or any other CQC registered provider
– will only be used as a vaccination site
– healthcare professionals bring equipment and records to carry out vaccinations and remove them at the end of the session. (No medical equipment or medicines are held on site.)
‘You will not need to make any application to vary your registration.
‘If you are responsible (as a lead practice), you will need to:
– update your statement of purpose to tell us you are running the vaccination site as a ‘satellite’ of your own practice.
‘Groups of practices could work together at such sites to deliver flu vaccinations to patients from any practice within the group. This would include groups in a Primary Care Network. In these cases, the group could either:
– identify the lead practice responsible for the regulated activity. Only this practice should update their statement of purpose to tell us they are running the vaccination site as a ‘satellite’ of their own practice
or
– all the practices share responsibility. They should all update their statement of purpose to tell us they are running the vaccination site as a ‘satellite’ of their own practice.
For other model examples, please refer to the CQC webpage for full details.

NHSE and PHE Flu Updates

NHSE published the Annual Flu Letter setting out the current eligible cohorts and the 20/21 Seasonal Influenza DES specification is available on NHSE website.

NHS England have published an advice and guidance letter on the recommended vaccines for the 2020/21 annual seasonal flu vaccination programme with the following update from Public Health England (PHE) to clarify the position on vaccines for those aged 65 years and over which is as follows:-

Vaccine delivery and reimbursement

JCVI advises the use of the following vaccines:

• Adjuvanted trivalent inactivated influenza vaccine (aTIV)

• high-dose trivalent vaccine (TIV-HD)

• Quadrivalent influenza cell-culture vaccine (QIVc) is also suitable for use in this age group if aTIV or TIV-HD is not available. (Reminder – TIV-HD is currently not eligible for reimbursement)

JCVI advise that the QIVc is considered preferable to standard egg-culture influenza vaccines (TIVe/QIVe).

The expectation is that practices should have ordered the preferred vaccine – aTIV for this age group. QIVc is suitable and should be offered as an alternative when aTIV is not available.

PHE published a further letter dated 31.3.2020 with some additional national guidance on flu vaccine ordering for the 2020/21 seasonal flu programme. This advises that aTIV is the vaccine that will be reimbursed for the >65 cohort. QIVc will only be reimbursed for the >65 where aTIV is not available from the manufacturer.

All practices will have already ordered their vaccinations based on the above and are starting to consider how best to ensure the correct vaccination is given to the correct cohorts.

This can be managed in a variety of ways:

Only invite patients from set cohorts to each clinic
Organise signposters (admin staff or PPG/volunteers) to check which cohort the patient is in and send them to the correct room/area in the practice or drive thru lane
Provide patients with a coloured letter to bring so they can be directed appropriately.

Please note that your current stock should not be used to vaccinate the new cohorts of children in year 7 or those aged 50-64 for whom the DHSC has procured a further 7.9 million doses. These will only be made available for the new cohorts once the eligible cohorts have been vaccinated and there is enough vaccine available.

Training

The responsibility for the delivery of healthcare is always the responsibility of the partners to make sure that their staff are competent to safely deliver care to their patients.

The flu guidance this year includes information for those new to giving the flu vaccine and should be read in conjunction with the immunisation training standards.

It is up practices to judge whether their HCA is competent to deliver flu immunisations.

Carole Cusack is director of primary care at Wessex LMCs