To: All GP practices, NHS England South West area August 2018
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To: All GP practices, NHS England South West area August 2018
Dear Colleagues,
SEASONAL INFLUENZA VACCINATION 2018/19
We are writing to confirm planning arrangements for the 2018/19 influenza
vaccination programme and to encourage practices to have all necessary actions in
place to ensure increased uptake in target groups. This resource pack has a range
of materials to help you.
Last year more people than ever received a vaccination against flu as part of the
national flu immunisation programme. In addition, children from reception to year four
in primary school education were offered flu vaccination in all areas. These major
achievements, which contribute significantly to reducing illness and deaths caused by
the influenza virus, are a credit to all involved with the programme.
In 2018/19 changes to the programme are as follows:
School Year 5 (children aged 9-10 years, date of birth on or after 1 September 2008 ):
As part of the phased roll-out of the children’s programme, this year children in school
year 5 will also be offered the vaccination.
The childhood programme for 2018/19 will be delivered as follows:
Two and three year olds (but not four years or older on 31 August 2018) by GPs.
Children aged four years (reception) and children of appropriate age for school years
one, two, three, four and five will have a service commissioned by NHS England, in
schools across the South West.
The eligible groups are, therefore:
all children aged two to nine (but not ten years or older) on 31 August 20181
those aged six months to under 65 years in clinical risk groups
pregnant women
those with a Body Mass Index calculation in excess of 40
those aged 65 years and over
those in long-stay residential care homes or other long-stay care facilities
carers
Further details regarding Health Care Workers and Social Care Workers will follow in a
separate document.
As with all parts of the flu programme, there should be a 100% active personal
invitation for immunisation (e.g. by phone, letter, text or email) to all eligible children.
1 This includes all children of appropriate age in school years Reception (age 4-5 yrs.) 1, 2, 3, 4 and 5, even if their age falls outside the birth
cohorts specified. This also includes all children in the relevant age cohort irrespective of whether they attend school
1For those at-risk, there should be a proactive personal call and recall by the same
means.
Providers and commissioners will be required, if asked, to demonstrate that such
an offer has been made.
Vaccine uptake ambitions in 2018/19
Eligible groups Uptake ambition
Children’s programme
Preschool children aged 2
At least 48% with practices
and 3 years old
aiming to achieve higher
School aged children ( in
An average of at least 65% to be
reception class and years 1-
attained by every provider across all years
5)
Routine Programme
75% reflecting the World Health
Aged 65 years and over
Organisation (WHO) target for this group
At least 55% in all clinical risk groups
maintaining higher rates where those
Aged under 65 ‘at risk’ have already been acheieved. Ultimately,
including pregnant women the aim is to achieve at least a 75%
uptake in these groups given their
increased risk of morbidity and mortality
from the flu.
We are asking practices to support the national strategic objectives of increasing
immunisation uptake rates as early in the season as possible, especially in healthy
children aged 2 to 9 yrs. and those aged from 6 months to 64 years who have
qualifying chronic conditions (‘at-risk’).
The ‘at-risk’ group includes pregnant women, all of whom should be offered
vaccination including those who become pregnant during the season. In addition, the
majority of maternity units across the South West will be offering the flu vaccination
when women attend for antenatal or routine scan appointments. Some maternity units
will also be offering pertussis.
Trusts offering flu vaccination are: Royal United Hospital Foundation Trust Bath,
Gloucestershire Royal Hospitals NHS Foundation Trust, Great Western Hospital
Foundation Trust Swindon, Salisbury Hospital Foundation Trust, United Hospitals
2Bristol, North Bristol Trust, Taunton Hospital, Yeovil District Hospital, North Devon
Healthcare Trust, Royal Devon and Exeter Hospitals, Torbay and South Devon
Hospitals, University Hospitals Plymouth & Poole Hospital NHS foundation Trust.
Improving uptake of healthcare workers, including those in primary care, is also
seen as a national priority to reduce the transmission of flu and to maximise
protection to others, particularly those most at risk of complications of flu.
Morbidity and mortality attributed to flu is a key factor in NHS winter pressures and a
major cause of harm to individuals, especially vulnerable people. The annual flu
immunisation programme helps to reduce GP consultations, unplanned hospital
admissions and pressure on A&E, and is therefore a critical element of the system-
wide approach for delivering robust and resilient health and care services during
winter.
We would like to thank everyone for their continued hard work.
If you have any questions about the influenza vaccination programme 2018/19
please contact the South West Screening and Immunisation Team:
england.swscreeningandimms@nhs.net (for practices in Bristol, North Somerset, South
Gloucestershire, Somerset, Devon, Cornwall & Isles of Scilly and Dorset)
england.bgswareateampublichealth@nhs.net (for practices in B&NES, Gloucestershire,
Swindon and Wiltshire)
Yours sincerely,
Julie Yates
Screening and Immunisation Lead, Public Health England / NHS England South West
3Contents
1 Eligibility for NHS Flu Vaccination 5
2 Contraindications for Flu Vaccination 6
3 Patient Group Directions (PGDs) 6
5 Influenza Vaccine and Porcine Gelatine 6
6 Community Pharmacy Service 6
7 Good practice: A checklist for GP Practices 8
8 Increasing Uptake among Children – Best Practice Guide 10
9 Flu - References and Useful Resources 13
10 Vaccinating GP Practice Staff and Data Collection Tool 14
11 Flu Facts 15
13 Appendix 1: Flu Vaccines for 2018/ 2019 (with Ovalbumin content) 17
14 Appendix 2: Full Influenza Read Codes 18
15 Appendix 4: Flu Vaccination Invitation Template Letters 23
16 Appendix 5: Reducing excess LAIV ordering in General Practice 32
41 Eligibility for NHS Flu Vaccination
In 2018/19, flu vaccinations will be offered at NHS expense to the following groups:
all those aged two and threeyears (but not four years or older) on 31 August 2018
through general practice
all children in reception class and school years 1, 2 , 3 ,4 and 5 (Date of birth on or after
1 September 2008 and on or before 31 August 2014)
people aged from 6 months to less than 65 years of age with a serious medical
condition such as:
o chronic (long-term) respiratory disease, such as severe asthma, chronic
obstructive pulmonary disease (COPD) or bronchitis
o chronic heart disease, such as heart failure
o chronic kidney disease at stage three, four or five
o chronic liver disease
o chronic neurological disease, such as Parkinson’s disease or motor neurone
disease, or learning disability
o diabetes
o splenic dysfunction
o a weakened immune system due to disease (such as HIV/AIDS) or treatment
(such as cancer treatment)
o morbidly obese i.e. those with a Body Mass Index calculation of 40 and above
o all pregnant women (including those women who become pregnant during the flu
season)
o people living in long-stay residential care homes or other long-stay care facilities
where rapid spread is likely to follow introduction of infection and cause high
morbidity and mortality. This does not include, for instance, prisons, young
offender institutions, or university halls of residence
o people aged 65 years or over (including those becoming age 65 years by 31
March 2018)
o people who are in receipt of a carer’s allowance, or those who are the main carer
of an older or disabled person whose welfare may be at risk if the carer falls ill.
Consideration should also be given to the vaccination of household contacts of
immunocompromised individuals, specifically individuals who expect to share
living accommodation on most days over the winter and therefore for whom
continuing close contact is unavoidable.
The list above is not exhaustive, and the healthcare practitioner should apply clinical
judgement to take into account the risk of flu exacerbating any underlying disease
that a patient may have, as well as the risk of serious illness from flu itself. Flu
vaccine should be offered in such cases even if the individual is not in the clinical risk
groups specified above.
In the 2018/19 flu season , NHS England will support the delivery of flu immunisation for social
care workers and health and care staff in the voluntary managed hospice sector that offer direct
patient/client care.
5Flu immunisation should be provided to:
health and social care staff, employed by a registered residential care/nursing home or
registered domiciliary care provider, who are directly involved in the care of vulnerable
patients/clients who are at increased risk from exposure to influenza. Vulnerable means those
patients/clients in a clinical risk group for flu or who are aged 65 years and over; and
health and care staff, employed by a voluntary managed hospice provider, who are directly
involved in the care of vulnerable patients/clients who are at increased risk from exposure to
influenza. Vulnerable means those patients/clients in a clinical risk group for flu or who are
aged 65 years and over.
This scheme is intended to complement, not replace, the occupational health schemes already put
in place by employers to support flu vaccination in 2018-19.
As part of the extension of seasonal influenza vaccination, a GP ES for delivery to this group has
been developed to allow practices that sign up to deliver this scheme. This ES will be delivered by
GP practices alongside community pharmacies registered to deliver the seasonal flu vaccination
advanced service.
Which flu vaccine to give
This year, three types of flu vaccine will be used in the flu programme. This will benefit
patients by ensuring that they have the most suitable vaccine that gives them the best protection
against flu. The three vaccines are:
Adjuvanted trivalent flu vaccine (aTIV) – This is licensed for people aged 65 years and over
and is the vaccine recommended by the Joint Committee on Vaccination and Immunisations
(JCVI) for this age group.
Quadrivalent vaccine (QIV) – This is recommended for children aged from 6 months to 2 years
and in adults from 18 years to less than 65 years of age who are at increased risk from flu
because of a long term health condition.
Live attenuated influenza vaccine (LAIV) – This is a nasal spray and is licensed for children and
young people from 2 years old to less than 18 years of age. The age groups targeted in England
for this vaccine in 2018/19 are two and three year olds (through their GP surgery) and school
aged children in reception class through to Year 5 (through schools). If LAIV is clinically
contraindicated QIV is used in this age group. Both are procured centrally by PHE and can be
ordered via ImmForm.
General practices and community pharmacies are responsible for ordering flu vaccines for the adult
programme directly from manufacturers. As the deliveries of aTIV will be staged between September
and early November, NHS England have issued “Flu Vaccination Programme Delivery Guidance” to
help practices and pharmacies plan the vaccination programme around this phased delivery:
https://www.england.nhs.uk/publication/flu-vaccination-programme-delivery-guidance-2018-19/
62 Contraindications for Flu Vaccination
Full details regarding contraindications and precautions are available from the Green
Book, Chapter 19, Influenza (Pp16-18)
https://www.gov.uk/government/publications/influenza- the-green-book-
chapter-19. If you have any concerns, appropriate advice should be sought
promptly either from the screening and immunisation team on
england.southwestscrimms@nhs.net, a consultant in communicable disease control
or a consultant paediatrician.
3 Patient Group Directions (PGDs)
Please follow this link https://www.england.nhs.uk/south/info-professional/pgd/
to download the NHS England South (South West) Influenza Vaccine PGDs for
adults and the NHS England South West Influenza Vaccine PGDs for those under 18
years.
4 Influenza Vaccine and Porcine Gelatine
For further guidance on influenza vaccine and porcine gelatine please follow this link:
https://www.gov.uk/government/publications/influenza-vaccine-and-porcine-gelatine-
guidance-for-health-professionals
5 Community Pharmacy Service
Since 2015/16, all community pharmacists can provide flu vaccination through the
Community Pharmacy Contractual Framework to eligible adult patients (aged 18 and
over), if they satisfy the requirements of the Advanced Service. This will continue in
the 2018/19 season.
This service is commissioned by NHS England as an advanced service and
contractors have the choice as to whether they provide it.
The service can be provided by a community pharmacist in any community
pharmacy in England that satisfies the requirements of the advanced service within
the community pharmacy contractual framework including having a consultation room,
able to procure the vaccine and meet the data recording requirements, and has
appropriately trained staff.
There is no limit on the number of vaccinations community pharmacies can claim for
as long as they are given to eligible patients.
Vaccination for children will not be offered through the Community Pharmacy
Contractual Framework Advanced Service.
7 Community Pharmacy contractors will be required to offer the service in accordance
with the service specification for 2018/19 which will be published on
www.PSNC.org.uk. This service specification will include details such as:
o payment and reimbursement details
o details of eligible patients
o accreditation requirements
o data recording requirements
o claiming for payments
o post payment verification arrangements
Data on flu vaccinations administered outside general practice must be passed back
to the patients’ GP surgery for timely entry (i.e. by close of business on the working
day following the immunisation) on the electronic patient record and submission to
ImmForm for the national data survey. This is important for clinical reasons (such as
any adverse events) and also to ensure that these vaccinations are included in the
vaccine uptake figures.
Most pharmacy contractors can send the patient vaccination details to a verified
NHS.NET email address.
86. GP Practice Checklist
The following practice checklist is based upon the findings from a study examining
the factors associated with higher vaccine uptake in general practice.2 General
practices are urged to implement these guidelines in order to help improve vaccine
uptake.
Named lead
Identify a named lead individual within the practice who is responsible for the flu
vaccination programme and liaises regularly with all staff involved in the programme.
Registers and information
Hold a register that can identify all pregnant women and patients in the under 65
years at risk groups, those aged 65 years and over, and those aged two to three
years.
Update the patient register throughout the flu season paying particular attention to the
inclusion of women who become pregnant and patients who enter at risk groups
during the flu season.
Submit accurate data on the number of its patients eligible to receive flu vaccine and
the flu vaccinations given to its patients on ImmForm (www.immform.dh.gov.uk),
ideally using the automated functions, and submit data on uptake amongst healthcare
workers in primary care using the ImmForm data collection tool.
Meeting any public health ambitions in respect of such immunisations
Order sufficient flu vaccine taking into account past and planned improved
performance, expected demographic increase, and to ensure that everyone at risk is
offered the flu vaccine. For children, guidance to be followed on ordering the vaccine
from PHE central supplies through the ImmForm website.
Robust call and recall arrangements
It is a requirement of the enhanced service specification that all patients
recommended to receive the flu vaccine are invited to a flu vaccination clinic or to
make an appointment (e.g. by letter, email, phone call, text).
Follow-up patients, especially those in at risk groups, who do not respond or fail to
attend scheduled clinics or appointments.
With all parts of the flu programme there should be a 100% active invitation for
immunisation (e.g. by letter, email, phone call, text) and providers and commissioners will
be required, if asked, to demonstrate such an offer has been made.
2
Dexter L et al. (2012) Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of
UK general practice. bmjopen.bmj.com/content/2/3/e000851.full
9Maximising uptake in the interests of at-risk patients
Start flu vaccination as soon as practicable after receipt of the vaccine with initial
priority for aTIV being for those aged 75 years and over. Aim to complete
immunisation of all eligible patients before flu starts to circulate and ideally by end of
November.
Collaborate with maternity services to offer and provide flu vaccination to pregnant
women and to identify, offer and provide to newly pregnant women as the flu season
progresses.
Offer flu vaccination in bespoke clinics and opportunistically during routine primary
care encounters
Where the patient has indicated they wish to receive the vaccination but is physically
unable to attend the practice (for example housebound patients) the practice must
make reasonable effort to ensure the patient is vaccinated.
The GP practice and/or CCG will collaborate with other providers such as community
pharmacies and community or health and social care trusts to identify and offer flu
vaccination to residents in care homes, nursing homes and house-bound patients, and
to ensure that mechanisms are in place to update the patient record when flu
vaccinations are given by other providers.
NICE Guidelines: “Flu vaccination: increasing uptake”
The National Institute for Health and Care Excellence (NICE) has published guidelines on increasing
flu vaccination uptake whi on 22 August,
The guidance is intended for providers of flu vaccination and gives recommendations on how to
increase uptake in:
clinical risk groups (aged 6 months to 64 years)
pregnant women
carers
health and social care workers
https://www.nice.org.uk/guidance/ng103/chapter/Recommendations
107 Increasing Uptake among Children – Best Practice Guide
Plans for 2018/19
In 2018/19 all children aged two and three years old on 31 August 2018 will be offered
flu vaccination via their GP as part of the programme.
GPs will continue to offer flu vaccination to children in at risk groups aged between
6 months and under 18 years of age. Children of appropriate age in reception class
and school Years 1, 2, 3, 4 and 5 are being offered vaccination in school.
Rationale for the programme
The programme will help to protect children against flu which can, although rarely, cause
serious complications. By having the flu vaccination children are less likely to pass the virus on
to friends and family, and the wider community.
Evidence (Dexter et al, 2012; Newby et al, 2016) and best practice examples
demonstrate that certain key strategies can improve vaccine uptake. What follows
is a summary of those strategies that will help to increase flu vaccine uptake
among children aged 2 and 3 years
Pre-season preparation
All eligible patients should ideally be vaccinated by the end of November before flu
starts circulating. Advanced preparation is vital for a successful programme to
achieve high vaccine uptake. Clinical judgement should be used to assess whether
to vaccinate beyond December particularly if it is a late flu season.
Staff responsibilities
Every practice should have a lead member of staff with responsibility for running the
flu immunisation campaign.
All staff should know who the lead person is.
All staff should understand the reason for the programme and have access to PHE
resources.
Every member of the practice should know their role and responsibilities.
Get all staff involved in promoting the vaccine message to parents.
Hold regular meetings so that all staff knows the practice plan and progress.
Include health visitors, midwives, pharmacists and other healthcare professionals
linked to your practice in your planning.
Use NHS Employers website free resources to put your pictures on a poster (so all staff
and parents know who can provide immunisation).
11Practice goals
Set a higher goal than the previous season.
Create computer searches to measure uptake and assess progress towards the goal or
use practice ImmForm report.
Calculate practice income depending on uptake – each extra 1% of uptake = £xxx
income.
Identifying Eligible Children
The lead member of staff to identify eligible children.
Check the accuracy of searches and coding to ensure all eligible children are identified.
Make sure the correct flu vaccination codes are in your system and that staff are aware
– don’t let hard work go unmeasured.
Create IT system reminders so that opportunistic immunisation happens.
Create a system for opportunistic identification of eligible children attending the practice
for other clinics or with parents and siblings – use flags or sticky notes to alert staff.
Don’t send a child away unimmunised
Invitation/contacting parents
Send a personalised invitation to eligible children – use the parent’s and child’s names,
sign your name at the bottom.
Phone calls can be more effective than letters; try text messages for reminders
Ensure that staff phoning patients have a script but can also answer questions and
address concerns.
Plan phone calls after 4pm when more working parents might be available
Send letters if telephone contact is not possible.
Set a date – invite every eligible child before the end of October.
Be tenacious – make multiple contacts until child is immunised or an active refusal is
received.
Clinics and appointments
Plan to have completed all routine immunisation activity byNovember.
Use time after November to mop-up unimmunised children, particularly children in at
risk groups. If clinically indicated, vaccination can be given up to the end of March.
During the season
Increasing resources in-season is difficult so comprehensive preparation and planning
is critical. There are things you can do to help sustain efforts and uptake:
Review your uptake against your goals and financial plan; celebrate/promote success
as the programme progresses.
Remain tenacious – re-run searches for eligible children.
Continue to offer vaccination, even once you have achieved your practice and
campaign goals.
Keep staff engaged and enthused – consider incentives, promoting staff competition.
Ensure all practice staff have their flu jab – it is powerful to be able to say to patients
“I’ve had mine”.
12Post season
Share the review of your campaign with your stakeholders, patient focus group and
partners who helped you achieve your goals.
Capture lesson learnt and adapt next year’s plan – aim for higher uptake next year.
138 Flu - References and Useful Resources
Title Thumb Product
The Flu Vaccination 2018 to 2019: Who Should nail Code
Have it Cover
and Why 3079111C
https://www.gov.uk/government/publication
s/flu-vaccination-who-should-have-it-this-
winter-and-why
Protecting Your Child From Flu
https://assets.publishing.service.gov.uk/g 2902552B
overnment/uploads/system/uploads/attac
hment_data/file/431953/9312_PHE_Prote
cting_Child_Flu_DL_10_web.pdf
5 Reasons to Vaccinate Poster
https://www.gov.uk/government/publication
s/five-reasons-to-vaccinate-your-child- 3079111C
against-flu
All About Flu and How to Stop Getting It
https://www.gov.uk/government/publications/flu-
leaflet-for-people-with-learning-disability 2904202
Preparing for Primary School
https://www.gov.uk/government/publicatio
ns/pre-school-vaccinations-preparing-for- Download
primary-school only
2903655
Vaccinations in Pregnancy
https://www.gov.uk/government/publications/preg
nancy-how-to-help-protect-you-and-your-baby
NHS Employers flu fighter resources:
Oxford Academic Health Science Network – children’s flu webpages
https://www.oxfordahsn.org/
Public Health England training slides and resources:
https://www.gov.uk/government/publications/vaccine-update-issue-284-august-2018-flu-
special-edition
14Dexter LJ et al. (2012). Strategies to increase influenza vaccination rates:
outcomes of a nationwide cross-sectional survey of UK general practice. BMJ
Open.
Newby KV et al (2016). Identifying strategies to increase influenza vaccination in GP
practices: a positive deviance approach. Family Practice, March; 1-6
159 Vaccinating GP Practice Staff and Data Collection Tool
The NHS Flu Vaccination Programme has an ambition to see 75% of those working
as frontline healthcare workers receive vaccination as a means of reducing the
spread of the disease, and of providing resilience at a time when demand for their
services is greatest. Practices are asked to report the numbers of employees who
have been vaccinated using the system below.
Frontline healthcare workers vaccine uptake data collection tool 2018/19
The ImmForm data collection tool enables GP Practices to upload their own data
regarding staff uptake of the flu vaccine. As we did last year, we will be asking GP
Practices to use this tool to submit their own data. Updated user guides are due to be
published later this summer but no changes are planned for 2018/19. The 2017/18
user guide for this tool is available at:
https://www.gov.uk/government/publications/seasonal-influenza-frontline-
healthcare- workers-vaccine-uptake-data-collection-tool-guidance
Cumulative data will be collected on vaccinations administered from 1 September
2018 onwards and will comprise of four monthly surveys for October, November,
December and January. The data collection tool will open in November and run
through to February so there are four monthly data collection tool periods.
Please note, the data collection is cumulative; data submitted should be on
vaccinations given from 1 September 2018 until the relevant month end, and not
just on vaccinations given since the previous month’s survey.
As some providers may finish their vaccination programme of their frontline
healthcare workers (FHCW) before the final collection, there will be an option on the
form that allows data providers to indicate that their programme has been
completed. If the appropriate box is selected, data providers will not have to submit
data for remaining months as their last submitted data will be carried forward as their
final data. If data providers do not select the box to indicate their programme has
been completed, they will appear as a ‘non- responder’ for the following month’s
survey, data will not be carried forward and it will be necessary for the area team to
contact practices to chase up the data.
We strongly recommend that the FHCW vaccination programme starts as early as
possible after 1 September. Any practices that are unable to access the ImmForm
data collection tool or have difficulty completing the form should contact
england.swscreeningandimms@nhs.net for assistance.
1610 Flu Facts
Flu kills
For the majority of people who catch it flu is unpleasant, but for some it can lead to chest
infections, severe complications and death. Globally, seasonal flu accounts for about three
to five million causes of severe illness annually and between 250,000 and 500,000 deaths.
The flu vaccine has an excellent safety record
The risk of having a serious (anaphylactic) reaction to the seasonal flu vaccine is less than
one in a million: much lower than the risk of getting seriously ill from having the flu itself. If a
patient has had a serious allergic reaction (anaphylaxis) to a flu vaccine before, please refer
to the latest guidance in the ‘Green Book’.. If a patient has a serious allergic reaction
(anaphylaxis) to hens’ eggs, then please source a vaccine with a very low egg content and
vaccinate the patient under clinical supervision.
The flu jab can’t give you the flu
It is impossible to get flu from the having the flu jab because the vaccine doesn’t contain live
viruses. A very small number of people experience side effects such as aching muscles, but
this is simply the immune system responding to the vaccine.
The side effects of the flu vaccination aren’t bad
For the most part, seasonal flu vaccine side effects are mild or often non-existent. The most
common side effect is soreness around the site of the injection and occasionally aching
muscles. These symptoms are a lot less serious than having flu.
Health professionals need to protect patients
Vaccination isn’t just about keeping yourself safe, it’s about protecting your colleagues, your
family and your patients. You can carry and pass the virus on to others without having any
symptoms yourself, so even if you consider yourself healthy, you might be risking the lives
of others.
The flu vaccine is one of the safest in the world
Seasonal flu vaccine is given to millions of people in the UK each year. The specific strains of
flu that are included may change from one year to the next but vaccines are still thoroughly
tested and are safe.
The flu vaccine is an annual vaccine
Patients vaccinated last year helped to fight the flu and took an extra step towards
excellent patient care. Please do the same again this year. Patients won’t be protected
against the new strains of flu circulating.
17Vaccination works
The World Health Organisation cites clean water and vaccination as the two interventions
that have the greatest impact on public health - vaccination works. Trivalent seasonal
influenza vaccines generally give 60-80 per cent protection against infection.
Pregnant women can be vaccinated
Pregnant women can have the flu vaccination at any stage of their pregnancy. Having the
vaccination when pregnant is beneficial and helps protect baby from flu over the first few
months of life.
Healthy diets won’t prevent flu
Your diet could well be helping to boost your immune system, but eating well will not protect
you from flu. The best way to protect you, your family and your patients against flu is by
getting the flu jab.
Hand-washing is very important, but it won’t stop flu
It is vital to follow universal infection prevention procedures and wash your hands, but once flu
has been passed on to your family, colleagues or your patients, clean hands won’t keep flu at
bay. Book your flu jab as soon as possible, and encourage those around you to do the same.
Anyone can get the flu
One of the most common reasons for not getting vaccinated is “I’ve never had flu before”.
There’s no such thing as natural immunity to influenza; with new strains circulating this year,
it’s best to get vaccinated against flu.
1811 Appendix 1: Flu Vaccines for 2018/19
1912 Appendix 2: Clinical Codes
Childhood seasonal influenza vaccination programme
Clinical codes - SNOMED
The clinical codes are based on the list of vaccines included in the PHE annual flu plan, the codes in
this section are still under review by NHS Digital and will be included in an updated version of this
document in due course.
READ codes have not been made available for 2018/19 so if your practice does not use SNOMED
then please contact
enquiries@nhsdigital.nhs.net
2021
22
Clinical codes used for payment
The clinical codes used for the calculation of payments will be available to download from the NHS
Employers website in due course. This document is available to download here:
http://www.nhsemployers.org/-/media/Employers/Documents/Primary-care-contracts/V-and-I/2018-19-
Seasonal-influenza-vaccination-clinical-codes.xlsx
2313 Appendix 3: Flu Vaccination Invitation Template Letters
The following templates have been adapted from the generic national flu letter template.
These templates are provided as an aid and there is no obligation to follow this format. GP
practices are therefore advised to review these templates and amend as they feel
appropriate.
https://www.gov.uk/government/publications/
Invitation for children age 2 and 3 years flu-vaccination-invitation-letter-template-for-
children-aged-2-3-and-4-years
https://www.gov.uk/government/publicatio
Invitation for ‘at-risk’ patients and their ns/flu-vaccination-invitation-letter-
carers template-for-at-risk-patients-and-their-
carers
https://www.gov.uk/government/public
Easy Read invitation letter ations/flu-vaccination-easy-read-
invitation-letter-template
Invitation letter for schools https://www.gov.uk/government/publicati
ons/flu-vaccination-in-
schoolshttps://www.gov.uk/government/c
ollections/annual-flu-
programme%232018-to-2019-flu-season
24Pregnant women invitation letter
[Patient Address Block] [GP Surgery]
[First address line] [Second address line] [Town/city]
[County Postcode] T [000 000 0000]
F [000 000 0000]
www.gov.uk
[Date]
Dear (INSERT NAME)
Annual flu vaccination
You may be aware that because you are pregnant you are at greater risk of serious illness if
you catch flu this winter. We therefore recommend that you have your free, annual flu
vaccination to protect yourself and your baby against these risks.
You are therefore invited:
Either
To have your free, annual flu vaccination at the surgery on:
[Insert dates – preferably ones that allow for people’s working hours and other demands on
their time]
Please phone us now on [phone number] to arrange a time on one of these days.
Or
To phone the surgery on [phone number] to arrange a time for your free, annual flu
vaccination.
If you decide not to have the vaccination please let us know so we can enter this on your
medical records.
[When we compile our mailing list we make every effort to ensure that the information is up to
date. If you have received this letter and have recently suffered a pregnancy loss, please
accept our sincere apologies and disregard this letter – optional].
Thank you. We look forward to seeing you soon. Yours sincerely
[GP name – Suggest GP signs letter] [Position/title]
Please see overleaf for some frequently asked questions about the flu vaccination.
25How serious is flu?
Flu is an unpleasant disease that spreads quickly and easily through coughing and sneezing.
Flu can also give you headaches, a sore throat, fever, chills, and muscle and joint aches.
Pregnant women are at increased risk of getting serious complications from flu compared with
other healthy adults. If a pregnant woman catches flu, she is much more likely than a woman
who isn’t pregnant, to be admitted to hospital or on rare occasions be admitted to intensive care
and even potentially die. Flu can also be serious for new born babies, who can catch the
infection from their mothers.
Why get the vaccine?
Catching flu during pregnancy can lead to an increased risk of pneumonia, miscarriage,
premature birth or having a low weight baby. The vaccine provides the best available
protection against flu and will also protect the baby in the first few weeks of life after birth
when they are too young to have a vaccination themselves
I’ve heard that the vaccination can give you flu. Is that true?
No; the flu vaccine that is given to adults is made from dead flu virus and cannot cause the
infection. The flu vaccine that will be given to most children is a live vaccine, but the viruses in
it have been weakened so they can not cause flu. You may get some side effects after the
vaccination but these are quite mild like a slightly raised temperature or aching muscles for a
couple of days or an ache in the arm where the injection was given. Other reactions are very
rare.
Is the vaccine safe?
The flu vaccination has been given safely to millions of women over the last few years and in
several countries around the world. This experience has shown that there are no safety issues
relating to the pregnancy or the baby – for example, the number of miscarriages or birth defects
in pregnant women who have been vaccinated for flu is no different from those who haven’t
been vaccinated.
I had the seasonal flu vaccination last year or in my last pregnancy. Do I
need another flu jab this year?
Yes; the flu viruses change every year, so the vaccines are changed to match them. Being
vaccinated one year won’t protect you during the next.
When should I have the vaccine?
The vaccine is available now and you just need to contact the surgery on [phone number] to
book an appointment. The best time to get the jab is as early as possible to be protected in
time for winter, but will be available up until 31st March. You can safely have the vaccine at
any stage of your pregnancy from conception onwards.
26I am pregnant and not sure about the seasonal flu vaccination- where can
I find out more information?
Further information is available in the NHS England leaflet ‘Flu, your pregnancy and
you’. You can also discuss any concerns with your midwife or GP.
27Invitation for Flu Vaccination 65+
[Patient Address Block] [GP Surgery]
[First address line] [Second address line] [Town/city]
[County Postcode] T [000 000 0000]
F [000 000 0000]
www.gov.uk
[Date]
Dear [Name]
Annual flu vaccination
Your medical condition or your age suggests that you are in a group of the population who
may be at greater risk of the complications of flu.
You are therefore invited:
either
to have your free, annual flu vaccination at the surgery on:
[Insert dates – preferably ones that allow for people’s working hours and other demands on
their time]
Please phone us now on [phone number] to arrange a time on one of these days.
or
phone the surgery on [phone number] to arrange a time for your free, annual flu
vaccination.
You may also be offered a vaccination against pneumococcal disease which can cause severe
pneumonia or a new vaccine to reduce the chance of getting shingles and neuralgia.
Carers are also eligible for the free flu vaccination (as the welfare of the person they care for
may be at risk if the carer falls ill). If there is someone you rely upon to care for you, we suggest
they contact their own GP practice to ask for a free flu jab.
If you decide not to have the vaccination please let us know so we can enter this on your
medical records.
Thank you. We look forward to seeing you soon.
Yours sincerely
[GP name – Suggest GP signs letter]
[Position/title]
28Common questions about the flu vaccination
What is flu?
Flu is a highly infectious disease. The symptoms, that come on very quickly, include fever,
chills, headaches, aches and pains in the joints and muscles, and extreme tiredness. For most
healthy people, a bad bout of flu is worse than a heavy cold usually requiring someone to spend
a few days in bed. However, serious infections, especially in those with underlying health
conditions, although less common, can lead to hospitalisation, permanent disability and even
death.
What causes flu?
Flu is caused by viruses that are spread from person to person. They infect the respiratory
system, where they can lead to pneumonia and other complications. The viruses are
constantly changing and this is one of the main reasons why people should be vaccinated
annually.
How is flu spread?
Flu is spread by coughs and sneezes that propel infected droplets of saliva or nasal
secretions into the air which are then breathed in by others. The disease is also spread by
people touching surfaces that the droplets have landed on and then touching their mouth,
nose or eyes. This is why frequent hand washing or using an antiseptic hand rub is so
important during the winter flu season.
How can I avoid catching flu?
It’s quite hard to avoid because people may be able to pass the virus on to others a day or so
before symptoms start to show (as well as up to seven days after), so they won’t know if they
are spreading the virus or not. So it’s very hard to avoid contact with people infected with the flu
virus. And, of course, members of your family can always bring it into the home.
You can also wash your hands regularly but this won’t stop you catching the disease by
breathing in the infected droplets in the air. The best way to help avoid getting flu is by
having the vaccination.
Why is flu more serious for me if I am an older person?
The risk of serious illness from flu and consequent hospitalisation and death is higher among
those aged 65 years and older as they are more likely to have an underlying health problem
and the immune system does not work as well. The best way for people at risk from flu to
protect themselves is to get the flu vaccine.
Why do underlying health conditions or pregnancy make it more serious
for someone who gets flu?
You are at particular risk of severe illness if you get flu and have an underlying health condition,
or are pregnant. This means that you are more likely to be admitted to hospital or on rare
occasions be admitted to intensive care and even potentially die.
29Will I be completely protected by the vaccination?
By having the vaccination you will be significantly reducing your risk of getting flu but no
vaccine offers 100% protection.
Will I get any side effects?
There are some fairly common but mild side effects. Some people get a slight temperature and
aching muscles for a couple of days afterwards, and your arm may feel a bit sore where you
were injected. Any other reactions are very rare. Serious side effects in children are
uncommon but many develop a runny or blocked nose, headache, general tiredness and some
loss of appetite that lasts for a short period.
I had the flu vaccination last year. Do I need another one this year?
Yes, the flu vaccine for this winter provides protection against some different strains of flu from
last year’s. For this reason we strongly recommend that even if you were vaccinated last year,
you should be vaccinated again this year.
Where can I get more information?
Speak to your GP practice or visit the flu pages on the NHS Choices website at:
https://www.nhs.uk/conditions/vaccinations/flu-influenza-vaccine/
30Carers invitation letter
[Patient Address Block] [GP Surgery]
[First address line] [Second address line] [Town/city]
[County Postcode] T [000 000 0000]
F [000 000 0000]
www.gov.uk
[Date]
Dear (INSERT NAME)
Annual flu vaccination
You may be aware that because you are a carer for someone whose welfare may be at risk
should you catch the flu virus this winter, you are strongly recommended to protect yourself and
them with a free, annual flu vaccination.
You are therefore invited:
Either
To have your free, annual flu vaccination at the surgery on:
[Insert dates – preferably ones that allow for people’s working hours and other demands on
their time]
Please phone us now on [phone number] to arrange a time on one of these days.
Or
To phone the surgery on [phone number] to arrange a time for your free, annual flu
vaccination.
If you decide not to have the vaccination please let us know so we can enter this on your
medical records.
Thank you. We look forward to seeing you soon.
Yours sincerely
[GP name – Suggest GP signs letter]
[Position/title]
Please see overleaf for some frequently asked questions about the flu vaccination.
31What is flu?
Flu is an unpleasant disease that spreads quickly and easily through coughing and sneezing.
Flu can also give you headaches, a sore throat, fever, chills, and muscle and joint aches.
Those people who are at risk, either because of their age or medical conditions, may develop
complications such as chest infections and pneumonia or in some rare cases cardiac problems,
meningitis and/or encephalitis.
Why get the vaccine?
The vaccine provides the best available protection against flu. It is not 100% but it will
protect a significant number of people and reduce the severity of flu if you get it. It could also
help your relatives or anyone you are a carer for because you will not be passing the
disease to them.
Who should get it?
Young babies, older people, pregnant women and those who have other underlying health
conditions, especially those of the lungs, heart, liver or kidneys, are particularly vulnerable to
serious complications and possibly hospitalisation. Every year in the UK a number of people
in these groups die from the complications of flu.
I’ve heard that the vaccination can give you flu. Is that true?
No; the flu vaccine that is given to adults is made from dead flu virus and cannot cause the
infection. The flu vaccine that will be given to most children is a live vaccine, but the viruses in
it have been weakened so they can not cause flu. You may get some side effects after the
vaccination but these are quite mild like a slightly raised temperature or aching muscles for a
couple of days or an ache in the arm where the injection was given. Other reactions are very
rare.
When can I get the vaccine?
The vaccine is available now and you just need to contact the surgery on [phone number] to
book an appointment. The best time to get the vaccine is as early as possible, to be protected
in time for winter.
3217 Appendix 4: Reducing excess LAIV ordering in General Practice
Ordering controls using allocations based on previous years’ uptake were first introduced two
years ago on centrally supplied flu vaccines. These were put in place to reduce the amount of
excess vaccine, in particular LAIV, ordered by NHS providers but not administered to children.
The latest information on ordering controls and other ordering advice for LAIV will be available
in Vaccine Update and on the ImmForm news item both prior to, and during, the flu vaccination
period. It is strongly advised that all parties involved in the provision of flu vaccines to children
ensure they remain up to date with this information.
Please take measures to ensure that ordering of LAIV is better matched with the pattern of
delivery of the vaccine to eligible patients, and based on realistic expected uptake rates.
All those responsible for the ordering of LAIV vaccine should review their past ordering and
identify ways in which ordering can be better informed. This could help the NHS save a
significant amount of money and ensure vaccine is available for those who need it.
33Title goes here as running header
Better ordering
Your answers to these questions will help you identify possible areas for improvement:
1. How much LAIV was ordered but not used in your practice last year, i.e. how much did
you dispose of?
The higher the ratio of unused vaccine, the more need there is for improvement.
2. Did you have to dispose of expired LAIV and re-order more during the course of the
season?
If you disposed of expired vaccine during the season and had to re-order, then it is possible
that you ordered too much vaccine early in the season.
3. How many eligible children were vaccinated in your practice in previous years?
The total number of eligible children that you vaccinated, plus a small ‘buffer’, should give an
indication of the total number of vaccines that you need to order over the course of the season.
4. How many children did/will you realistically vaccinate in a given week? Was this higher at
the start of the season, did it peak during a certain time?
Being pragmatic about the number of vaccines that you are likely to use in a given week will
help you devise an ordering plan that matches the rate at which they will be used.
Your ordering plan
Answering the points above will move you towards better informed ordering.
Once you have identified the number of vaccines you think you need to order for the
2018/19 season, you should examine the practice plans to deliver the vaccine, for example:
Are there planned clinics?
Are they weekly or more/less frequently? For how many weeks are clinics planned?
How many you vaccines do you realistically expect to give at each one?
Answering these questions will help you improve your ordering plan.
Remember that this can be flexed as the season progresses. You will continue to have the
opportunity to order more or less each week if the number of vaccinations delivered in a
particular week is not as expected.
34Main title goes here as running header
The example shown below outlines a practice plan to order 440 doses over the season:
Week No of vaccines ordered Notes
1 50
2 50
3 20 Reduced clinics this week due to staff absence
4 80 School half term – holding extra clinics
5 40 Check fridge stock before ordering, amend if
necessary so that we are only holding a
maximum of 3 weeks’ stock
6 40
7
8 Check fridge stock before ordering, amend if
necessary so that we are
9 Last week ofonly
planned clinics
holding a maximum of 3
weeks’ stock
10 Christmas – only order if stocks are low
11 Low demand expected
12 Begin to allow stock level to decrease due to end
of vaccination season
approaching
REMEMBER the General Principles for LAIV ordering
Remember that LAIV is supplied in a 10-dose pack
Remember that you can order weekly and receive weekly deliveries
Be realistic about the amount of vaccine that you need
Spread your orders over the course of the flu vaccination season – later ordered stock will
have a later expiry date and will last longer
Hold about 2–3 weeks stock in your fridge; local stockpiling can delays or restrictions on
stock being released to the NHS, and increases the risk of significant loss of stock if there
is a cold chain failure in your practice.
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