Seasonal influenza vaccination advanced service


Since September 2015, certain at-risk adult patients (aged 18 or over at the time of vaccination) have been able to access their free seasonal influenza vaccination from community pharmacies. 

NHS England has confirmed that the service will continue into 2017/18 and so the service below runs from September 2017 until 31 March 2018. Further information can found on the NHS England website.  

Pharmacy contractors are paid £7.64 for each vaccination provided, with an additional £1.50 per vaccinated patient in recognition of costs related to providing the service, including collection of clinical waste, staff training and revalidation. Pharmacies can also provide private vaccinations to patients outside the eligible groups covered by the annual flu letter.

The service specification has been updated for 2016/17 and jointly published by NHS Employers, Pharmaceutical Services Negotiating Committee (PSNC) and NHS England. The Immunisation against infectious disease Green Book includes details on the background, dosage, timings and administration of the vaccination. Patients aged under 18 are not currently able to receive NHS seasonal flu vaccinations in community pharmacies. To vaccinate a patient in long stay residential care home or care facility, the contractor must complete the relevant form and email it to the local NHS England team for community pharmacy. 

Eligible patients for the community pharmacy NHS seasonal influenza advanced service
This service covers those patients most at risk from influenza aged 18 years and older. The selection of these eligible groups has been informed by the target list from the annual flu letter and the Green Book.
Eligible groups  Further details 
All people aged 65 years or over  Including those becoming age 65 years by 31 March 2017.
People aged from 18 years to less than 65 years of age with one or more serious medical condition(s) outlined below: 
Chronic (long term) respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission.  
Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).
Chronic heart disease, such as heart failure  Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease.
Chronic kidney disease at stage three, four or five Chronic kidney disease at stage three, four or five, chronic kidney failure, nephrotic syndrome, kidney transplantation. 
Chronic liver disease  Cirrhosis, biliary atresia, chronic hepatitis. 
Chronic neurological disease, such as Parkinson’s disease or motor neurone disease, or learning disability  Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers).
Clinicians should offer immunisation, based on individual assessment, to clinically vulnerable individuals including those with cerebral palsy, learning disability, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.
Diabetes  Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes. 
A weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment)   Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, bone marrow transplant, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement deficiency). 

Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age), or for children under 20kg, a dose of 1mg or more per kg per day. 

It is difficult to define at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of influenza and should be offered seasonal influenza vaccination. This decision is best made on an individual basis and left to the patient’s clinician. 

Some immune-compromised patients may have a suboptimal immunological response to the vaccine.
Splenic dysfunction This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction.
All pregnant women (including those women who become pregnant during the flu season)
Pregnant women aged 18 or over at any stage of pregnancy (first, second or third trimesters).
People living in long-stay residential care homes or other long-stay care facilities  Vaccination is recommended for 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. For the pharmacy service, this only applies to those aged 18 or over.
Carers  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.
Household contacts of immunocompromised individuals  People who are household contacts, aged 18 and over, 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. 

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