Community Pharmacy Adult NHS Influenza Vaccination Pilot

Birmingham Solihull and the Black Screening and Immunisation Team.

Summary

  • Influenza vaccination uptake for adults has been consistently below national target across the CCGs in the Area Team
  • Other areas have implemented a community pharmacy programme for providing NHS vaccination through this route with some success
  • Local Pharmacy Committees were enthusiastic about taking such an initiative forward.
  • The Screening and Immunisation Team have been working with the two lead LPC leads to develop the service proposal and an evaluation plan
  • Administration and evaluation of the process will be facilitated by using the Pharmoutcomes system

1Aim

The aim of this paper is to outline the current situation forNHS influenza vaccination for adults and details of the pilot to provide a service through community pharmacies for 2014-15. Please note that the pilotdoes not cover influenza vaccination for occupational reasons, pregnant women or the vaccination of children.

2Background

The Department of Health (DH) recommends annual flu vaccination to all individuals aged 65 years and over and individuals aged from 6 months to less than 65 years if in recognised clinical risk groups. Vaccination usually takes place between October and January.Birmingham, Solihull and Black Country Local Area Team’s current vaccination programme is offered through general practice. It has achieved a reasonable uptake in the 65 years and over cohort but thecoverage rate of 71.3% in 2013-14 is still below the 75% target. Practices have consistently struggled to achieve the 75% target in those in clinical risk groups with only 50.9% coverage in 2013-14. Based on 2013-14 figures, there are approximately 254, 361 unimmunised eligible individuals in this area (116,661 aged 65 years and over and 137,700 in clinical risk groups.)

3Using pharmacists to deliver influenza vaccination

Every year the NHS deals with 438 million visits to a pharmacy in England for health related reasons and 340 million GP consultations1. The majority of the population can access a community pharmacy within 20 minute walk and crucially, access is greater in areas of highest deprivation2. Sir Bruce Keogh in the first report of his Urgent and Emergency Care Review highlighted community pharmacy as an under-used resource and suggested the need to capitalise on the potential, skills and expertise of the pharmacy workforce3. In December 2013 NHS England identified provision of seasonal flu immunisation to ‘at risk groups’ as one of the various services for commissioners to consider via community pharmacies locally to help manage winter pressures1.

Much of the evidence in support of community pharmacy provision of seasonal flu vaccination comes from the US where the programme was first introduced in 1990s. Reviewson the contribution of community pharmacies to improve public health concluded that immunisation services can be provided safely through community pharmacies, user satisfaction with pharmacy-based immunisation is high4, 5, 6. Private vaccination services are already provided from many community pharmacies in the UK. Since 2002, various PCTs and subsequently Area Teams have commissioned community pharmacies to provide a flu vaccination service. Eligible groups have varied across the services. Where the NHS has commissioned flu vaccine targeted for ‘at risk’ groups, there is evidence that many people who received the vaccine have never been vaccinated beforee.g.in Sheffield where 20% of those vaccinated in community pharmacies were vaccinated for first time and 19% said they would not have had it if vaccine was not being offered at pharmacy7. Patient satisfaction with pharmacy flu vaccination provision is high with 99% of patients in Cumbria, Sheffield and Isle of Wight, and 97% in Norfolk identifying the service good or excellent7-10. Patients cite easy access, convenience and no need to wait or need to book appointment as main reasons.

The percentage vaccinated in pharmacies as a proportion of all vaccinations varies from 1.8% in Arden, Hereford and Worcestershire (5250 vaccines administered) to 10% in Isle of Wight (2903 vaccines administered). Subsequent years see an increase in numbers. City and Hackney PCT in London introduced an enhanced pharmacy flu service in 2005 and increased its uptake from 59% in 2005 to 76% in 2008 for patients aged 65 years and over6. In Cumbria, 8000 vaccines were administered in 2012 which rose to 15,603 in 2013. Pharmacy service did not impact on uptake via GP practice as numbers did not decrease8,10.

4Proposal development

Formal sign up of pharmacies will take place when they sign the SLA (Appendix 1). They also have to sign up to a PGD. Data will be collected though the Pharmoutcomes system, already used for flu vaccination in other areas. The system will be able to send an electronic record of the vaccination to the GP surgery, as long as an NHS net address is available for the practice. If not, a paper copy will be printed which would be delivered to the practice in the routine delivery. Pharmacies will be offered the same fee as GPs. All influenza vaccinations given by pharmacists can count toward a practice’s QOF total, where applicable eg Stroke, diabetes, COPD and CHD. They will also count toward the total for the practice on ImmForm, but a different Read code applies.

The emphasis throughout the process has been about particularly increasing uptake in the under 65years at risk. For the 65 years and over, pharmacists are expected first to enquirewhether the patient has made arrangements with their GP to be vaccinated and to offer the pharmacy option if the patient says they will not be taking up their GP’s offer.

The process will be actively monitored though the winter season and a detailed evaluation will be carried out by a Public Health specialist (Appendix 2). The lead pharmacists from the LPCs will be also be part of the monthly flu teleconferences that the SIT host through the flu season.

References

  1. Community Pharmacy – helping with winter pressures. December 2013. NHS England
  2. Transforming urgent and emergency care review services in England, Urgent and Emergency Care review, Phase1 Report, Nov 2013.
  3. Todd A, Copeland A, Husband A, et al. The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England. BMJ Open 2014;4:e005764. doi:10.1136/bmjopen-2014-005764
  4. Anderson C, Blenkinsopp A, Armstrong, M. The contribution of community pharmacy to improving the public’s health. Summary report of the literature review1990-2007. Available at:
  5. Fajemisin F. Community Pharmacy and Public Health. 2013.
  6. Francis M, Hinchliffe A. Vaccination services through community pharmacy: aliterature review. 2010. Public Health wales.
  7. NHS Sheffield Community Pharmacy Seasonal Flu Service Evaluation 2011–12. of-Pharmacy-Flu-Service-2012-13-1.pdf
  8. NHS Flu Vaccination Evaluation Report. 2014. Community Pharmacy delivery in Cumbria, Northumberland, Tyne and Wear
  9. Isle of Wight Community Pharmacy Seasonal Flu End of Service Report 2010–12.
  10. Patient experience of the Community Pharmacy Flu Vaccination service in Norfolk. 2014.

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