Influenza Vaccination Briefing for GP Practices 2017/2018

The national flu immunisation programme aims to provide direct protection to those who are at higher risk of flu associated morbidity and mortality.

Full guidance for the 2017/2018 influenza season can be found at

This briefing aims to give practices a summary of the changes in eligible groups, commissioning arrangements and some tips for improving the uptake of influenza vaccination.

For the full list of groups included in the national flu immunisation programme,please refer to appendix A of this briefing

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Main Changes for 2017-2018

  • Morbidly obese patients are now included in the clinically at risk groups
  • GP to offer flu immunisation to 2 and 3 year olds
  • School based programme extended to include children in reception and school years 1,2,3 and 4 (delivered by community school nursing provider)
  • Housebound patients (excluding those who are in nursing homes) will be vaccinated by the district nurse teams.
  • Practices will need to follow the guidance in appendix B and provide a list of housebound patients to district nurses by the end of October.
  • GP Practices will ensure administration of vaccines to their patients in nursing homes. This will includeall residents on the District Nursing caseload to reduce the risk of double doses

Tips for improving flu vaccination uptake

The OCCG infection control leads worked with practices in the last immunisation season to improve uptake. The following initiatives by the practices had a positive impact on percentage improvement of vaccination uptake:

  • Practices with a definitive flu plan and identified lead for flu performed better
  • Writing directly to patients rather than relying solely on email or text messaging increases response from patients.
  • If using text messaging and email invitations the practices need to consider if they have these details for all patients or if a cohort are being missed as the contact details are incorrect or incomplete.
  • GP surgeries where internal incentives were used to encourage staff to immunise patients performed well, demonstrating that ownership of the programme brought improved results.
  • Opportunistic immunisations worked well, for example having vaccine ready in a GP consultation room and vaccinating during a routine appointment (e.g. asthma review)
  • Holding weekend and evening flu immunisation clinics allows greater access to patients and these were very well attended.
  • Practices that carried out a ‘mop-up’ of patients (going through their lists of eligible patients and identifying those who had not attended) and inviting them by telephone was successful.

Summary table for CommissioningArrangements

Cohort / Provider
Primary Care / Pharmacy / Maternity Services / Community School Nursing Provider
People Aged 65 & Over /  /  /  / 
Clinically at risk groups under 65 /  / 
(aged 18 to 64) /  / 
Pregnant Women /  /  / see note below / 
Carers /  /  /  / 
Children Aged 2 & 3 /  /  /  / 
Children in Reception & School Years 1, 2, 3 & 4 /  /  /  / 

Note re Pregnant Women:

GP practices should offer influenza vaccination to pregnant women in primary care.

To further improve uptake vaccination will also be offered when pregnant women attend maternity services at:

John Radcliffe Women’s Centre scan department Mon- Fri 8am – 4pm, Sat 8am – 1pm. No appointments necessary

Also opportunistically in Maternity Outpatients at the Women’s Centre and Horton Maternity Unit.

Community Maternity Units: Cotswold (Chipping Norton), Wantage and Wallingford.

Maternity services will notify the GPs of vaccinations performed and recommend flu vaccination to all pregnant women at any stage of pregnancy

Appendix A: Groups included in the national flu immunisation programme

1. In 2017/18, flu vaccinations will be offered under the NHS flu vaccination programme to the following groups:

  • All those aged two and three (but not four years or older) on 31 August 2017 (i.e. date of birth on or after 1 September 2013 and on or before 31 August 2015)
  • All children in reception class and school years 1, 2, 3 and 4
  • All primary school-aged children in former primary school pilot areas
  • People aged from six months to less than 65 years of age with a serious medical condition such as:
  • Chronic (long-term) respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis
  • Chronic heart disease, such as heart failure
  • Chronic kidney disease at stage three, four or five
  • Chronic liver disease
  • Chronic neurological disease, such as Parkinson’s disease or motor neurone disease, or learning disability
  • Diabetes
  • Splenic dysfunction
  • A weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment)
  • Morbidly obese (defined as BMI of 40 and above)
  • All pregnant women (including those women who become pregnant during the flu season)
  • People aged 65 years or over (including those becoming age 65 years by 31 March 2018)
  • 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
  • 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

2. 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.

3. It is also important that health and social care workers with direct patient/service user contact should be vaccinated as part of an employer’s occupational health obligation.

Healthcare practitioners should refer to the Green Book influenza chapter for further detail about clinical risk groups advised to receive flu immunisation. This is regularly updated, sometimes during the flu season, and can be found at:

Reception Year is defined as four rising to five year olds (i.e. date of birth between 1 September 2012 and on or before 31 August 2013)

Year 1 is defined as five rising to six year olds (i.e. date of birth between 1 September 2011 and on or before 31 August 2012)

Year 2 is defined as six rising to seven-year-olds (i.e. date of birth between 1 September 2010 and on or before 31 August 2011)

Year 3 is defined as seven rising to eight-year-olds (i.e. date of birth between 1 September 2009 and on or before 31 August 2010)

Year 4 is defined as eight rising to nine-year-olds (i.e. date of birth between 1 September 2008 and on or before 31 August 2009)

Some children in Reception year and years 1, 2, 3 and 4 might be outside of these date ranges (e.g. if a child has been accelerated or held back a year). It is acceptable to offer and deliver immunisations to these children with their class peers.

Appendix B housebound patients

Eligibility

All people who are housebound are eligible for flu vaccine whether or not they are on the current district nursing caseload.

OCCG and Oxford Health Foundation Trust have agreed to define housebound patients as:

  • Patients that require assistance from two or more people to get in and out of a vehicle or who need nursing support during the journey.
  • Patients with a medical condition or exceptional social circumstances where it would be detrimental to the patient’s condition or recovery to travel by any means.
  • The patient’s status should be assessed in relation to the point that the specific service needs to be delivered, and may be subject to change over the short or long term.
  • Patients not on the DN caseload (including those in residential and care homes), will be vaccinated by the DN Service, and paid for by the CCG on a case by case basis.

Exceptions

This will not include administration of vaccines to patients in nursing homes. The GP Practices need to ensure vaccination of all eligible residents in nursing homes (including DN caseload patients) to reduce the risk of double dosing.

Patients who are active on the District Nursing caseload

The district Nursing service will offer a flu vaccination to all patients they visit from 1st October to 31st January, excluding those patients in nursing homes.

Process for Patients who are not on the District Nursing caseload

Practices that choose to participate will provide a list of eligible patients who are not active on the District Nursing caseload and:

  • Are housebound as per the definition
  • Have not already been given a flu immunisation by another health care professional
  • Have not been coded as refusing flu immunisation in the previous 12 months.

The list will be requested at the beginning of October and should be provided by the practice at or before the end of October.

Practices will provide a list of patients to their local district nurse team, including the patients name, NHS number, address, telephone number and any other relevant contact details such as key codes. The DN team will only be able to accept lists which fully meet these requirements.

The DN team will respond to practices stating that they:

  • Confirm that they intend to immunise the patients on the list provided
  • Ask the practice to update the DN service with relevant changes to the non-caseload list as they occur

The DN teams will:

  • Access practice records to confirm each patient’s clinical immunisation status
  • Update the practice within 1 week of contact to advise vaccine administered or declined
  • Give the practice monthly updates on progress and forecasts of completion
  • Return a completed list to the practice showing any patients not immunised

In the event that the DN service finds more than three inaccuracies which affect providing an efficient service (i.e. patients died, moved, already immunised, not housebound), the service will return it to the practice to re-check the list.The DN service will continue with vaccinations when the practice provides a more accurate list.

GP Practices will ensure administration of vaccines to their patients in nursing homes. This will includeall residents on the District Nursing caseload to reduce the risk of double doses.