To: All GP practices, NHS England South West area. August 2018

Transcription

1 To: All GP practices, NHS England South West area August 2018

2 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 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 ) 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 1

3 For 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 Children s programme Uptake ambition Preschool children aged 2 and 3 years old At least 48% with practices aiming to achieve higher School aged children ( in reception class and years 1-5) An average of at least 65% to be attained by every provider across all years Routine Programme Aged 65 years and over 75% reflecting the World Health Organisation (WHO) target for this group Aged under 65 at risk including pregnant women At least 55% in all clinical risk groups maintaining higher rates where those have already been acheieved. Ultimately, 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 2

4 Bristol, 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 systemwide 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 3

5 Contents 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 Vaccinating GP Practice Staff and Data Collection Tool Flu Facts Appendix 1: Flu Vaccines for 2018/ 2019 (with Ovalbumin content) Appendix 2: Full Influenza Read Codes Appendix 4: Flu Vaccination Invitation Template Letters Appendix 5: Reducing excess LAIV ordering in General Practice 32 4

6 1 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. 5

7 Flu 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 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: 6

8 2 Contraindications for Flu Vaccination Full details regarding contraindications and precautions are available from the Green Book, Chapter 19, Influenza (Pp16-18) the-green-bookchapter-19. If you have any concerns, appropriate advice should be sought promptly either from the screening and immunisation team on a consultant in communicable disease control or a consultant paediatrician. 3 Patient Group Directions (PGDs) Please follow this link 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: 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

9 Community Pharmacy contractors will be required to offer the service in accordance with the service specification for 2018/19 which will be published on 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 address. 8

10 6. 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 ( 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, , 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, , 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/e full 9

11 Maximising 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 10

12 7 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). 11

13 Practice 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. 12

14 Post 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. 13

15 8 Flu - References and Useful Resources Title The Flu Vaccination 2018 to 2019: Who Should Have it and Why s/flu-vaccination-who-should-have-it-thiswinter-and-why Protecting Your Child From Flu overnment/uploads/system/uploads/attac hment_data/file/431953/9312_phe_prote cting_child_flu_dl_10_web.pdf Thumb nail Product Code C B 5 Reasons to Vaccinate Poster s/five-reasons-to-vaccinate-your-childagainst-flu C All About Flu and How to Stop Getting It Vaccinations in Pregnancy nancy-how-to-help-protect-you-and-your-baby Download only NHS Employers flu fighter resources: Oxford Academic Health Science Network children s flu webpages Public Health England training slides and resources: Preparing for Primary School ns/pre-school-vaccinations-preparing-forprimary-school 14

16 Dexter 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;

17 9 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: 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. 16

18 10 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. 17

19 Vaccination 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 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. 18

20 11 Appendix 1: Flu Vaccines for 2018/19 19

21 12 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 20

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24 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: Seasonal-influenza-vaccination-clinical-codes.xlsx 23

25 13 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. Invitation for children age 2 and 3 years flu-vaccination-invitation-letter-template-forchildren-aged-2-3-and-4-years Invitation for at-risk patients and their carers ns/flu-vaccination-invitation-lettertemplate-for-at-risk-patients-and-theircarers Easy Read invitation letter ations/flu-vaccination-easy-readinvitation-letter-template Invitation letter for schools ons/flu-vaccination-inschoolshttps:// ollections/annual-flu- 24

26 Pregnant women invitation letter [Patient Address Block] [First address line] [Second address line] [Town/city] [County Postcode] T [ ] [GP Surgery] F [ ] [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. 25

27 How 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. 26

28 I 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. 27

29 Invitation for Flu Vaccination 65+ [Patient Address Block] [First address line] [Second address line] [Town/city] [County Postcode] T [ ] [Date] [GP Surgery] F [ ] 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] 28

30 Common 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. 29

31 Will 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: 30

32 Carers invitation letter [Patient Address Block] [First address line] [Second address line] [Town/city] [County Postcode] T [ ] [GP Surgery] F [ ] [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. 31

33 What 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. 32

34 17 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. 33

35 Title 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. 34

36 Main 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 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 Check fridge stock before ordering, amend if necessary so that we are 9 Last week of only planned holding clinics a maximum of 3 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. 35