GPs FACE DELAY IN PHARMACY FLU VACCINATION PLANS
LMC forces delay in pharmacy flu vaccination plans
From FMS Global News Desk of Jeanne Hambleton PULSE 22 August 2014 | By Caroline Price
Exclusive: GP leaders have forced NHS England in one area to halt plans to co-opt pharmacies into delivering flu jabs, amid concerns it would put practices at serious financial risk without helping to improve uptake in at-risk groups.
LMC leaders in Shropshire and Staffordshire said they have managed to get the plans – announced earlier this month – put on hold, after objecting over the short notice for GPs who had already ordered in vaccine stocks for their at-risk populations.
GPC leaders have criticised NHS England’s continued push for pharmacy-led schemes across the country, which they said had not increased flu vaccine uptake and were potentially depriving GPs of income at the same time as adding to their workload.
NHS England Shropshire and Staffordshire area team sent out a letter to local pharmacy groups in the first week of August, offering them service level agreements to provide the flu vaccinations to patients aged 65 years and over; those aged from 18 years to under 65 years in clinical risk groups and pregnant women aged 18 years and over.
Dr David Dickson, secretary of South Staffordshire LMC, told Pulse that GP leaders in the area – which also covers Shropshire and North Staffordshire LMCs – immediately raised their concerns with the area team. They have now been informed by NHS England that the plans are on hold while the area team formulates a proper plan.
Dr Dickson said: ‘They have put it on hold for the moment. They have not given sufficient notice for this, practices have already placed their orders for vaccine and they are at financial risk if they are not taken up. It is too late in the year to change those orders – and some practices do not have return of sale arrangements.’
‘We also do not think there is evidence it will improve the uptake and are worried pharmacy colleagues do not have the same recording and reporting duties – they are not going to target the hard-to-reach groups.’
A spokesperson for NHS England Shropshire and Staffordshire said discussions about the scheme were ‘ongoing’ and it would likely be in place ‘by the end of the year’.
But Dr Dickson said the Government should instead adopt more vigorous publicity campaigns to encourage uptake in difficult to reach at-risk groups – such as young working men, housebound people and people with impaired mobility – as well as better strategies to help inform pregnant women about the benefits of vaccination.
He said: ‘There are key things like that they need to address before handing all the easy ones over to pharmacies.’
Pharmacy-led flu vaccination programmes have been implemented in several areas in recent years, and NHS England is continuing to encourage CCGs to commission them to help boost vaccine uptake in at-risk groups, which is falling well below the national target of 75%, as part of its ‘winter pressures’ strategy to prevent avoidable hospital admissions.
The NHS England Shropshire and Staffordshire area team spokeperson said: ‘We are committed to ensuring that people who are most at risk have easy access to the flu vaccination.
‘NHS England in Shropshire and Staffordshire proposed a scheme earlier this year to allow pharmacies to administer flu vaccinations to adults in the “at risk” groups. We are continuing to have on-going discussions with GP practices, Local Medical Committees (LMCs) and Local Pharmacy Committees (LPCs) and anticipate the scheme will be available by the end of this year.’
But GPC Wales chair Dr Charlotte Jones, who is also co-lead for the GPC on immunisations, said initiatives to get pharmacies to deliver flu vaccines to at-risk groups in Wales had not helped to reach more patients in vulnerable groups.
Dr Jones said: ‘Whilst we do not disagree with any initiative to increase flu vaccine uptake, our experience has been it is those patients who would have always had their flu jabs done in the GP surgery that are being captured by the pharmacies – and they are not actually reaching those who have not been getting it, so it is not meeting that need.
‘We are concerned it is removing this work from GPs who deliver the vast bulk of the programme, and end up chasing the harder to reach patients.’
Dr Richard Vautrey, GPC deputy chair and also co-lead on immunisation, said experience elsewhere in the country had similarly demonstrated that pharmacy-based schemes were causing disruption for practices but not helping to boost uptake.
He said: ‘All it does is add complexity and confusion to the process rather than producing any greater benefits in terms of numbers of vaccinated.’
He added that the GPC wanted to reinstate national publicity campaigns to promote flu vaccinations, despite Department of Health claims they were ineffective.
‘The more the Department of Health and Public Health England can promote vaccination the better there is no loss and only gain to be made if it is more widely promoted whether through direct publicity or articles in the media.’
A spokesperson for the Pharmaceutical Services Negotiating Committee (PSNC) told Pulse ‘there is evidence for the positive impact that pharmacies can have on [flu vaccine] delivery rates’.
The PSNC spokesperson added: ‘There is also evidence that patients strongly welcome the additional choice that alternative providers allow them.’
Note: This story was amended at 11:51 on 22 August 2014 to incorporate NHS England Shropshire and Staffordshire area team’s comments
FLU ANTIVIRAL ALERT ‘SHOULD BE SENT OUT EARLIER TO GPS’
From the FMS Global News Desk of Jeanne Hambleton PULSE 8 August 2014 | By Caroline Price
Peak flu activity had already been reached in two areas of England when the national alert went out for GPs to start using antivirals in at-risk groups, according to regional surveillance data for the 2012/13 flu season.
The data also showed levels of circulating flu were high in some areas up to two weeks before the Department of Health sent out its national advice to start using antivirals.
Currently the DH times the antiviral alert based on national surveillance information, such as acute respiratory outbreaks in the community and rates of GP-reported influenza-like illness consultations and linked respiratory swab results co-ordinated by the RCGP.
Researchers from Public Health England looked at how the timing compared with more detailed regional data that has begun being collected since the 2009 swine flu pandemic, including the Respiratory DataMart System (RDMS) that provides weekly virological data mainly from secondary care.
These data showed influenza B activity peaked in East Midlands and North West England in Week 51 of the flu season, the week the DH sent out the national alert to prescribe antivirals. Prior to this, pre-epidemic thresholds of influenza B activity had already been reached in three other areas in weeks 48 or 49.
The researchers said: ‘For two regions, peak RDMS activity had already been reached in the week community antiviral prescription commenced, suggesting this did not occur early enough for some regions.’
They concluded: ‘Any early signals at a subnational level should feed into the decision to improve the timeliness of reporting of the start of significant influenza activity and increase awareness in the community.’
GPS TOLD TO CARRY OUT CHILD FLU VACCINATION PROGRAMME IN THREE-MONTH WINDOW
From the FMS Global News Desk of Jeanne Hambleton PULSE 9 May 2014 | By Caroline Price, Alex Matthews-King
Public health chiefs have told GPs they must vaccinate children aged between 2-4 years within a three-month window this winter because the chosen vaccines will expire midway through the flu season.
Experts from Public Health England (PHE) said in guidance for this year’s flu immunisation programme that it was ‘highly likely’ central stocks of the chosen Fluenz vaccines will have expired by the end of January, despite the vaccination programme expanding to include all 2-4 year olds this year.
The guidance also told GPs they must focus their efforts on improving uptake of the flu vaccine in patients with liver or neurological diseases.
GP leaders said that increased numbers of patients could be left unimmunised as a result of the short time-frame for immunising children.
The update stated: ‘Vaccine has been ordered to cover the period over which historically the flu vaccine has been administered, extending from September to mid-December.’
‘It is highly likely that all the Fluenz Tetra® supplied centrally will have expired before the end of January 2015. In the light of this it will be important to ensure that efforts are made to vaccinate children before the Christmas holidays.’
Last year, stocks of the vaccine had a similar expiry date, and some practices said they were struggling to vaccinate two- and three-year olds as a result.
Dr Richard Vautrey, a member of the GPC negotiating team and a GP in Leeds, told Pulse that patients could be left unimmunised and GPs could see their QOF achievement hit by failure to provide adequate stocks of vaccine.
Dr Vautrey said: ‘There is an increasing problem, as more patients fall into the cohort for immunisation with Fluenz, it means that increasing numbers of patients will be left unimmunised unless practices use their own supplies of the alternative vaccine for those patients.’
He added: ‘This year, it has been extended to 2-4 year olds. So it is a bigger group and it is bound to have a much bigger impact because it then impacts on QOF targets for immunisations as well. So it is important that the vaccine is available throughout the flu season.’
‘We were told that with the extension of the scheme, to include a greater number of patients, they would ensure there was a considerable supply right through the immunisation program, right through to the end of March. It is a manufacturing issue, and that is simply not good enough.’
The public health update also urged GPs to concentrate their vaccination programmes on patients with liver or neurological diseases.
Average uptake of the flu vaccine in the under-65s clinical risk groups has been stuck at about 50% for the past three years. But it is even lower in patients with chronic liver disease, in whom uptake was around 43% last flu season, while coverage in those with neurological disease was 49% last year, despite them being among the most at risk of dying from the complications of flu.
A spokesperson for PHE told Pulse: ‘For a number of years now around only half of patients in at-risk groups have been vaccinated and increasing uptake in these groups is important because of the increased risk of serious illness should people in these groups catch flu.
‘However, we know that establishing the true uptake rate is hard because of difficulties in determining the denominator and therefore this year we decided to take a different approach which is to ask that particular attention is focused on those in at risk groups who are most at risk of death from flu but who have the lowest uptake rates amongst the at risk groups (that is those with chronic liver and neurological disease, including those with learning disabilities).’
PHE declined to comment on what additional resources or support GPs could get to help boost uptake in these groups, but said it wanted to see coverage upped to that of other clinical risk groups.
The spokesperson added: ‘We would expect vaccine uptake in those with chronic liver and neurological disease (including learning disabilities) to reach levels closer to those being achieved for other at risk groups who have a higher level of uptake.’
GP-LED FLU VACCINATION OF CHILDREN TO BE EXTENDED TO ALL FOUR-YEAR-OLDS FROM SEPTEMBER
From the FMS Global News Desk of Jeanne Hambleton PULSE 21 February 2014 | By Caroline Price
GPs will be expected to vaccinate all four-year-olds as well as two- and three-year-old children against flu from September, Public Health England has confirmed.
The public health body said the national childhood flu vaccination programme in children and adolescents aged two to 17 – which began to be rolled out last year – will now be extended through GP practices to four-year-olds nationally, as well as through pilot programmes in schools to children aged 11 to 13 years.
A PHE spokesperson confirmed to Pulse GPs would be expected to deliver the flu vaccines to four-year olds.
The spokesperson said: ‘Yes, [the] plan is for vaccination for four-year-olds to be delivered by GPs’.
It comes as GP leaders had already criticised the workload associated with this season’s campaign, which spanned only two- and three-year olds.
The GP-led campaign was hailed a success by public health chiefs, after around 40% of children were vaccinated by the end of January, but GP leaders said GPs shouldered too much of the responsibility for informing parents and ensuring adequate uptake.
PHE advised GPs the live-attenuated flu vaccine – Fluenz – used would again be provided centrally and practices will need to take into account the additional four-year-old cohort when ordering stocks.
In a new vaccine update communication to GPs, Public Health England wrote: ‘The flu vaccine ordering season for the winter 2014/15 is already upon us, so we are using this month’s issue to update readers on who will be eligible for the flu vaccine later in the year when the vaccination programme starts.
‘Next winter sees the addition of two more age groups of children to those introduced in winter 2013/14. These are planned for eligible four-year-olds, and in several pilot programmes around the country to 11- to 13-year-olds.
‘GP practices should note that flu vaccine will be provided centrally for all children in the extended programme, and those of all ages in clinical risk groups, up to and including those aged 17 years.’
I seem to be eligible as fibromite as I have a compromised immune system. Last year our surgery had i the “flu jab session” working like clockwork. We were given an appointment at maybe 10.05am The next would be 10.10pm and within that five minutes the staff would ‘jab’ quite number of patients. We queued patiently and all went in with sleeves rolled up, chatting to other patients about the weather and the winter. It was almost a reunion as you saw some of your friends. I believe we should leave it with the GPs. They know what they are doing and who they can help. All I can say it paid dividends for me each winter and I got through the cold months quite well. Painful it certain was not.
As my other main WordPress blog, FMSGlobalNews.wordpress.com, seems to have been stuck on August 14th page, I am asking folks to look at the Archives to see I am still posting daily. It is soul destroying that I cannot find anyone to email to ask them to sort out this glitch. Today I sent stories about very old metal, the Tibetans who live at high altitudes and something else – fibro fog….sorry.
Sorry our blog is a bit longer today but I felt the information was important to those of us who have elderly relatives and young children in the family. The Flu Jab is really life saving. Back tomorrow. Jeanne