From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY                        September  15 2014 | By Caroline Price


GP practices will only be able to order a maximum of 50 doses of nasal flu vaccine next week to start routine immunisations in children, public health officials have warned.

Public Health England (PHE) said it will be temporarily capping orders of the new Fluenz Tetra vaccine at 50 doses – or five packs – per practice per week, when central ordering of the vaccine opens next Wednesday, 24 September.

PHE said in its latest vaccine update the cap was needed to make sure the vaccine could be distributed equitably across the country. The update also reminded practices the vaccine has a limited shelf life and said they should only order what they need for a week or two in advance.

The update states: ‘To ensure that vaccine is distributed equitably across the NHS in England for the children’s part of national flu programme, an initial restriction on the number of doses of Fluenz Tetra that can be ordered by each practice per week will be implemented from the start of ordering on Wednesday 24 September.

‘The controls will allow practices to order 50 doses per week (five packs) initially. We will be monitoring the situation on a daily basis and as soon as we are in receipt of sufficient quantities of vaccine we will lift the restriction.’

GPs are this year taking on seasonal flu immunisation of four-year-olds, as well as two- and three-year-olds as they did last year when the routine flu vaccination programme children was first introduced.

However, as all the vaccine stocks will expire by the end of January, PHE is again urging GPs to get as many children immunised before Christmas as possible – which GPC warned could leave practices struggling to fit them in.

A PHE spokesperson told Pulse the restriction was the result of a ‘gradual supply’ of vaccine from the manufacturer, as well as the shorter shelf-life of live-attenuated vaccines.

The spokesperson said: ‘The temporary order restriction is concerned with the gradual supply of the vaccine and the shorter shelf life of the flu nasal spray vaccine Fluenz Tetra which means that it has been agreed with the manufacturer that deliveries will be staggered to ensure that there is sufficient in-date vaccine for patients who present later in the season.’

PHE added there is no restriction on the nasal flu vaccine Fluarix Tetra.

The spokesperson said: ‘There is not an order cap in place for Fluarix Tetra but it should only be ordered for eligible children aged from three years who are contraindicated for Fluenz Tetra. It should not be used for children for whom Fluenz Tetra is suitable and flu vaccine ordered via ImmForm should not be used for patients over the age of 18.’



From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY    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’s 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.’



From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY         2 December 2013 | By Caroline Price


Two-thirds of young children have yet to be vaccinated against flu, as practices battle to immunise two and three- year olds before central stocks of vaccine expire in January.

The most recent weekly figures showed 34.1% of two-year-olds and 30.6% of three-year-olds had received influenza vaccine by 24 November.

The data show uptake has gone up around 10% since the end of October, when the monthly breakdown showed 22% and 20% of two- and three-year-olds overall had been vaccinated.

But LMCs said practices face an uphill battle to immunise children before central supplies run out after the 16 January – with some batches expiring in mid-December.

It comes as Public Health England revealed that a ‘small number’ of GP practices had yet to order any nasal vaccine at all and that NHS England would be in touch with them to make sure they have not ‘overlooked’ the scheme.

Public health chiefs advised GP practices last month that they should make their own arrangements with the manufacturer of the nasal vaccine if they need additional doses after then.

Public Health England said the uptake with the new programme was ‘encouraging, given the extra workload this has generated for primary care’.

It added: ‘It is interesting to note that a small number of GP surgeries have yet to order any Fluenz vaccine. For some, this is because they have opted out of offering childhood immunisations, but for the others NHS England will be in contact to make sure they have not overlooked the fluvaccination programme for healthy two- and three- year olds.’

But LMC leaders expressed concerns about a lack of a national campaign to help GPs keep parents aware of the campaign – and how low uptake could impact on practices using up vaccine stocks that they are currently ordering in centrally from Public Health England.

Dr Paul Roblin, chair of Berkshire, Buckhingamshire  and Oxfordshire LMCs, told Pulse: ‘I sent an email to practices about two weeks ago pointing out there was concern in the Thames Valley about low uptake – and that all the national vaccine stock will be out of shelf-life after Christmas.

‘But practices are inundated and the last thing they can do is chase parents who do not want the vaccine.’

Dr Roblin added: ‘It is a worry that as vaccines expire, there could be a whole load of wasted stock. But I would expect the central procurement team to have sorted that out in advance – to have a financial arrangement if stock was not used.

‘If parents do not want it and there has not been a national campaign then Public Health England and politicians should take responsibility for not making it clear what the recommendations were for parents of two- and three-year-olds.’

For clinical at-risk groups, the latest weekly figures are up slightly on last year with over 67% of people aged 65 and over, 44% of those under 65 in an at-risk group and 34% of pregnant women having been vaccinated – compared with 65%, 41% and 32% of each groups around the same time last year.



From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY        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.’

Anonymous comment from a GP reader

Whilst agreeing that Flu vaccination in these age groups is a good thing it is yet one more job to be added to an incredibly busy time of year. This year I decided enough was enough. It was underfunded and distracted from my primary purpose. I will not be doing it this year either. Nor the shingles vaccine.

Whether you do it is up to you but please then do not complain that you have not enough time to see your ill patients and you have not time to have lunch or even take a break.

Time management is key here. NHS England and HMG really do not give a monkeys and will keep piling this stuff on us until we say no or crack.

Make your choice.

GPs do their best but they are not supermen .. we only think they are. J.



From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY       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.’


For even  More  Medical Trouble  with lost patients and  GPs’ cut backs, please log into

Back tomorrow I hope. Jeanne





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