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LMC forces delay in pharmacy flu vaccination plans

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 don’t 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 don’t 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’s not meeting that need.

‘We’re 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

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Readers' comments (16)

  • GP leaders really need to grow some, it should be all or nothing - if they want pharmacies to do it let them take on all costs and risks and admin of all vaccinations.

    GP's should stop recording and doing any vaccine related work across the board. It really would be a simple negotiation.

    The GPC members are well meaning but are weak.

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  • ‘There is also evidence that patients strongly welcome the additional choice that alternative providers allow them.’

    I am sure patients would also like their GPs to dispense medications......oh I forgot thats not allowed by the monopoly pharmacies have.

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  • Excellent point made above @10.17.
    If NHS E is going to allow pharmacies to do work normally done by GPs, they must also allow GPs to do work normally done by pharmacies. i.e. dispense.

    " patients strongly welcome the additional choice that alternative providers allow them." works both ways matey.

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  • Of course the desicion to commision it was nothing to do with the AT coming under pressure from pharmacies (who aren't local anymore just big national/multinational chains).
    Unintended consequence = GPs don't bother doing it next year.

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  • i agree with all the comments

    the main problem is we have a very weak and spineless leadership-unfortunately

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  • Yep I agree let pharmacist do all vaccines, at least cqc can stop worrying about expiry dates of vaccines, emergency adrenaline being in date , nurse training, even child hood imms, fridge temperatures, It's actually when you work it all out far more cost effective for practices not to do this work at all, and actually concentrate on seeing more patients. Will improve uptake as well

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  • Very disappointing comments
    If Pharmacies can improve uptake of vaccines then that is good for patients and the NHS

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  • Quite agree NHS manager but payment for vaccines and administration is becoming more vital to keep surgeries viable. If all the lucrative easy work keeps disappearing then the complex / non profitable stuff is not funded. Patients who need hours of support due to depression, cancer, new diagnosis etc... are just not reflected by 73 quid a year/patient. The real work of a GP that patients value is not valued by DH NHSE or HMG. If I did the work I should do [only[ as a trained dr, I'd bankrupt my surgery.

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  • "If Pharmacies can improve uptake of vaccines then that is good for patients and the NHS"

    That's fine, if pharmacies want to take on all of the work including the admin and the overheads involved in this. But of course they don't, they just want to do the jabbing which is the easy bit.

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  • I am a pharmacist who has provided a flu vaccination service for the last few years. I feel that our reliance on customer satisfaction as a business helps us to approach patients in a way that they appreciate.
    Since delivering a good number of vaccines I have seen a realisation by local practices that they need to adapt to their patients needs in order to succeed. This can only be a good thing for patients in my eyes.
    What are the overheads of a vaccination service? Stock? This type of overhead is how we have always worked. We stock well over £50,000 worth of medication in anticipation of a patient walking in with a compatible prescription. No payment per patient here.
    Pharmacists are mired by admin too so actually filling something in that makes us some money is not a huge problem.
    I value the work that GPs do, and many do in fact own pharmacies or dispensaries. Competition as long as it is fair should breed excellence.

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