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Pharmacy flu scheme ‘failed to improve uptake and increased admin’

A scheme paying local pharmacies to give the seasonal flu jab failed to improve uptake of the vaccinations in at-risk groups, led to duplication of record keeping and data going missing, according to the largest evaluation of such schemes to date.

A BMJ Open study of the pan-London seasonal influenza programme – which was set up in 2013/14, before a similar national scheme was rolled out – found uptake did not change after pharmacies started offering the flu jab to eligible groups of patients in the 2013/14 flu season. 

The findings come after Pulse has reported that the national scheme, which was introduced this year, has resulted in practices losing £4m in flu vaccine payments while failing to boost uptake in the target groups as intended.

The London ‘pharmacy initiative’ was set up by NHS England London Region in 2013/14 to 'increase access and improve patient healthcare opportunity, particularly within underserved communities’, and acted as a precursor to the national scheme.

The initiative started by paying community pharmacies across the capital to offer the seasonal flu jab to people aged over 13 years in clinical risk groups, before being expanded to allow them to also offer the jab to at-risk children in 2014/15.

But a study of the scheme by investigators from the London School of Hygiene and Tropical Medicine found coverage across all at-risk groups failed to increase.

In 2012/13, the coverage was 60.4%, and remained stable at 60.5% in 2013/14 in the first year of the scheme. It actually fell slightly to 58.1% in the second year of the scheme in 2014/15.

Meanwhile, at least a quarter of vaccinations administered in pharmacies in 2014/15 were not recorded on ImmForm, the database for recording all vaccine doses given to GP-registered patients outside the practice.

The researchers concluded that while ‘flu vaccine delivery through pharmacies shows potential for improving convenience’, there was ‘no evidence that vaccination uptake increases’ and that ’the use of two separate recording systems leads to time-consuming data entry and missing vaccine record data’.

Dr Andrew Green, chair of the GPC's clinical and prescribing subcommittee, said the London study was 'consistent with previous ones which also concluded that there were no health benefits in opening this service up to pharmacists, and there are considerable detriments with respect to record keeping'.

He added that it was 'incomprehensible that disruption to the existing services by a national roll out of this scheme has taken place without an evidence base'.

A spokesperson for NHS England London said: ’In London we are committed to making it easier for people – particularly those who are clinically at risk - to access flu vaccinations through pharmacies, maternity units, district nurses and outreach services, however the evaluation showed there was no significant change in uptake of flu vaccinations as a result of the introduction of the community pharmacy component.'

'Although some GPs were concerned with the incompleteness of reporting, the evaluation found that three quarters of all pharmacy-administered vaccines have been recorded. We are working closely with GPs and pharmacists to improve this element of data recording.'

The latest findings come after the GPC revealed GPs will be paid more for all vaccinations under the new GMS contract for 2016/17, with the item of service fee going up nearly 30%, from £7.64 to £9.80.

BMJ open; available online 16 February


The 'shambles' of the national pharmacy scheme

Flu vaccination

Flu vaccination_PPL

The ‘community pharmacy seasonal influenza vaccination advanced service’ is a national scheme to ‘sustain uptake of flu vaccine by building the capacity of community pharmacies as an alternative to general practice’ that was launched in July 2015.

The data on uptake on the national pharmacy flu scheme has so far showed that flu vaccination coverage has not improved at all.

GP leaders have warning the scheme has made the national vaccination programme ‘a shambles’, with pharmacists ‘poaching’ patients who would usually get their jab at GP-run flu clinics and patients missing out on check-ups and other vaccinations as a result.

Read more about the pharmacy scheme here



Readers' comments (4)

  • GPs and Pharmacies will be left holding unwanted stock. Immunisation levels fall, but the 'brains' behind the flu campaign get a pat on the back from JH. It's all part of his package. I've seen many of the pharmacy doses given to low-risk adults as word got round that you just had to say you were a 'carer' and you could have a jab for free with no attempt to check the validity

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  • When you cherry pick your favourite bits of a study.

    Results may not be generalisable to other areas of the country or the national pharmacy delivery programme.

    Results No significant change in the uptake of seasonal vaccination in any of the risk groups as a result of the pharmacy initiative. While on average a pharmacy-administered flu vaccine dose costs the NHS up to £2.35 less than a dose administered at a GP, a comparison of the 2 recording systems suggests there is substantial loss of data.

    Conclusions Flu vaccine delivery through pharmacies shows potential for improving convenience for vaccine recipients.

    Nonetheless, our analysis does not include the possibility of a secular trend of decreasing vaccine uptake in GP practices, which may obscure increases in coverage because of pharmacy administration. Moreover, it is likely that over time, pharmacy-administered vaccines will become more widely known and a rise in coverage observed. Our surveys indicate that pharmacy patients report convenience as the main factor in the decision to seek the flu vaccine at a pharmacy rather than their local GP, a finding consistent with other studies. For instance, people trust pharmacists to administer vaccines,4 ,15 they are happy with the vaccination service they receive5 ,14 and they believe that pharmacies offer a convenient way to receive the vaccine.14 ,16 Indeed, one study reports that some people would rather pay out of pocket at the pharmacy instead of receiving the vaccine for free in primary care, largely due to convenience and accessibility.

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  • Anonymous | Pharmacist29 Feb 2016 12:04pm

    Its cheaper because you just give a dose, and "there is substantial loss of data." In General Practice we use that £2.35 to manage the call and recall of patients, and administer the national data without which no one knows what has happened. Its why the scheme is a complete mess.

    The conclusion that vaccines are likely to be given in pharmacy more is a justification for them doing so is a circular and poor arguement.

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  • I had to fill in a consultation form, consent form and conduct a patient questionnaire. I then had to put this information onto our PMR system and pharmoutcomes, which raises an invoice and notifies the GP.

    In my opinion that is plenty of admin and I'm not including commercial admin such as contacting patients, advertising etc. as that goes with the territory.

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