Tackling this year's flu campaign effectively
Primary care has been extremely effective in delivering vaccination against influenza with more than 75 per cent of the
target population being immunised in 2005.
The target population includes all those aged 65 years and over, and all those aged over six months in the following clinical risk groups:
1 Chronic respiratory disease (COPD, emphysema, bronchiectasis, cystic fibrosis) and including asthma where daily inhaled steroids are used or where acute exacerbations requiring hospitalisation have taken place.
2 Chronic heart disease (congenital heart disease, hypertension with cardiac complications, chronic heart failure, ischaemic heart disease.
3 Chronic renal disease (chronic renal failure, renal transplant, nephritic syndrome).
4 Chronic liver disease (cirrhosis, biliary atresia, chronic hepatitis).
5 Diabetes mellitus (type 1 or type 2 on oral therapy).
6 Immunosupression (asplenia, HIV infections, chemotherapy, long-term more – than one month – significant dose – >20mg/dy – prednisolone steroid therapy).
7 Those living in residential care homes where infection may lead to high morbidity/mortality.
8 Those who are the main carer (or in receipt of a carer's allowance) for an elderly or disabled person whose welfare may be at risk if the carer falls ill.
In addition, NHS employees directly involved in patient care, as well as social care employees working in nursing and care homes, should also be offered vaccination by their employers. This service falls outside that provided by the national programme and is therefore funded by the individual employer.
Due to delays in vaccine supply, vaccine should be given to those in groups 1-6 first, and then the other groups as vaccine becomes available.
The successful prosecution of an influenza vaccination campaign is dependent on sound leadership and good organisation. The campaign should be led by one or two individuals who retain a strategic overview of the objective and targets. In consultation with other staff, they should be given overall responsibility for all aspects of the campaign from inception to review and audit.
As a rule, a practice nurse should lead and be able to draw in other expertise, whether GP, nursing, administrative, IT or pharmacy, as and when required. The process of a flu vaccination campaign falls into several distinct steps including:
Planning for the next campaign should begin as soon as the present campaign has finished and therefore should take place in the winter months. Decisions are taken based on the review of the current campaign including the meeting of targets, coverage across all vulnerable groups, vaccine supply and performance, both administrative and financial.
Figures for target groups need to be raised via records searches. The partners may wish to explore whether the incentivisation of staff through performance-related bonuses is a way of encouraging overall team effort.
For 2006 there were six manufacturers supplying the UK market. These were Sanofi Pasteur MSD, Novartis (formerly Chiron), GSK, Solvay, Wyeth and MASTA. There is therefore considerable competition between these companies which actively market their products from January each year.
With each product having equal efficacy, there is little to choose between suppliers thus allowing the purchaser considerable freedom in negotiating the best deal for their individual needs. Points to consider when seeking supplies include:
The final composition of the vaccine for 2006 has been delayed due to vaccine formulation problems, but supplies should still be arriving in GP surgeries by the end of this month and should be completed by late November.
Although a majority of vaccine recipients will be familiar with their needs from previous years, the overall percentage of take-up suggests that a significant proportion are still falling through the net.
A complication of 2006 due to delayed vaccine supply is that patients who are used to having a vaccination in early October will need to be informed the start of the campaign has been postponed to the beginning of November. Moreover this will have to be done in a sympathetic manner that will allay the anxieties that some may have over delayed immunity.
Advertising the campaign takes place at a national and local level. In our practice we have taken advertising space, in conjunction with other practices, in the local paper.
Copy informs readers of the details of the campaign including dates and venues of open vaccination days. Some PCTs
assist in the funding of such
Our surgery-based advertising includes posters and leaflets provided by vaccine suppliers, PCTs and SHAs, and the practice newsletter or website, as well as word of mouth from receptionists and all staff.
The actual task of vaccinating target groups takes place at many levels. Practices are increasingly offering a mixed approach, including dedicated vaccination days, often at weekends, weekday vaccination clinics, ad hoc opportunistic vaccination in clinics and roving vaccination teams covering residential and nursing homes. In addition, medical staff may be involved in private sector vaccination of company employees.
Staff, including nurses, doctors and administrative, may have to work extra and unsociable hours. They will need to be rewarded accordingly.
Mass vaccination days include an emphasis on no other medical condition being discussed. The patient, in essence, passes along a production line of details taken, jab given and details recorded.
This year may have begun by creating problems in the rescheduling of open days and clinics but, providing secondary delivery of vaccines is not further delayed, the majority of the target population should be vaccinated by December.
An efficient recording system should highlight target patients who have not had their vaccination by December 2006/ January 2007. Provided vaccine supplies hold out, these patients will need to be contacted individually by phone or post and asked to make an appointment with the nurse. Those declining the offer should have this stated in their records.
The incentive to provide a high overall uptake of vaccination is not only that of good clinical practice but also financial
This can be achieved through rigorous review of the discounts provided by vaccine manufacturers coupled with
efficient claims for reimbursements of unit BNF drug
cost plus item-of-service fee (from PCT) of £7.51 per target
patient as agreed in the directed enhanced services for 2006 and provided through the
£18m allocated from central budgets.
Campaigns should always be reviewed and audited, both
administratively and financially. This can sensibly take place in parallel with the strategic planning for the 2007 campaign!
Any areas of poor performance should be highlighted and addressed. The partners should not neglect praising the practice team as a whole for the successful execution of the campaign.
Vaccination against flu has been shown to reduce the possibility of death as a result of flu infection by as much as 75 per cent. It is a cost-effective public health measure.
The annual influenza vaccine programme is a good opportunity for practices to not only test their organisational skills in delivering an aspect of health service but also to benchmark their management skills against those of the primary care sector as a whole.
Jim Sherifi is a GP in Sudbury,