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Mr Stevens, what should I do with my leftover flu vaccinations?

Elaine Smith writes

Dear Mr Stevens,

I’d be really grateful if you could advise me what you think I should do with the flu vaccinations that I ordered in October 2014, many of which will now be of no use to my practice. The sudden swerve to the contract for provision of flu vaccinations that crept up on us in September 2015 has had a significant impact on general practice.

 I think a minimum of 1,150,000 flu vaccines will be going into landfill this year - a cost to general practice of £3,795,000 

I’d like to know your thoughts about the simplicity with which patients can obtain free immunisations when not eligible, basic unfairness in how the same contract is allowed to be applied differently between organisations and about the behaviour by some pharmacists.

My agreement with Pfizer when I placed my order allows me to return 10% of any stock I ordered, but my current estimate suggests that I’m likely to be left with 300 to 400 flu vaccines by January.

I suspect hundreds of practices throughout the country will find themselves with the same dilemma. A fag packet statistic – if my practice is average and I’m using a figure of 350 unuseable/non-returnable vaccines, and I multiply up across a population of 50 million, I think a minimum of 1,150,000 flu vaccines will be going into landfill this year - a cost to general practice of c£3,795,000. Nearly £4m that could have been spent on caring for patients.

The actual net loss to our practice is circa £8,000 (enhanced service fee, dispensing fee, PPA differential, wasted postage, unfilled appointments and associated staff costs) – income that we had planned to receive this year, essential to run our practice, pay our staff and top up areas that are so under-funded that they’re actually not viable. The lack of foresight in suddenly pulling that funding from general practice makes me once again question the decision making at higher levels.

I’ve been telephoned this week to place our order for 2016. What a difficult position I find myself in – your advice about how to make a sensible forecast would be hugely appreciated. What will the enhanced service look like in September 2016 – how can I plan when the goalposts change so readily?

I’m currently undertaking an audit at my practice of all patients who have had immunisations by pharmacists, but were not actually eligible. Patients are quickly realising that it’s incredibly easy to walk into any pharmacy and get a flu vaccination at a cost to the very kind and generous NHS. I walked into a chemist, said I was eligible for flu vaccine because I’m a carer – and they were only too happy to oblige. I fear nobody is going to question whether I’m really a carer, or whether I live in a house with an immunocompromised individual – or indeed whether I have Diabetes or COPD. I’ll happily share my results with you at the end of the flu season.

Has the ruling for charging patients been reviewed recently? The community pharmacy contract allows pharmacists to charge non-eligible patients; the GP contract still prohibits us from charging our own patients for a service they often request from us? How can the rules be so different and non-sensical? For years that one’s baffled me.

What was the thinking behind giving the very generous administration rate to pharmacists who give flu vaccinations – it’s so kind of them to then send the information to us (they don’t always remember!) so that our administrators can actually do the work required to enter the data onto the patient’s records – of course free of charge. The reality is that the only way the Government are going to be able to assess the statistics is by extracting the data from our clinical systems – surely there’s been an error in who receives the admin fee, and it was really meant to be for practices.

And this may be unique to our practice, maybe not – but we have suffered by chemists doing their utmost to maximise an increase in their income. Proactively poaching our patients who we’d sent a personal invitation letter to has definitely created ill-feeling. I have many examples of patients who had already booked appointments in our clinics on receipt of their invitation, as they’ve done for years, but were told on ad-hoc visits to the chemist that they would do them - they were doing us a favour apparently because we couldn’t cope with the workload. They kindly offered to cancel their appointments with us – needless to say that never happened and numerous patients subsequently DNA’d. Our nursing and reception team were grateful to be given so many breaks on the Saturday mornings they’d come into work on their enhanced rates of pay.

Your thoughts about the above would be appreciated, because personally I’m struggling to make sense of the decisions made by your team.

Yours sincerely,

Elaine Smith

Practice Manager, Bristol

 

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Readers' comments (30)

  • Thank you Elaine Smith for telling the truth

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  • Integration innit

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  • Simple answer: BUY AS YOU GO.
    This is what we do every day in our pharmacies even with flu vaccines.
    You operate a very protected business unlike us and that's why you don't buy stock like a real business.

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  • This is what the government wants - competition! (and yes I think it is a bad thing in healthcare)
    I don't know much about the specifics of the vaccinations saga - but more generally I think the only way practices and partnerships will survive is if they become more cut throat in their business approach. They need to be able to say no when things do not fall in to their remit - which means not having a block contract.
    Either that or as a profession (much in the same way junior doctors are currently) we stand up for ourselves and fight for a decent contract

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  • Elaine Smith is being rather disingenuous.

    I have encountered patients who fit none of the criteria for an NHS flu vaccination, but are in receipt of a text invite from the surgery. Asthmatics with only a ventolin inhaler, patients looking after elderly relatives etc.

    I have also forwarded notifications to the surgery, only for them to attempt to vaccinate the patient on their next visit as the records weren't updated.

    Your 'fag packet' calculations are a gross exaggeration too and attempting to multiply them out to represent a nations population shows ignorance on many levels. If I were Mr Stevens, I'd put this letter in the bin where it belongs.

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  • Buy as you go, yes that's how it will be next year and absolutely no letters will be sent either.

    I thought this was supposed to be a National Health Service, trying to create herd immunity, but perhaps it's a plot to kill off our vulnerable patients with an epidemic.

    While this year is not great, next year, NHS England will reap what it sows, the market sometimes has perverse incentives.

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  • Brilliant letter.Eye opener for the DH.

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  • Divide and rule, but clearly the chemist shop owners won't see it that way

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  • Absolutely perfect article. tells the truth, I agree with everything you have said.

    There are clearly significant probity issues in the administration of flu's by pharmacy because it is being driven by profit and not patient care. The rules are unfair and there is no level playing field.

    Another point you didn't mention is the CQC. They are exempt but are providing patient care. The CQC should be inspecting their cold chain like they do ours.

    You would almost think the government is planning these measures to destroy General Practice ?

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  • Why are so many pharmacists suddenly posting on here when they clearly know little/nothing about general practice?

    Pharmacist @9.15 - perhaps your remit is different from ours but the asthma indication is as follows: "Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission." (We can't force patients to use steroid inhalers but GPs should be aware of their history and able to identify the vulnerable).

    Those looking after elderly relatives may be covered by the additional recommendation for "those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. Vaccination should be given on an individual basis at the GP’s discretion in the context of other clinical risk groups in their practice" - again, something we would know.

    "Gross exaggeration" - how would you know? Wasted expenditure coupled with loss of income to say nothing of all the QOF points we can pick up by catching up with patients coming in for their flu jab: seems a reasonable estimate.

    To pharmacist@8.20 - simply not practical when we have to immunise a large number of people in a short space of time and that policy would result in no guarantee that sufficient vaccine would be available for all our vulnerable patients. If pharmacist runs out, so what? Practices feel some level of responsibility for those on their list.

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