A closer look at the impact of this autumn's flu and Covid vaccine programme

Eligible flu groups

The number of flu vaccinations administered by community pharmacists under the NHS Advanced service grew by 3.2 per cent in 2022/23 compared to the previous year – according to NHSBSA data – with 5,007,578 administrations being claimed by the end of March 2023. 

However, even with the new September 11 start date, this year’s flu vaccination season may well struggle to meet, let alone beat, this figure since people aged between 50 and 64 years old are not eligible for a free NHS jab this 2023/24 season. 

Eligible groups are:

• Those aged two and three years on August 31
• Eligible school-aged children (reception to year 11)
• Those aged six months to under 65 years in clinical risk groups
• Pregnant women
• All those aged 65 years and over
• Those in long-stay residential care homes
• Carers, those in receipt of a carer’s allowance or main carer of an older or disabled person
• Household contacts of immunocompromised
• Frontline health and social care staff.

Other specifications

NHSE has said that pharmacy owners must use a NHS-assured point-of-care IT system (e.g. Sonar Informatics and PharmOutcomes) to make their clinical records for the service and to submit payment claims to the NHSBSA’s Manage Your Service platform (automatically via an application programming interface). 

As last year, the PGD will be able to be used by an appropriately trained practitioner to provide the Advanced service, which will allow pharmacy owners to use other healthcare professions listed in the PGD to provide the service under the supervision of a pharmacist. 

A national protocol is also available, which can be used by pharmacy owners as an alternative to the PGD, where they are able to make use of the skill mix flexibilities allowed by the protocol to administer the vaccine (e.g. by pharmacy technicians. Clinical supervision of the service must still be provided by a pharmacist.

Something else that hasn’t changed for the 2023/24 season is the service fee, which remains at £9.58 plus the cost of the vaccine (and an allowance for VAT on the cost of the medicine).

Covid vaccinations

In August, NHSE opened an expression of interest (EOI) process for pharmacy owners wishing to take part in this autumn’s Covid-19 vaccination service. This was seen as a positive move as it meant more pharmacies would be able to choose to participate than had previously been the case.

Pharmacy owners who do wish to participate in the service at their pharmacy must show they meet the minimum requirements, which include:

• Providing the Flu Vaccination Advanced Service until March 31, 2024
• Being able to offer at least 100 Covid-19 vaccinations per week
• Being ‘in good standing’ from a regulatory perspective with the NHS and other organisations such as the General Pharmaceutical Council.

Pharmacy owners will not be required to administer all vaccinations from the pharmacy, but must also vaccinate eligible housebound/care home patients if requested by NHSE and may also provide outreach services if agreed with NHSE.

Owners were also invited to express an interest in providing the service from a location away from their pharmacy, although NHSE said it would “usually only approve requests to operate services in the vicinity of the pharmacy where there is a population need”; for example within the same integrated care system. 

Eligible patients

In early August, the Government accepted the final Joint Committee for Vaccination and Immunisation (JCVI) advice for the Covid-19 autumn 2023 seasonal campaign. This narrowed the groups to be offered a Covid-19 booster vaccine to:

• Residents in a care home for older adults
• All adults aged 65 years and over
• Persons aged six months to 64 years in a clinical risk group, as laid out in the Immunisation Green Book, Covid-19 Chapter (Green Book)
• Frontline health and social care workers
• Persons aged 12 to 64 years who are household contacts (as defined in the Green Book) of people with immunosuppression
• Persons aged 16 to 64 years who are carers (as defined in the Green Book) and staff working in care homes for older adults.

The JCVI also advised that people in the above cohorts who have not had any previous doses should be offered a single dose of Covid-19 vaccine during the campaign period.

It is anticipated that updated versions of the Moderna, Novavax and Pfizer boosters are in the pipeline, in order to offer better protection than existing vaccines against the new Covid variants.

Covid fee adjustments

Despite widening the potential number of pharmacies that could join the Covid vaccination programme, NHSE had initially decided to reduce the fee paid for jabs by 25 per cent, to £7.54 – to widespread condemnation. However, following the announcement of the revised start date, NHSE said it was putting in place “interim financial arrangements” to support acceleration of the vaccination programme, “recognising the additional administrative, organisational and delivery costs which pharmacy owners will incur”.

Pharmacies commissioned to provide Covid vaccinations will now be eligible to claim:

• An additional acceleration payment of £10 (in addition to the item of service (IoS) fee) for each Covid vaccination administered to care home residents between September 11 and October 22
• A separate one-off additional payment of £200 for each completed care home by midnight on Sunday October 22 that is confirmed to the commissioner by the submission of a live time survey no later than midnight on Sunday October 29.

To support the acceleration of Covid-19 vaccinations to other eligible cohorts:

• An additional £5 acceleration payment (in addition to the IoS fee) will be paid for each Covid vaccination administered to eligible people between September 11 and October 31 (excluding care home residents, housebound people, and any health and care worker vaccinations commissioned under the NHS Standard Contract). “The acceleration payments for early vaccinations will make it more financially viable for some pharmacy owners to take part,” said CPE’s Alastair Buxton. The negotiator had repeatedly warned NHS England that the previous fees were too low, he added.

Private jabs

Thirteen million people who had a Covid jab last year no longer qualify following the Government’s decision to exclude the majority of 50-64-year-olds from the clinical risk group this autumn.

Although the UKHSA has confirmed that it will not restrict the private sale of Covid vaccinations – private jabs are not expected to be available until next year – media speculation has suggested that a possible cost of around £100 per jab puts them way out of reach for many people. 

This is in contrast to the relatively affordable cost of a private flu jab in the UK. These range from between £10-£20, although Superdrug was quick to announce what it called “the UK’s cheapest private flu vaccination service” priced at £8.79 for its health and beauty card members, or £16.99 for non-members.

Dr Avinash Hari Narayanan, clinical lead at London Medical Laboratory, says the Government should consider subsidies for people who want a Covid jab but are unable to afford it.
He describes the decision to not vaccinate the majority of 50-64-year-olds this autumn as “questionable”. 

“Our European neighbours such as Germany, Italy and Holland are at least giving boosters to everyone aged 60 and over. If the UK had opted to follow suit, that would have ensured almost 4 million more people would be eligible for a top-up,” he said.

“Perhaps uniquely, the Covid vaccine is not [just] about individual protection as much as it is about group protection. It succeeds by increasing the level of immunity across the community.”