PDA Pandemic Series Update – 19 August 2020

With each edition, we will aim to bring to your attention important issues either those that we are working on or general background information that helps you with your practice.

Wed 19th August 2020 The PDA

Earlier this month, the DHSC published an update to the initial Flu Letter with further detail about this year’s immunisation programme. Scotland and Wales have also published details about their 2020 programmes.

The English pharmacy Advanced Flu Service provided in excess of 1.7 million vaccinations from approximately 10 thousand English pharmacies (as recorded by the NHSBA) during the 2019-2020 season. This averages at approximately 170 vaccinations per pharmacy, but there are some pharmacies that provided in excess of 1,000 NHS flu vaccinations in 2019-2020. Data is not available for the total number of private non-NHS vaccinations provided through pharmacies.

The peak months for vaccinations are September, October and November. It takes approximately two weeks to achieve immunity (to the antigens in the vaccine). The prevalence of flu tends to increase markedly in December and may peak at any time in December, January or February.

If each of the 10 thousand pharmacies vaccinated 3 persons each day for 20 days for the 3 months of September, October and November, England could achieve a comparable vaccination rate through pharmacies as the 2019-2020 season (i.e. approximately 180 patients). Pharmacies should work cooperatively and not competitively to deliver the flu service in a safe and manageable manner.

Pharmacies could provide significantly more vaccinations if they engaged in co-operative behaviours in localities, for example commissioning one or more pharmacies (depending on the exact identified need) in each PCN area for Sunday opening. These Sunday pharmacies would be open only to provide flu vaccinations. Patients could be socially distanced more easily and flows into and out of the pharmacy could be managed better.

Assuming one patient was vaccinated every 10 minutes, over a period of 7 hours, say between 10 am to 5 pm (with a one hour break for lunch) that could result in 36 extra vaccinations. Support staff would ensure the form filling and data recording was done whilst the pharmacist did the vaccinations. This would imply a substantial uplift from the average of 15 vaccinations per week per pharmacy in England achieved during September, October, and November 2019.

Alternatively, pharmacies could be allowed to make use of altered opening hours. For example, a pharmacy which opened 9 – 6, Monday to Friday could be allowed to open only for flu vaccinations for the first and last hour of each day. With only flu vaccination patients in the pharmacy, social distancing could be observed, and privacy maintained even if the vaccination took place in a private open area of the pharmacy rather than in a confined consulting room.

Assuming 4 patients were vaccinated in each hour this could lead to potentially 8 vaccinations daily or 40 each week, a substantial uplift in capacity.

This would ultimately be safer for patients, safer for staff and would lead to a substantial uplift in capacity at a time of national need. The workload (and payments) could be divided/shared fairly with pharmacists and each pharmacy within the PCN.

There would be the added benefit of a reduction in the need for putting on and taking off full PPE (i.e. compared to randomly timed vaccinations) and thus saving on a precious resource.

The situation in the other 3 home nations is different. The total number of vaccinations provided by GPs and pharmacies in the other 3 home nations totalled less than 2.4 million. There is no indication that pharmacies in these 3 nations may be asked to play a bigger role in the flu vaccination service this year.

However, to ensure timely administration of the flu vaccine and perhaps a subsequent COVID-19 vaccine, the devolved Governments should be considering how a safe service could be provided by pharmacists and pharmacies.

It is unhelpful that the devolved Governments have failed to apply eligibility criteria in a co-ordinated manner and their use of descriptive language for cohorts is inconsistent. A notable and significant difference in cohorts is the over 50’s. England aspires to vaccinate all this cohort (in November and December but only if sufficient stocks of vaccine can be secured), Wales also has plans to vaccinate anyone over the age of 50, whilst Scotland has proposed all adults over 55 will be eligible for the vaccination from September onwards.

The PSNC is still awaiting clarification on certain aspects of the England flu programme. 
The target immunisation rate has usually been set at 75% for eligible cohorts and 100% for frontline NHS staff. The achieved rates for all cohorts, across the UK, was below 75% in 2019-2020. A summary of eligible cohorts across the nations is listed on here.

Key considerations for pharmacies and pharmacists providing the service:

  • Ensure vaccinators have completed all the relevant training (as face to face training may not be possible this year, online refresher training will need to be taken, please refer to individual nation requirements). 
  • Ensure that an updated 2020 SOP (standard operating procedure) is created relating to providing flu vaccinations that SPECIFICALLY takes into account the risk of transmitting COVID-19.
  • Perform a full detailed risk-assessment relating SPECIFICALLY to the provision of the flu service and specific measures to identify staff who are at higher risk (by way of an individual risk assessment, which MUST be conducted for all vaccinators).
  • If the service is provided in unregistered offsite “hub” premises a SPECIFIC RISK ASSESSED COVID-19 aware SOP must be in place.
  • Full PPE to be provided for vaccinators with contractors ensuring that this is safely secured and disposed of (as a high volume will be required).
  • The provision of a vaccination area where social distancing can be observed.
  • The provision of an area where patients can be observed, post-vaccination, for 15 minutes whilst maintaining social distancing.
  • Creating a safe process by which patients sign the relevant consent forms.
  • Specific and detailed instructions and provision of materials needed to safely clean the area where vaccinations are provided (following every vaccination and not just once daily).

You can read the details about the English pharmacy flu service by the PSNC here
You can read the details about the Scottish Flu programme here
You can read the details about the Welsh Flu programme here

VIEW THE PDA’S DEDICATED COVID-19 WEB PAGE

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