A spokeswoman for the BMA said that the negotiations had broken down after ministers refused to relax the targets for the patient experience indicators, PE7 and PE8, in the quality framework.

Ian Dalton, the director of flu resilience for England, has sent out a letter to all PCT chief executives urging them to act quickly to set up LESs to enable the under-fives to be vaccinated before the Christmas break.

The letter states that PCTs should look to see if they can administer the jabs through practices that are willing to participate, their directly managed staff, such as district nurses and health visitors, or by arranging with alternative providers such as pharmacists and hospital services.

Rosemary Cook, director of the Queen's Nursing Institute, said that nurses have the skills to put together vaccination clinics and that practice nurses would be well-placed, in terms of organisational skills, to handle clinics.

But, she stressed it was important not to see nurses as a 'fall-back' option.

'Undoubtedly nurses are experts from a clinical point of view at organising vaccinations and they would be well-placed to set up clinics. But using them as a way of the muddle is not very helpful,' she warned.