'Complex' flu season could cause problems for practices and patients, GPs warn

Practices could face higher costs and workload than usual and patients may wait longer for jabs because of complex arrangements for the upcoming flu season, GP leaders have warned.

Flu jab (Photo: iStock/thodonal)

GPs have voiced concern over the impact of changes to the 2018/19 scheme - NHS England has recommended that different ‘at risk’ groups should receive different jabs, while supplies of some vaccines are subject to a 'phased' delivery process.

NHS England has said the adjuvanted trivalent influenza vaccine (aTIV) - FLUAD - should be made available to patients aged 65 and over this year, while patients in clinical at-risk groups aged 18-65 are to receive the quadrivalent vaccine (QIV).

In addition, Seqirus, the manufacturer of FLUAD, will be dispatching orders in three batches - 40% in September, 20% in October and another 40% in November - meaning that practices will not be able to administer all their inoculations in one go.

GP workload

GPC clinical and prescribing lead Dr  Andrew Green told GPonline: ‘The complexity of the scheme, as well as GP workload, will undoubtedly be increased by the requirement to have different vaccines for different at-risk groups this year.'

He said the phased delivery of FLUAD may also present ‘challenges’ for practices who previously provided vaccination ‘on an "open house" basis’. He added: ‘Overall costs may well be higher than previously, but these can be minimised with careful planning.'

GPC chair Dr Richard Vautrey said: ‘We are concerned about the impact for both patients and practices that the changes to the normal pattern of vaccine delivery will have this year. We are already hearing of practices that have been unable to meet the expectations of patients who have attended for immunisation, but practices have not had sufficient vaccine available.

‘PHE, NHS England and CCGs need to do more to explain to patients that this is not the fault of practices but due to the phased supplying of vaccine over which practices have no control.’

Vaccine supply

GPonline reported earlier this week that some GP practices in England have been told their orders of FLUAD cannot be fulfilled - potentially causing them to lose thousands of pounds in vaccine fees.

A spokeswoman for Seqirus said the company had processed more than 8,500 orders for FLUAD from practices and pharmacies across the UK, totalling almost 9.3m doses. A total of 7.8m doses are destined for GP practices, she said.

‘We experienced some processing challenges during the ordering period due to the sudden high volume of requests, however we believe this impacted a relatively small number of orders and that the majority of issues have been resolved,’ the spokeswoman said.

‘Based on previously reported influenza vaccination rates for people aged 65 years and older, and the total number of doses we will be supplying, there will be sufficient quantities of FLUAD available across the UK to vaccinate this vulnerable population.'

Data from NHS Digital show there are currently about 10.3m patients aged 65 and over registered with a GP practice in England. In the 2017/18 flu season, uptake among over-65s was 73% - if this uptake is maintained, 7.5m patients will receive the jab in 2018/19.

'Right thing to do'

Although the upcoming flu season does pose problems for practices, Dr Green says that ‘clinically, this is the right thing to do’.

He added: ‘It would have been untenable to continue vaccinating patients with a vaccine which had as poor efficacy as we have seen recently, to have done so would have risked bringing the whole programme into disrepute.’

NHS England said it did not wish to comment. However, a letter advising practices on vaccine ordering for 2018/19 influenza season sent in February this year advised: ‘If you encounter any difficulties from a manufacturer placing or amending an order, please advise your local NHS England team.’

NHS England also confirmed in the letter that there would be additional funding made available in 2018/19 to ‘support use of adjuvanted trivalent vaccine and quadrivalent influenza vaccine’.

Dr Green concluded: ‘What is clear is that if providers cannot immunize over 65-year-old patients with FLUAD for whatever reason then they must direct patients to alternative providers. Giving a less effective vaccine to a patient when alternatives exist would be clinically and ethically unacceptable, and any resulting complaints would be indefensible.’

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