You may recall that the LMC recently wrote to NHSE expressing our concerns about the ongoing issue with aTIV supply and we have received the following response from the NHSE Screening and Immunisation Lead in the North Midlands. Following discussion at the last LMC meeting, we agreed that the LMC should share this with you for you to draw your own conclusions.
Practices have also asked about giving QIV to the over 65s in the absence of any local supplies of aTIV and we sought guidance from NHSE whose line is that nationally aTIV is still available so are not yet supporting the giving of QIV to over 65s.
Please find NHSE answers to your questions below:
Q1: Are you proposing they ring every practice either in the CCG area (or worse still in other CCG areas) to try and acquire further vaccines?
A1: Practices who contacted the SIT for advice in respect of a shortfall in aTIV were supported to raise further orders with Seqirus, this resulted in some practices being able to secure further vaccines at that time from Seqirus. The recent decision taken to encourage practices to use their local networks to identify any surplus available to them was taken to support practices to secure what appear for the most part to be small quantities of aTIV to enable practices to vaccinate the remainder of their eligible population aged 65 and over. The CCG level data was provided to assist practices to identify local areas where vaccine orders exceeded likely uptake.
Q2: What has become of the work that you initiated last week asking practices what stocks and surpluses they have – at least this information may have enabled practices to focus queries to other practices?
A2: Unfortunately the practice level response for vaccine surplus was very poor which is why we circulated data showing CCG level data. In specific relation to Derbyshire, the limited data for practices that responded was shared with the Assistant Chief Nurse Primary Care for NHS North Derbyshire CCG.
Q3: The ability to transfer stocks also places a heavy burden of compliance on practices leaving them in no uncertain terms that they must follow all of the regulations which they will not be used to dealing with in a day to day basis.
A3: We recognise the additional complexity involved in the MHRA decision to allow vaccine transfer in the 2018 Flu Season of aTIV vaccine and we have provided guidance to practices to ensure that this can be achieved safely to further support practices to maximise vaccine usage and uptake this year.
For guidance re ‘they are expected to signpost patients to pharmacists’ please see NHS England Gateway Reference: 08443, which states:
‘4. Where a practice has not been able to order aTIV, they should work closely with local pharmacies to direct patients to a locally available source of aTIV. In this circumstance, issuing prescriptions for aTIV would not be appropriate.’
Flu vaccine should be offered on an annual basis for the eligible population by GP practices. The Screening and Immunisation Team had sent numerous communications to practices prior to the start of the Influenza immunisation campaign to help their preparation for the season. The relevant national guidance explained that a new, most effective vaccine was recommended for the over 65 population. This guidance was circulated in March, to enable GP practices to put sufficient vaccine order in place. Please see attached.
The attached guidelines stipulate:
‘On 5 February NHS England stated that GP practices and community pharmacy providers should offer the adjuvanted trivalent influenza vaccine (aTIV) to all those aged 65 and over in 2018/19. This is the most effective vaccine currently available for this group. This is based on current Joint Committee on Vaccination and Immunisation (JCVI) advice on aTIV that was published in the Green Book in December 2017.’
NHS England gateway reference: 07658
‘GP practices and Community Pharmacy providers should offer: The adjuvanted trivalent vaccine (aTIV) for all 65s and over.’
NHS England gateway reference: 07648
‘…ahead of orders being placed for 2018/19, is clear that for the 2018-19 winter season, GP practices and Community Pharmacy providers should offer: The adjuvanted trivalent vaccine (aTIV) for all 65s and over. Given aTIV was only licensed for use in the UK in August 2017, this was not an option for the 2017/18 season. However the JCVI advice is that this is now the best option for 2018/19 for 65+ age group.
‘GPs and community pharmacy contractors should review all orders (provisional and firm) for the 2018-19 season and ensure these are in line with the evidence-based clinical view i.e. 65 year olds and over to receive aTIV, and under 65s in at risk groups, including pregnant women, to receive QIV for the 2018-19 flu season.
Suppliers have confirmed that there will be enough adjuvanted trivalent vaccine and quadrivalent influenza vaccine to meet demand. Orders will need to be placed by 29 March 2018. If you encounter any difficulties from a manufacturer placing or amending an order, please advise your local NHS England team.’
GP practices should have reviewed their vaccine order and put sufficient orders in place to ensure that all their patients, who are eligible for Flu vaccination and give their consent, have access to the recommended vaccine.
In addition, in April, the Screening and Immunisation Team contacted practices, who had not ordered aTIV, asking assurance regarding sufficient vaccine ordering. We also established a good working relationship with the manufacturer and supported practices if they had had difficulties in ordering adjuvanted Flu vaccine.
Between July and August, NHSE requested CCGs to submit a weekly report on GP practice level aTIV ordering. All practices were contacted by their CCG Flu leads to obtain this information and, where NHSE identified gaps, we encouraged GPs to put additional orders in place and directed their request to the manufacturer.
In September Sarah Mayfield emailed the Nottinghamshire and Derbyshire LMC’s suggesting a meeting to address some of the issues and agree working arrangements suitable for everyone. I have attached the email for your consideration.
We acknowledge that this Flu season is a very challenging and demanding for GP practices but we would like to emphasise that GP practices are responsible for the delivery of the Flu immunisation programme in line with relevant national guidance. Understanding the size of eligible population and ordering sufficient numbers of recommended vaccine is a very important element of the successful preparation for the forthcoming Flu season.
Although, the overall stock of aTIV ordered by GPs is sufficient to vaccinate the 76 % of the population in Derbyshire and Nottinghamshire, our understanding is that despite the frequent communication, some GP practices might not have sufficient aTIV to vaccinate their eligible population. To provide them with guidance, we circulated the email below to reduce potential vaccine wastage and ensure the most efficient utilisation of available aTIV.
Unfortunately, only a handful of GP practices have indicated that they have surplus stock and that they are happy to share it. The Screening and Immunisation Team are working with CCG Flu leads and keeping them up to date regarding any available additional stocks. The Team are also more than happy to answer questions and provide GP practices with further assistance.
The Team run a monthly Flu Group. A regular feedback from LMC would be extremely helpful, therefore, I would like to invite you to attend the meetings and contribute to the work of the Flu Group.