Boost your seasonal flu vaccination income

There is a target for 100% of eligible patients to receive an invitation for flu vaccination. At a typical practice of 5,000 patients, achieving 100% coverage of all target patients would provide income of approximately £10,000. 

Who can have the vaccine on the NHS? 

NHS England has confirmed eligibility of the 2023/24 campaign as being:  

• those aged 6 months to under 65 years in clinical risk groups, such as patients who are morbidly obese or with chronic respiratory disease (COPD or asthma requiring inhaled or oral steroids), chronic heart disease, chronic kidney disease, chronic liver disease, splenic dysfunction or asplenia, chronic neurological illness, diabetes, immunosuppression or learning disabilities. 
• pregnant women 
• those aged 65 years and over on 31 March 2024
• people in long-stay residential care homes  
• carers  
• close contacts of immunocompromised individuals  
• housebound patients
• locum GPs
• frontline staff employed by social care providers without employer led occupational health schemes, including registered residential care or nursing homes, registered domiciliary care providers, voluntary managed hospice providers, direct payment (personal budgets) or personal health budgets, such as personal assistants.

Primary school age children are also eligible for the NHS vaccine but are now being immunised by the school age immunisation service. And this year, all secondary school-aged children (Years 7 to 11) will be offered a flu vaccine too, again by school age immunisation providers.

Similarly, children aged 2 or 3 on 31 August 2023 are eligible but are covered by a separate enhanced services contract. 

This year, low-risk 50-64-year-olds have been excluded from the eligibility groups having been included only as part of a temporary expansion during the pandemic.

What about patient-facing general practice staff?

Under the 1974 Health and Safety at Work Act, employers are required to protect employees from risks associated with their work and this could include contracting influenza. Since GPs are not able to provide occupational health services under the GMS contract (they have to offer it as a private service to employers), it means they cannot claim an item of service fee or dispensing fee for vaccinating staff.

This situation changed during the pandemic so practices didn’t suffer any monetary loss but this season, it has been confirmed that practices aren’t eligible for fees or reimbursement when vaccinating frontline practice staff.

That said, there are exceptions, NHS England has confirmed. Reimbursement can be claimed for members of your frontline patient-facing team who also fall within the eligibility criteria for an NHS jab due to age or clinical risk and are registered with their employing practice.

Meanwhile, locum GPs remain eligible for an NHS jab from any practice whether they are registered there or not, for which surgeries can be reimbursed, says the 2023/24 Enhanced Service Specification (adults and at risk).

When should practices sign up?

Practices must sign up to participate in this year’s flu campaign by 31 August. For practices also participating in the Covid-19 enhanced service, the deadline is before 5pm on 29 August.

Which vaccines are reimbursable? 

The flu campaign has become increasingly complicated because of the different types of vaccine used for different cohorts. It is important to ensure staff are familiar with the latest guidance and the right vaccine is given to the right patient. The vaccines that will are reimbursable as part of the programme are:  

For those 65 and over – aQIV or QIVr. (QIVc may be used if others are unavailable) 

For all in at-risk groups, including pregnant women, and those aged 18 to 64 – QIVc or QIVr.  (QIVe may be used if others are unavailable). 

Practices are warned in the guidance that: ‘Providers should only purchase alternative vaccines to the ones recommended above if all attempts to secure the recommended first line vaccines have failed. Providers may be asked to provide evidence to show this upon request from their commissioner.’

Uptake targets

Target coverage has been increasing in recent years but dipped in 2022/23. The aim of the flu programme is to demonstrate a 100% offer and to achieve at least the uptake levels of last season for each cohort (see table below), and ideally exceed them.

Eligible cohort	2022 to 2023 flu vaccine uptake (provisional data)
Aged 65 years and over	79.9%
In clinical risk group	49.1%
Pregnant women	35%
Aged 2 years old	42.3%
Aged 3 years old	45.1%
Frontline healthcare workers	49.9%

Uptake has in the past been confounded supply chain issues. This can be minimised by ordering ahead and sharing between different suppliers. 

It is possible to submit orders a year ahead but changing guidance has made this difficult in recent years. 

What is it worth to practices?  

The fee for administering a seasonal influenza vaccine is £10.06.  

The government isn’t procuring central stocks of vaccine for this year’s campaign, so the vaccine needs to be pre-ordered directly from the pharmaceutical company – this means practices can cut their costs if they negotiate decent discounts. This involves liaising with drugs reps as early as January for the following winter. Bulk buying can attract discounts and there are buyer groups, such as those run by LMCs, which can help. The vaccine reimbursement is claimed back from NHS prescription services (NHS Business Services Authority). With careful negotiation and swift claiming it is possible to get the reimbursement before paying the original invoice. 

How to claim and ensure payment

Practices must be signed up as delivering the service or ‘accepting a quality service’ on CQRS (Calculating Quality Reporting System) by 30 September in order for payments to be made.

Practices should also be aware that this year the deadline to submit payment claims has been shortened from six months to three. This is for work carried out under both the adult and children’s flu programmes.

Payments will be made monthly. Check every month to ensure all the claims made correspond to monies received and make sure that any errors are chased up swiftly. Any problems should be addressed initially with the commissioner (which is NHS England).

How to maximise coverage

• Run big conveyor-belt clinics to get people through fast and early (and beat the pharmacists).
• Keep on top of address and telephone number changes to meet this target.
• Book patients directly to clinics by phoning the target groups.
• Leave messages on the right-hand side of prescriptions (many of these patients are on repeat prescriptions).
• Put posters up in the waiting room from August onwards.
• Change the greeting message on the practice phone to include a reminder.
• Advertise in the local paper (in conjunction with other surgeries this may be cost effective).
• Take the vaccine on home visits to known target patients (telephone ahead).
• Don’t forget the less obvious groups. Good coding for pregnant women and cooperation with midwives helps, and make sure the under-18 at-risks are coded. Occupational coding for healthcare workers in the target groups may be useful.
• Match appointments to vaccine availability and try and use it as fast as possible (it beats the pharmacists and clears space in the fridge).
• Remember to code the refusers, as this helps with QOF targets, further boosting practice income.

Authored by Dr John Allingham who is a GP in Leeds