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Flu fever

23 October 2015

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Measures that have allowed pharmacists to support general practice with NHS flu vaccinations can help improve coverage with hard to reach groups

This year pharmacy has been commissioned to provide NHS flu vaccines alongside the private service. Developing pharmacy involvement to support provision of the vaccine to NHS patients is an important step forwards for all primary care providers. For the last two years, we have been asking patients whether or not they were eligible for a free NHS flu vaccine, and if so why they were choosing to come to a pharmacy to receive it and pay. Interestingly nearly 10% of customers were eligible for free flu vaccinations on the NHS, but came to the pharmacy because of convenience
and choice.
An extremely important cohort of these people were working pregnant women, who were unable or reluctant to take time off work to have a flu jab at the pre-determined clinic slots at their surgeries, but were more than happy to pop out in their lunch break, or indeed after work, and have their paid for vaccination at the pharmacy. This is one of the ‘hard to reach’ cohort of patients, with up to an estimated 50% of women not having flu vaccinations during pregnancy. If pharmacy, alongside the GP surgery, can help this population move towards 80% plus coverage then that has to be the right direction of travel.

Working with general practice
There are concerns expressed by some GPs and practice managers that having forward ordered for this winter this change in the scope of pharmacy provision could leave them with excess stock. But at my pharmacy, in Nottingham, in the six years of flu vaccination provision, overall there has been a shortage of vaccinations across pharmacies and GP practices, not a surplus. However, this could be an opportunity for the two professions to liaise, with excess general surgery stock purchased by pharmacies, if demand exceeds expectations.
Back in 2009 my pharmacy was one of the pilot pharmacies providing the first pharmacy winter flu vaccination service. It was operated under a patient group direction (PGD) – a mechanic that enables non-prescribers to provide prescription only medicines (POM) without the need for an FP10 prescription. The PGD is signed off by an authorised prescriber and has very clear protocols and guidelines. So, for example, the pharmacy had a clear cohort of patients who were eligible for vaccination. They had to be more than 16 years of age, not immunocompromised or on long-term steroids, not on anticoagulants, not HIV positive, nor allergic to eggs or latex, and not currently suffering with a high temperature – a lower risk sector of the population. On completion they were, and still are, asked to inform their GP surgery that they had been vaccinated with that year’s winter flu vaccination.
Over the course of that winter, we vaccinated around 250 people. They were asked for feedback as to why they had chosen to be vaccinated in the pharmacy rather than at the GP surgery. The majority response was that they were not eligible for a free flu vaccination but didn’t want to run the risk of catching flu, but a significant cohort of customers liked the convenience of selecting the pharmacy of their choice, and being able to choose a time convenient to them, especially those of working age.
A trend that has become visible in the last three years is that the flu vaccination season has extended into February of the following year. My pharmacy starts vaccinating in September, but with the increase in international travel, pilgrimages, and an increase in immigration, demand can be expected to spread across a longer period of time, and increase the overall number of people requiring vaccinations.

Communication is key
One of the more interesting patients we had was a gentleman who on entering the consulting room started to perspire profusely, explaining that as he had a needle phobia his GP wouldn’t administer his flu vaccine, but he was going travelling and wanted to be vaccinated. At which point he started to hyperventilate, became hypoxic and collapsed onto the floor. On calling for help, the pharmacy dispenser called 999, requested an ambulance, and impressively quickly, the paramedics arrived. Needing oxygen, the patient was taken out of the pharmacy to the ambulance to recover. After about 10 minutes one of the paramedics came back to the pharmacy counter. He said the patient wanted the vaccination in the ambulance.
It was politely explained that the PGD didn’t cover the pharmacist vaccinating patients in ambulances, and that perhaps the patient would be better going back to his GP to discuss his extreme anxiety issue and request a flu jab in the surgery setting.
This highlighted how much better the service could have been for the patient if there was a sharing of patient data between his GP surgery and pharmacy. Alternatively this patient’s GP would have benefitted from sharing this incident and/or populating his record. Although the patient gave information about his phobia, it is just possible that this information was not in his patient notes.
This patient data disconnection between primary care providers is of course about to change. Changes like these will enable both more cost-effective primary care provision and better care for patients.
Pharmacies in England that lend support to the NHS flu vaccination are to inform GPs about the patients they have vaccinated so that patient records can be kept up to date.
And imminent closer working and information share does not stop at flu vaccination. From later this year, and after very positive results from pilots, a programme to provide pharmacists with read access to patient summary care records gets underway in England. This represents a major step forward in enabling pharmacists and general practice to work in partnership to provide more effective, holistic, patient-centred care through sharing essential patient medical information. Among other things it will enable patients to receive emergency, life-saving medicines through the convenience of a local pharmacy, taking pressure off NHS emergency and GP out-of-hours care.
As the sharing of the summary care record with pharmacies is rolled out, with read-write pharmacist access already under discussion as the next step, hopefully the communications between the two professions will improve further. If patients are truly put first, working in unavoidable isolation is stopped, better use of IT is adopted, reduce duplication and share the workload, the two professions can indeed continue to improve patient care together.

Sibby Buckle, community pharmacist and member of the Royal Pharmaceutical Society’s English Pharmacy Board.