Immunisations specifically flu vaccinations, are one of the

Immunisations within both primary and secondary care, more
specifically flu vaccinations, are one of the most common services offered in
the UK. Flu vaccination services are typically offered each year from October
through to January, targeting all patients who are at high risk of developing serious
complications such as bronchitis and pneumonia from the influenza virus.
Community pharmacies across the UK offer flu vaccinations as a private service
where patients willing to pay for this service can do so. In recent years
community pharmacies have been commissioned to provide NHS funded flu
vaccinations. Flu vaccinations prove to be one of the most successful and
economical ways of providing health care protection and are the foundation of
public health. A high number of immunisations is key to preventing outbreaks of
infectious disease, complications and protecting public health through both
individual and herd immunity. Typically, the influenza virus is a simple
self-limiting disease but for some populations such as children, pregnant women
and elderly people are at risk of serious illness. The main objective of the
flu vaccination service is to protect those populations who are at major risk
of severe illness or death if they suffer from the virus. In order to do this
vaccinations are made up of the most common strains of the influenza virus and
grown in hens’ eggs. Later the virus is deactivated and then used to make an
inactivated vaccine, which is injected in to the service user. The inactive
virus is introduced to the body causing antibodies to be produced, which are
used at a later date if the body is introduced again to the virus, thus making
the service user immune.

Effectiveness

Flu vaccinations were first introduced during the Second World War
to prevent the spread of influenza. Later flu vaccinations were introduced in a
primary care setting however was only available directly from a GP surgery. A
doctor or a trained nurse either administered it. This was an amazing service,
which provided great results for local communities for prevention of influenza,
however as with all new services, there were flaws. Firstly, the service was not
intended for the wider population and was more specifically targeted at those
patients who were considered high risk. Another limitation to this service was
the fact that vaccinations were only administered on an appointment basis only,
thereby increasing workload of the GP and general waiting time within the GP
surgeries. To address this issue locum GP’s or nurses were hired daily with the
sole purpose of carrying out the flu vaccination service. This then lead to a
funding issue as the cost of a locum would have to be factored into the whole
cost of the service. This also meant that additional space within the surgery
was required to carry out the service. Furthermore, the flu vaccination service
comes with paperwork, which would need to processed and filed thereby
increasing the workload for the receptionists. With GP surgeries prioritising only
at-risk patients along with increased workload meant that paying patients who
were also interested in the service were neglected. Limited advertisement of
the service due to it being reserved for high risk patients was another
contributing factor towards the general population not being able to take
advantage of this service.

To rectify these issues NHS England commissioned pharmacies to
offer the yearly flu vaccination service, which runs along side the GP
vaccination service, giving patients an alternative place to get vaccinated.
This increased the number of vaccinated patients within the community and
limited the spread of the influenza virus both directly and indirectly due to
herd immunisation. Pharmacies offering the flu vaccination service profit from
the service so are more inclined to promote the service to meet targets and
increase profit margin. This in turn increases awareness of the influenza
virus, why it can be dangerous and the reasons behind being immunised. There
are many studies to show that pharmacies offering the flu vaccination service
have attracted hard to reach patients who would not normally take on this
service due to not being able to visit their GP surgery. Pharmacists play a key
role in ensuring that the immunisation service is carried out in their
community. They are not only responsible for advertising the service, as this
plays a part in public awareness of the scheme but also physically
administering the injection. This is because typically they are the only
trained personnel within the pharmacy team. Research has shown that offering
the immunisation service within a pharmacy saves the NHS on average £2.35 per
immunisation compared to when the service is provided in a GP surgery. This is
due to the fact that there are limited costs within the pharmacy; clearly
showing that pharmacists have a vital role in ensuring the flu vaccination
service is carried out in an effective and economical manner.

Implementation

In order to implement a
flu vaccination service in a community pharmacy there are several steps, which
have to be followed to ensure its success. The first and most important step to
offer the flu vaccination service would be to ensure that the pharmacist is
fully qualified and trained to vaccinate patients. This will require the
pharmacist to attend a flu vaccination-training day, which is provided by a
third party.  Upon completion of the
training the pharmacist should meet the national minimum standard for immunisations.
This standard set by the government requires pharmacists to have the following
knowledge; be able to provide accurate and up to
date information about the influenza virus and vaccines to their patients,
ensure that their practice is safe and effective and to provide a high standard
of care.

Once the
pharmacist and anyone else involved in the flu vaccination service are fully
trained the next step is to ensure that the pharmacy and more specifically the
area in which the immunisation will be carried out, is up to standard. The
first step is to ensure that there is a correct facility to store the
vaccinations. Due to the vaccinations being sensitive to heat they must be
stored in a refrigerator between two to eight degrees centigrade, therefore a
correct storing facility must be available in the pharmacy. The patient can not
simply be immunised on the shop floor in front of others therefore a
confidential space must be available. Typically most community pharmacies have
a private consultation room available, which will be the most ideal space to
offer the vaccination service. Within this consultation room there should be a
safe disposal solution for the used needles used for the vaccination. This may
simply be a yellow sharp safe bin which clearly highlights the use of the bin,
how to store and finally how to dispose of the bin correctly, this will require
a contract with a waste company who specialise in sharp clinical waste. Along
with this for prophylaxis of an anaphylactic reaction there should be a supply
of adrenaline shots within the pharmacy. After all these requirements have been
met the pharmacy and pharmacist are fit to carry out the flu immunisation
service within the community pharmacy.

Advertising will be the
next step that will need to be implemented in order to ensure service success.
The first steps will be to hand out leaflets and hanging up posters within the
pharmacy. The pharmacy can actively look for patients by looking at the
medication that they are on.  Diabetic,
asthmatic and elderly patients can be contacted and offered the flu
vaccination. In order to grab the attention of those patient groups who would
not typically be aware of the service the pharmacy will have to reach out to
the community by advertising within the town centres, at local events, local
churches, mosques and other places of worship. The pharmacy can reach out to
the local GP practises that do not offer the flu vaccination service and work
along side the general practitioners, nurses and surgery staff to promote the
vaccination service to the community. If the surgery does offer the service but
are fully booked or cannot accommodate all the flu vaccination bookings the
surgery and pharmacy can come to agreement that any overflow patients can be
vaccinated at the pharmacy at a walk in basis or by bookings depending on what
suits the patient best.

The pharmacy staff should
be the first to be vaccinated as it ensures that the pharmacist is confident in
offering the service. This will also enable the pharmacist to establish a work
process as there are a few steps before vaccinating the patient. Record keeping
will need to be in place as there will be vital information not only to keep
but also for later use when the pharmacy will be claiming money from NHS. There
are several pieces of information that will need to noted, this includes
patient details (name, address, date of birth etc.), GP details, emergency
contact details and signed consent by the patient agreeing to the service. Any
allergies will also need to be noted, if allergic to egg the patient cannot
continue with the service as the vaccination is cultured using hens’ eggs. The
next piece of data that would need to be recorded will be the vaccination
details this includes name and manufacturer of the vaccine, batch number, route
of administration, injection site and any adverse reactions. This data can be shared
with the GP and NHS England to improve any future care provided to the patient.

Once all these steps have
been put into place the pharmacy should now be running a successful flu
vaccination service in a community pharmacy. However, there are still many
areas in which this service is yet to be improved, as a few flaws remain. The
first being that not all pharmacy staff are adequately educated about the
service, this could be due to many reason from simply being too busy to take
time to learn about the service or to part time members of staff simply not
being aware. This can be fixed by the pharmacist taking the time to educate the
pharmacy staff either from self-knowledge or leaflets or other educational
material. This as a whole should help the pharmacy staff be more confident in
promoting the service and giving a professional approach to the patient,
building their trust in the pharmacy staff to take on the service. Another flaw
my be the fact that the pharmacist does not work everyday in the pharmacy
therefore some days when a locum pharmacist is on duty patients would be turned
away and would probably not return to take part in the service. The pharmacy
can implement a booking system where patients can book a time on a day that
suits them, however as research shows that the flu vaccination service is more
likely to be successful to work on a walk in basis, the best option would be to
ensure that all practising pharmacists are trained to be vaccinate patients.

Another approach that
community pharmacies have been taking to reach more patients is to move away
from the community pharmacy and become more mobile and vaccinate patients at
their workplace. This has improved immunisation numbers for many communities,
as it is once again a lot more convenient for patients. Typically most patients
will be paying as not many will come under the eligibility criteria. Typically
the pharmacy will visit schools, offices and factories etc. The main flaw with
this is the fact that the pharmacy will need to consider the cost for a locum
pharmacist to be working in the pharmacy whilst the normal pharmacist is away.
This is a major factor as to whether a pharmacy team will be willing to offer
this service as it may not be economically viable.

 A major patient group, which pharmacists can
target, are other health care workers. There are many organisations that have
been promoting that all health care workers should be vaccinated against the
influenza virus, as it is both a danger to themselves and to patients. The main
focus will be nurses as they come into close contact with many different
patients and can easily be infected with the virus themselves or transfer the
virus therefore infecting other patients. If in a hospital setting this can be
a serious health risk as the patients under a nurses care are already suffering
from an illness and the influenza virus can cause more serious complications.
Therefore community pharmacies can offer the flu vaccination services to other
health care professionals at a discounted rate, or should be included in the
NHS eligibility criteria as this is an effective way to help limit the amount
of serious complications and thereby saving NHS England money in the near
future.

With any existing or new
service being implemented in any setting there should be procedures in place to
evaluate the effectiveness of the service, how well it is being carried out, if
all the procedures are being followed correctly and if there is any room for
improvement. To achieve this an audit can be carried out every few months. The
audit will look to see if everything is being followed correctly and if the
service is safe for the patient. The audit will review the following; the pharmacist’s
qualifications, whether the pharmacy has a safe and confidential area to
vaccinate patients and if vaccinations are correctly stored and disposed of. pharmacy
have sufficient supplies available in case of an emergency (adrenaline shits
etc.). Determining if all paperwork has been processed and filed correctly
whilst considering patient confidentiality, along with checking if any targets
have been met also forms part of the audit. The audit may be carried out by
pharmacy staff, superintendent pharmacist or a third-party individual. The
easiest way of finding out if the service is effective is to ask the service
users themselves. This can either be done verbally or with a questionnaire, asking
for patient opinions on improvements and how efficient they believe the service
is.

One of the main points to
consider before offering this service would be the cost and profit margins
involved, as it is only worth offering the service if it is economically
viable. The cost of each vaccination varies depending on the manufacturer and
if the pharmacy has purchased at a discounted rate, if ordered in bulk. Prices start
at £5.22 and can go up to £9.34 per vaccine. For every administered NHS funded
vaccination the pharmacy will be paid £7.64 as well as a £1.50 administration
fee to cover the cost of disposal and training. A total of £9.14 will be paid
per vaccination as well as reimbursement for the cost of the vaccine against a
standard price list, clearly showing that this service is profitable.

 

Conclusion

To conclude, the flu vaccination
is one of the most common and important vaccination services offered in the UK.
It protects patients from suffering from the self-harming virus but also
prevents severe complications in high-risk patients. Pharmacists play a vital
role in seeing that this service is successfully implemented. Evidence shows
that since pharmacists have offered the vaccination service in community
pharmacies the number of administered vaccinations increased greatly and there
was an increased patient awareness of the flu vaccination service. With the
service being very straightforward to start up and materials being relatively
cheap and easy to obtain any pharmacy with a trained pharmacist, a confidential
space, correct storage and disposal facilities will be able to offer this service.
The only major cost that will need to be arranged will be for the training of
the pharmacist to correctly administer the vaccination as well as the cost of
the vaccine itself. However, as mentioned previously the cost of the vaccine is
reimbursed and the cost of training and disposal is included in the additional
£1.50 fee, such costs are not reimbursed elsewhere
in the Community Pharmacy Contractual Framework.  Not only is it another revenue for the
pharmacy, it also increases the patient walk in numbers thereby increasing OTC
sales and prescription item numbers. Offering this service in a community
pharmacy saves the NHS £2.35 per vaccination and reduces GP practise workload,
allowing patients who need to be seen by the GP easy access. Overall, the flu
vaccination service is a great scheme and with it being offered in a community
pharmacy there are many benefits to patients, health care providers, the
pharmacy itself and is a service which should be offered in all community
pharmacies.