The recommissioning of the national pharmacy flu vaccination service in England demonstrates just how successful it was last year, despite significant opposition from some GPs.

 

Over half a million flu jabs were delivered by the 60 per cent of community pharmacies that offered the vaccine last winter. Recipients included people in hard-to-reach at-risk groups who had previously not benefited from flu vaccinations on the NHS in large enough numbers.

A Durham University analysis of 32 flu vaccination services commissioned from pharmacies in 2014/15 showed that 16 per cent of the vaccinations were administered to those who had not previously received a NHS flu vaccination; 15.4 per cent of patients vaccinated would have potentially gone unvaccinated because their GP was unable to provide the service or the patient was unable to attend the surgery. This improved uptake is thought to be due to greater access to pharmacies in areas of high deprivation.¹

“Although this is the second year of the flu vaccination service in pharmacy, it is just as important as last year to make the most of this opportunity,” says Alastair Buxton, director of NHS services at PSNC. “One of the key aims of the campaign is to encourage at-risk groups to take up their free NHS flu vaccinations.

“With community pharmacy teams up and down the country offering a convenient place to receive the NHS flu vaccine, the pharmacy service will go a long way to helping Public Health England and NHS England achieve their target,” he continues.

“Community pharmacy needs to show the difference it can make and we are looking forward to seeing if the sector can improve on the number of patients vaccinated under the service last year.”

This view ties in well with plans to “radically enhance” the role of pharmacies, as outlined in the Community Pharmacy Forward View², with administration of flu vaccines cited as an example of how pharmacy can add value to patient care pathways.

 

 

Targeting at-risk groups

There is even more reason to offer the flu vaccination service this winter, as evidence for the vaccine has strengthened recently. For people with type 2 diabetes, for example, the vaccination has been shown to decrease their chance of cardiovascular-related hospital admissions by half and the risk of death by a quarter. Overall risk of hospital admission for flu or pneumonia was 15 per cent lower in people who had had the vaccine than those who had not.³

Older people are also advised to be vaccinated and there could be even more reason to do this now, after recent research showed the flu vaccine is associated with a lower risk of dementia in patients with heart failure.⁴

Other groups for which this advanced service is available include pregnant women, and people with chronic conditions including respiratory, heart, kidney, liver and neurological disease. People who live in residential care homes are eligible, as are carers and also people with diseases that suppress the immune system (e.g. HIV).

Hitting the target

Targeting carers proved key to one pharmacy’s success last year. Robert Bradshaw at Frost Pharmacy in Banbury vaccinated over 200 people by specifically targeting the carers of people in at-risk groups. Carers qualify for the flu jab under the scheme and it is important to make them aware of it so they are not overlooked, he says.

“We often see our patients who are eligible for free flu jabs when they come in for their medication and we have special stickers on their prescriptions about getting their vaccination. When we see the carer with them or coming to collect a prescription, we let them know that they are eligible too, and that they can get the flu jab here. It is important that they know what is available.”

Jane Devenish, a pharmacist at Well Pharmacy, says involving the whole team is essential if pharmacies are going to deliver a successful flu vaccination service. “Colleagues who deal with customers on a more regular basis will be able to help identify those who might benefit the most from the jab and help to answer any questions a patient may have,” she says.

Working with GPs

Robert Bradshaw meets regularly with GP practice managers in his local area and suggests they tell patients who can’t get a surgery appointment to visit the pharmacy instead. “We can offer a walk-in service six days a week but [the GPs] just can’t do that. They could give appointments for flu jabs but they don’t have the appointments to give,” he explains.

Setting up electronic information systems so that GP surgeries can be up-to-date with patient data in real time could also help to reassure doctors, says Sibby Buckle, a pharmacy manager at Boots in Nottingham and member of the RPS English Pharmacy Board. This would avoid potential problems with sending a letter, especially if surgery staff don’t have time to update patient records.

Previous GP opposition could also have been due to the pharmacy service being announced too late in the year, says Buckle. “This year it has been announced much sooner, so I think that there has been better communication. I think it should be a given that pharmacists offer the service.”

The service should definitely be confirmed earlier in the year, as pharmacists have been enquiring about starting to offer it from as early as August, says Rekha Shah, Kensington, Chelsea and Westminster LPC chief executive officer.

“Knowing about the service being recommissioned is helpful,” she says. “We can pull patients in through July and August and say ‘yes, it is really sunny outside but winter is not far away and you should think about your winter health’, particularly people who are more at risk. Part of that being possible is getting earlier flu jabs arranged.”

Describing the opposition from some GPs as improper, Shah points out that the vaccination programme was offered to GPs for years and they never met national targets. “That is why it was offered to pharmacies, so [GPs should] let it go and maybe focus on something else. Some practices are doing well and other people should learn from them,” she says.

Pharmacists should always speak to local GPs when they plan to offer the service to avoid any problems, recommends Alastair Buxton. “It is important for any community pharmacy contractor planning to provide the flu vaccination service to speak to their local GP practices in order to protect existing relationships.”

Prevention better than cure

The flu vaccine service can easily be cross-promoted with advice and products for winter ailments such as colds and flu – something that is reflected by Public Health England’s ‘Stay well this winter’ campaign.

Besides offering the flu vaccine to vulnerable groups, Jane Devenish stresses the importance of providing elderly patients with lifestyle advice on keeping healthy during the winter period, such as eating well, staying active and keeping warm, as well as staying indoors in severe weather conditions.

“Slippery pavements can contribute to falls and frail older people find it more difficult to warm up if they get cold or wet,” she says. Pharmacies regularly offer a free delivery service that allows elderly patients to stay at home when the weather is poor.

 

 

Treating patients with winter viruses

While the flu vaccine offers protection from the condition, there is a wide range of viruses and infections a patient can get during the winter months, which could lead to complications if not treated quickly. Symptomatic relief is also readily available.

The ‘Stay well this winter’ campaign from Public Health England targets colds, flu, asthma, sore throats and norovirus, in an attempt to encourage patients to self-treat by keeping warm and hydrated, and to contact a pharmacist if they need help.

When treating these complaints, it is important to ‘follow the symptoms’. For example, a sore throat can be eased with a throat spray or lozenges containing a local anaesthetic, while nasal congestion can be relieved with a decongestant nasal spray. Aches, pains and fever can be managed with OTC analgesics such as paracetamol or ibuprofen. If a single analgesic agent is ineffective, a combination product containing both paracetamol and ibuprofen may be suitable as, together, they provide greater relief while avoiding any confusion with alternating doses.

“If you go by the customer and the symptoms, you can’t go far wrong. For most of these complaints, we need to make sure the customer is resting and taking plenty of fluids and then offer them a flu jab when they are feeling better if appropriate,” says Angela Chalmers, a Boots pharmacy manager in Potters Bar.

It is also important to debunk myths surrounding common winter viruses, she adds. “We tell customers that if they have flu they should expect to be in bed for one or two weeks and point out it can be really debilitating. We also need to let people know that alcohol hand gel doesn’t work with norovirus, and they need to wash their hands with soap to control it. If norovirus is spreading, talk about hand hygiene and washing,” she advises.

When it comes managing coughs, Ed Round, Covonia marketing manager, urges pharmacists to ask detailed questions beyond whether or not a cough is dry, tickly or chesty, to ensure that they recommend the most appropriate product.

“Try to get a detailed overview of the patient’s symptoms – is their cough productive, for example? How long have they had the cough and have they taken any actions so far?

“Pharmacists should always ask if a patient has any medical conditions, such as diabetes, as this will determine which treatment is suitable, or if they are taking any form of medication, as often remedies may contain paracetamol and an overdose must be avoided.”

Olbas brand manager, Samantha George, stresses the need to stock a comprehensive range of winter remedies, including products that are suitable for all ages, and to ensure the category is well stocked throughout the winter.

“By nature, winter remedies are often a distress purchase, bought when customers are already feeling ill and looking for fast and effective relief,” she says. “This means that offering a fully stocked, comprehensive range of products is essential to ensure customers have purchasing options in their time of need – and it is vital that cold and flu products are easy to find.”

Raising the profile

As healthcare professionals face another ‘winter crisis’ in the NHS, pharmacists need to reach out with whatever tools they have to help reduce the impact of avoidable and treatable illness on medical services.  

“Through services such as flu vaccinations, the public is becoming more aware of the convenience and accessibility of community pharmacy. Providing this service will not only enable pharmacy contractors to earn extra income and support NHS provision of flu vaccinations, but it will also increase footfall and create a positive image for community pharmacy,” concludes PSNC’s Alastair Buxton. So let’s go for it!

 

<sup>References
1. BMJ Open 2014; 4:e005764 doi:10.1136/bmjopen-2014-005764
2. Community Pharmacy Five Year Forward View (PV, PSNC)
3. Eszter P, Vamos MD et al. Effectiveness
of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ, July 2016 DOI: 10.1503/cmaj.151059
4. Research presented at Heart Failure 2016 and the World Congress on Acute Heart Failure, Florence</sup>