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Flu vaccination service: let’s make it work!

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Flu vaccination service: let’s make it work!

There may have been a few teething problems but at last a national flu vaccination service is available through pharmacies in England. Effective patient recruitment and publicity for the service are now the priorities.

 

Learning objectives

After reading this feature you should be able to:

  • Explain the details of the new advanced service for pharmacy flu vaccination
  • Recognise how pharmacy teams can participate proactively in better antibiotic stewardship
  • Offer customers with common winter ailments advice on symptom relief and effective self-care.

 

September saw the launch of a community pharmacy national influenza vaccination service – an initiative that sees pharmacists in England offering NHS flu vaccinations to all ‘at risk’ adult patients. “Community pharmacy provision of NHS flu vaccinations makes absolute sense for patients and commissioners,” says PSNC chief executive Sue Sharpe, “and a national service will give pharmacies the chance to offer a fairly funded professional service to a full range of eligible adult patients.

It is an important step forward for the sector as we expand the provision of care and public health services alongside the dispensing of medicines.”1 So what are the key benefits this new advanced service looks set to bring to both pharmacists and patients – and how can the obvious practical challenges best be overcome?

Recruiting patients

Introduction of the new advanced service for flu vaccination provision forms one of a raft of changes to the community pharmacy contractual framework negotiated between NHS England and PSNC in return for a funding package totalling £2.8bn for 2015/16. “This new service expands the role of community pharmacy, making better use of the clinical skills of pharmacists, and delivering improved choice and access to services for people,” says Felicity Cox, lead negotiator for the NHS Employers organisation.1,2

Adult patients aged 18 years and over with one or more serious medical condition(s) outlined in the annual flu letter will now be able to access their seasonal influenza vaccination at participating community pharmacies. Other target patient groups include:3

  • Adults aged 65 years and over
  • Anyone aged six months to 65 years in the clinical risk groups
  • Pregnant women
  • All children who were aged two, three or four years old (but not children aged five years or over) on August 31, 2015
  • All year one and year two school-age children
  • Residents of long-stay care homes
  • Carers 
  • Primary school children in areas previously involved in pilot vaccination programmes.

Both the NHS and Public Health England have stressed that last year’s flu vaccine uptake needs to be improved upon and expanded, making effective patient recruitment a key priority area for pharmacy. The aim is to reach a minimum 75 per cent uptake in the 65s-and-over age group, while simultaneously achieving a substantial boost in coverage for clinical risk groups, where uptake last year stood at just 50 per cent.

There should also be a 100 per cent offer of immunisation to eligible children, with pharmacy providers required to demonstrate that such an offer has been extended.1-4 To drive effective patient recruitment, community pharmacies should take the opportunity to proactively offer flu vaccinations to eligible patients in tandem with the provision of other key services such as MURs and the NMS.

Public Health England is co-ordinating communications and resources around the 2015/16 flu vaccination programme. Information leaflets and other marketing materials are available to promote the service.

In addition, many local NHS England teams and local pharmaceutical committees, as well as the NPA, will also be developing or have already developed specific campaigns and toolkits for use by community pharmacies, and may even look to promote the service in the local press. Template communications materials for pharmacies and LPCs to consider are available from PSNC.4

Easing tensions with GPs

“There will be challenges and not everyone will welcome the news of pharmacy’s extended role,” concedes Sue Sharpe, “but community pharmacies are ready for this and the evidence and benefits for patients will speak for themselves.”1,2 The PSNC briefing document acknowledges that the new pharmacy-led flu vaccination service may create potential tension support for this would be helpful and should be encouraged, it is not necessary in order to successfully provide the service”.

PSNC is actively working with GPs on a national level to help ease any simmering tensions. It is hoped that this effort, plus the fact that the majority of local NHS England teams commissioned a flu service from community pharmacy during last year’s 2014/15 season, may already be helping to expose – and begin the process of resolving – any potential issues.

Winter is fast approaching – so get ready for the annual onslaught of coughs and sniffles

 

Making the most of the cold and flu season

It is vital that pharmacists get their offer right in order to maximise sales and make the most of the cold and flu season, says Craig Shaw, Nurofen marketing director at RB.

Shoppers care about choosing appropriate products, particularly when they have a cold or flu where the symptoms can impact on everyday life. The company’s research has shown that shoppers spend longer browsing cold and flu than any other fixture, spending around 56 seconds choosing their cough remedy compared to 34 seconds for analgesics and 41 seconds for haircare.

Research shows they are also more engaged with their cold and flu purchase – picking up on average 2.34 cough or cold products before selecting – which is more interaction than any other recorded category. However, difficulty navigating the winter remedies category is the biggest barrier to shoppers not purchasing products.

‘Repertoire category’

Pharmacists need to understand that cold and flu is a classic repertoire category, one where shoppers regularly pick from a handful of well-known brands and products, says Shaw. Why? Many purchases are distress purchases – consumers buying products because they already have a cold or flu and are suffering from unpleasant symptoms. So pharmacists should ensure their fixtures reflect this behaviour by:

  • Offering a good range of well-known products indicated for a range of cold and flu symptoms
  • Keeping watch for new brand advertising and campaigns that promote a particular product and looking to build greater awareness of the product benefits, underlining efficacy and the essential reassurance that drive demand.

Consumers commonly suffer from more than one symptom when they have a cold, so multi-symptom relief is important, says Shaw. With the right presentation, shoppers buying cough products may also buy cold or sore throat remedies at the same time in a bid to alleviate all their symptoms. It is therefore important that the fixture enables customers to make all their purchasing decisions in one place, he adds.

 

Smooth service delivery

According to PSNC, community pharmacy contractors should take the following proactive steps to ensure the flu vaccination service runs smoothly through its winter roll-out:4

  • Existing flu vaccination providers should consider the steps needed for the switch to the national service (e.g. potential additional training needs, service provision and the link to associated staffing requirements, plus initiatives to maximise vaccination opportunities on an everyday basis)
  • Pharmacies that do not currently offer flu vaccinations should consider what steps need to be taken in order to offer the new national service. A range of organisations currently offer training and support for provision of flu vaccination services and pharmacists are free to choose the training option they prefer. Core vaccination training should cover vaccine delivery as well as issues like the management of allergic reactions and patient consultation
  • Review working practices to ensure all pharmacy staff are equipped to incorporate the new service into routine pharmacy work, as well as continuing to offer NMS, MURs and any local services
  • Consider if standard operating practices (SOPs) within the pharmacy will need adjusting following the launch of the new service, and prepare for the logistics of appointment booking for flu vaccinations
  • Estimate stock requirements and begin the process of procuring the vaccine from registered suppliers 
  • Speak to local GP practices to encourage a collaborative approach that maximises patient uptake and minimises confusion for patients.

Other important points for pharmacies to be aware of regarding the delivery of the flu service include:1,2,4

  • The advanced service for flu vaccination can be offered by any community pharmacy in England with a consultation room that fulfils existing requirements for provision of MUR/NMS, can procure the vaccination and meet the data recording requirements, and has appropriately trained staff
  • Once contractors are ready to provide the service, they must notify NHS England of their intention to begin by completing a notification form on the NHS BSA website
  • The standard operating procedure for the service must include procedures to ensure cold chain integrity
  • Each patient will be required to complete a consent form before being administered the vaccine
  • The service runs to the end of February but focus should be given to vaccinating eligible patients before January 31
  • There is no limit on the number of vaccinations pharmacies can claim for, provided they are only administered to eligible patients. If a vaccine is administered to other patient groups as part of the flu vaccination service, the contractor will not be paid
  • The new national flu vaccination service will replace any previous service commissioned by local NHS England area teams from pharmacies
  • The NHS has set out a list of possible vaccinations in the annual flu letter and it will be the responsibility of pharmacy contractors to source these direct from suppliers. There will be no central procurement of vaccinations for pharmacies
  • Payment claims must be made by submitting a completed copy of the community pharmacy seasonal influenza vaccination claim form to the pricing authority with the pharmacy’s prescription bundle at the end of each month
  • Reporting to the patient’s GP practice will be a requirement for the new service, as is already the case for locally commissioned vaccination services
  • PSNC says it is striving to minimise the overall data capture burden for pharmacies but it will still be vital to gather enough information to accurately evaluate the success and uptake of this new service. At the time of writing, the manner in which completed patient questionnaires will be collated and analysed had yet to be finalised
  • Remuneration will be £7.64 per administered dose of vaccine plus reimbursement of the vaccine costs. Drug costs will be reimbursed at the basic price of the drug calculated in accordance with the Drug Tariff. An additional fee of £1.50 will also be paid per vaccination for expenses incurred in providing the service
  • Pharmacists providing the flu vaccination service need to attend face-to-face training for both injection technique and basic life support methods every two years. Pharmacists who undertook the training in 2013 therefore need to undertake training in 2015 prior to providing the flu vaccination service.

The PSNC briefing document 034/15 provides answers to any other key questions pharmacy staff may have about the scope and specifications of the new service.

NICE strengthens its stance on antibiotic over-prescribing

As the winter season approaches and levels of viral illness start to spike, NICE has taken steps to curb antibiotic over-prescribing by GPs. New guidance released in August focuses on the effective use of antimicrobials, with practical recommendations aimed at changing prescribing practices to slow the emergence of resistance.5

Despite ongoing advice to reduce prescribing rates, nine out of 10 GPs still feel pressured to prescribe antibiotics and 97 per cent of patients who enter the consultation room and ask for antibiotics are given them, according to NICE.6 In the first ever guidelines to officially address this important issue, NICE calls on healthcare professionals – including pharmacists – to play a greater role in promoting and monitoring the sensible use of antimicrobials.

If successful, NICE estimates that inappropriate antibiotic prescribing could be cut by over 20 per cent – the equivalent of 10 million individual prescriptions. Some of the main areas of emphasis in the new NICE guidelines include:

  • Taking the time to discuss with patients and family members the likely nature of their condition
  • Explaining why prescribing an antimicrobial might not be the best option
  • Offering alternative treatment or symptom relief options
  • Outlining the benefits and harms of antibiotic prescribing
  • Explaining what action to take if symptoms worsen.

Pharmacists are well-placed to cement these key communication messages with patients, as well as providing valuable self-care advice on OTC preparations to help manage common self-limiting viral conditions without relying on antibiotics. Pharmacy also has an important role to play in so-called ‘safety netting advice’ – explaining to patients what to do if their condition deteriorates and highlighting potential red flag signs and symptoms that warrant a (return) visit to their GP.

 

NICE has set out steps to curb antibiotic over-prescribing

 

Ready for the rush?

Driving penetration early in the season will stimulate winter remedies category growth and capitalise on those shoppers looking to stock up on products, says GSK. To give customers a choice, pharmacists should make sure they stock a variety of formats such as capsules, liquids, tablets and hot drinks, says Shivani Uppal, cold & flu senior brand manager at GSK.

“Pharmacists should ensure their cold and flu products are highly visible from October through to March by allocating more shelf space to help capitalise on the incremental sales opportunity presented during the peak of the season.” The 2014/15 cold and flu season saw an additional 1.47 million shoppers enter the category, with most growth coming from single purchase occasions, according to market research by Kantar Worldpanel. “Customers tend to shop the cold and flu category according to the strength of products,” says Uppal. 

“They look for efficacy and USPs, such as speed of relief, when planning their treatment. They will also purchase cold and flu treatments based on experience, with 64 per cent of shoppers opting to purchase the same brands again.” In 51 per cent of cases, immediate need for treatment was stated as the main trigger for purchasing cold and flu products – but stocking up is also important.

“With 86 per cent of shoppers claiming they feel confident in treating their cold and flu without medical advice, pharmacists should use point-of-sale materials to help customers navigate the fixture and choose the right product for each stage of their cold or flu,” adds Uppal. “Products such as tissues are likely to increase in sales throughout the cold and flu season, so pharmacists could use clip strips to position these close to the winter remedies fixtures to maximise the impulse opportunity.”

Both the NHS and Public Health England have stressed that last year’s flu vaccine uptake needs to be improved upon and expanded

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