The NPA answers some of the most commonly asked questions from pharmacists about the Service Specification and Patient Group Direction (PGD) for the NHS community pharmacy influenza vaccination Advanced Service in England

Which influenza vaccine available on the NHS Community Pharmacy Flu Vaccination Advanced Service (2016/17) is egg free?

None of the vaccines available under the Advanced Service for 2016/17 are egg
free. The PGD states that people who have had a severe anaphylactic reaction to egg that has previously resulted in intensive care are excluded from the service. Those patients with a less severe egg allergy can be vaccinated with an inactivated influenza vaccine with an ovalbumin (egg protein) content of less than 0.12mcg/ml (equivalent to 0.06mcg/0.5ml dose).

The PGD lists patients with confirmed anaphylactic reaction to any component of the vaccine to be excluded from the service; can I vaccinate if the patient has a hypersensitivity to a specific antibiotic?

No. The Summary of Product Characteristics (SPCs) for all influenza vaccines for
2016/17 have contraindicated patients with hypersensitivity to a specific antibiotic or any other listed component stated in the SPC.

I am not sure whether to vaccinate a patient as their specific condition is not listed in the Service Specification and PGD – what should I do?

If a specific condition is not listed in the Service Specification and PGD, the pharmacist will need to make a clinical decision as to whether a patient is covered under the inclusion criteria. If in doubt, the patient should be referred to their GP.

Patients with chronic neurological disease are eligible to receive the Advanced Service vaccination. Does this include a patient with epilepsy?

No. The PSNC has confirmed that a patient with epilepsy would not be eligible to receive a flu vaccination under the Advanced Service as patients with epilepsy are not considered to be a high-risk group.

Can I vaccinate off-site?

The Advanced Service allows pharmacists to provide off-site vaccinations to patients who are residents in a long-stay residential care home or other long-stay care facility. The pharmacist has to get approval from their local NHS England team prior to administering flu vaccinations off-site; separate approval has to be gained for each long-stay residential setting. Annex C of the Service Specification provides guidance on how pharmacists should respond to a request to vaccinate patients in long-stay residential care homes or other long-stay care facilities.

Does NPA professional indemnity insurance cover members for providing the flu vaccination Advanced Service? Members are covered to provide PGD services (private and/or NHS) which may include vaccination services, both from the registered pharmacy premises as well as from off-site locations – provided that all the PGD and service requirements are fulfilled correctly.

IMPORTANT NOTE: It remains the personal and professional responsibility of the pharmacist, in all cases, to ensure that they are trained, confident and competent to offer the vaccination services (NHS and/or private) including management of anaphylaxis and resuscitation techniques; the pharmacist must decide for themselves whether they should undergo the full vaccination training or the online refresher training.

Details of the influenza vaccines for the 2016/17 season, including their ovalbumin and antibiotic content, are in the NPA resource “Flu information pack 2016/2017: vaccine information”, available to download from npa.co.uk.