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Community pharmacy services

Pharmacy-led flu vaccination programme put on hold after GPs object

GPs in Shropshire and Staffordshire have objected to plans to allow pharmacists to deliver an influenza vaccination programme targeting at-risk patients.

Elderly person receiving flu vaccine

Source: Image Point Fr / Shutterstock.com

GPs have claimed that pharmacy flu vaccination schemes do not capture hard-to-reach patients

Plans to invite pharmacists to deliver an influenza vaccination programme have been put on hold after protests from GPs.

Pharmacists in Shropshire and Staffordshire were invited by the local NHS England area team to contract for the service — targeting patients aged over 65 years, adults in clinical risk groups and pregnant women — which has traditionally been delivered by GPs.

But, according to a report in Pulse[1], the British Medical Association’s (BMA) local medical committees (LMCs) objected on the grounds that GPs had already placed orders for this winter’s flu vaccines and claimed there was little evidence that a pharmacy-based service improves vaccination uptake.

The move has prompted an angry response from pharmacists.

“This resistance from GPs is particularly frustrating given that we know GP practices are consistently failing to meet the nationally set targets for NHS flu vaccination,” says Alastair Buxton, head of NHS Services at the Pharmaceutical Services Negotiating Committee (PSNC), which represents pharmacy contractors in England.

“Financial pressures and competition within the NHS, combined with the lack of incentives for GPs and pharmacists to work together to improve local care, is at the root of this territorialism,” he adds.

Buxton argues that aligning the community pharmacy and general practice contract would prevent such conflicts.

“All the evidence that we have suggests that pharmacies can and do positively increase NHS vaccination rates where they are commissioned to do so,” he says.

Mimi Lau, director of pharmacy services for the membership organisation Numark, which has members in Staffordshire and Shropshire, said the view of the LMCs “beggars belief”.

“I am appalled by their ignorance,” she says. “They seem to have forgotten the reason why the NHS introduced the service in the first place – which was to enable as many NHS eligible patients as possible to have access to the flu vaccine because of its benefits.”

Elsewhere in the country, GPs and pharmacists have worked well together to deliver flu vaccinations.

“I have also seen area teams holding their ground, not buckling under GP pressure and commissioning the service through both GP and pharmacy,” Lau says. “Both providers operate under the same service level agreement with the same level of funding, thus ensuring equity, fairness and transparency.”

David Dickson, secretary of South Staffordshire LMC, told Pulse that NHS England had not given enough notice for the pharmacy scheme to go ahead and argues that there is no evidence it will improve uptake.

“Practices have already placed their orders for vaccines and they are at financial risk if they are not taken up,” he says. “We are worried pharmacy colleagues don’t have the same recording and reporting duties – they are not going to target the hard-to-reach groups.”

His comments had the support of BMA leaders. “It is those patients who would have always had their flu jabs done in the GP surgery that are being captured by the pharmacies – and they are not actually reaching those who have not been getting it, so it’s not meeting that need,” Charlotte Jones, the chairman of BMA’s General Practitioners Committee (GPC) in Wales, told Pulse.

Richard Vautrey, GPC deputy chairman and its co-lead on immunisation, said pharmacy-based schemes were causing disruption for practices and failing to increase uptake.

“All it does is add complexity and confusion to the process rather than producing any greater benefits in terms of numbers vaccinated,” he told Pulse.

A spokesperson for NHS England in Shropshire and Staffordshire confirmed that the scheme had been proposed earlier in 2014. “We are having ongoing discussions with GP practices, LMCs and local pharmaceutical committees and anticipate the scheme will be available by the end of 2014,” the spokesperson said.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20066336

Readers' comments (4)

  • I recommend that readers click through to the Pulse article and read the comments... Illustrative...!

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  • ‘They have put it on hold for the moment. They have not given sufficient notice for this, practices have already placed their orders for vaccine and they are at financial risk if they are not taken up. It is too late in the year to change those orders – and some practices do not have return of sale arrangements.’

    Of course pharmacies in shropshire and staffordshire have never been able to offer flu vaccinations before, this is an affront to GPs in the area! They ordered vaccines already, they had no idea that pharma... wait... what do you mean there have been a significant number of areas in the UK that have had pharmacists administering vaccines over the past few years?! I'm sorry, my head was in the sand while I was buying these vaccines, please refund me!

    "We also do not think there is evidence it will improve the uptake and are worried pharmacy colleagues don’t have the same recording and reporting duties – they are not going to target the hard-to-reach groups"

    At the end of the day, it doesn't really matter what they think does it? If they have evidence of this let them put it on the table. Let's see the request they made to the CCGs for the vaccination numbers for the years that pharmacy provided the service compared to the years that it didn't. The medicine we practice is evidence based, if they have evidence then let's see it.

    There are those that work full time or worse in this case, are self employed, that are unable to take time off to get a vaccine from surgeries that are only open during normal working hours. in this instance they may go to pharmacies that open on weekends or to a pharmacy that is open 100 hours. In my area there are very, VERY few surgeries that offer this, mine certainly doesn't. Perhaps every surgery in shropshire or staffordshire are, excuse me if I don't hold my breath. From personal experience these are the people that come to pharmacies to have a flu jab, those that are unable and unwilling to take the time to go to their GP in order to receive the vaccine; The fact that they pay for it when they could receive it for free from their surgery in most cases is testament to the value of the pharmacy vaccination program.

    "But Dr Dickson said the Government should instead adopt more vigorous publicity campaigns to encourage uptake in difficult to reach at-risk groups - such as young working men, housebound people and people with impaired mobility - as well as better strategies to help inform pregnant women about the benefits of vaccination."

    I think he meant, people that can only be vaccinated at weekends or in the evenings and people that receive their medication via compliance aids and deliveries aka those that are served primarily by pharmacies.

    "The NHS England Shropshire and Staffordshire area team spokeperson said: ‘We are committed to ensuring that people who are most at risk have easy access to the flu vaccination."

    So where is the problem in letting more premises offer the vaccine? If the true goal was to have an increased availability and uptake then surely having 100 hour pharmacies offering the service is not a problem.

    "But GPC Wales chair Dr Charlotte Jones, who is also co-lead for the GPC on immunisations, said initiatives to get pharmacies to deliver flu vaccines to at-risk groups in Wales had not helped to reach more patients in vulnerable groups.

    Dr Jones said: ‘Whilst we don’t disagree with any initiative to increase flu vaccine uptake, our experience has been it is those patients who would have always had their flu jabs done in the GP surgery that are being captured by the pharmacies – and they are not actually reaching those who have not been getting it, so it’s not meeting that need."

    So let me get this straight: The real problem here is that pharmacies can offer the flu jab in a safe, convenient environment that has been approved around the country and many patients around the country prefer to have their flu vaccinations in a pharmacy rather than in a surgery. Please excuse me for bringing an aspect of economics into the discussion but it seems that rather than address the fact that the free market has dictated that for these patients it is a better CHOICE to go to pharmacies than it is to go to the surgery they would rather the government step in. Never mind that the patients prefer to go to the pharmacy, "we already ordered these vaccines so we would lose money! We didn't know pharmacies could offer this service, this has never happened before in the history of the UK!"

    ‘We’re concerned it is removing this work from GPs who deliver the vast bulk of the programme, and end up chasing the harder to reach patients.’

    So have the GPs focus on the hard to reach patients! If, at the very least, this leads all the "easy to reach" patiens to go to pharmacies that frees up plenty of time for the GPs to focus on the hard to reach patients and to increase flu vaccination uptake overall.

    "He added that the GPC wanted to reinstate national publicity campaigns to promote flu vaccinations, despite Department of Health claims they were ineffective."

    I wonder, where would this happen, adverts? Surgeries? Pharmacies...? Perhaps it would be an idea to allow pharmacists, competent medical professionals, to offer these vaccines on site so that if a patient inquires about it we can offer it then and there?

    'The more the Department of Health and Public Health England can promote vaccination the better there is no loss and only gain to be made if it is more widely promoted whether through direct publicity or articles in the media.’

    Let's rephrase that: The more the Department of Health and Public Health England can make vaccination available, the better there is no loss and only gain to be made if it is more widely available whether through direct GP surgeries or pharmacies.’

    Nowhere in this argument has it stated that pharmacies would be unable to provide this service, only that these surgeries had bought the vaccines and now have competition compared to the monopoly they had before. Were this the first area to have pharmacies offer the vaccine I would perhaps have more sympathy but it isn't, pharmacies across the country have been offering vaccinations for years now. These surgeries made the CHOICE to order the vaccinations that they did, perhaps they will look outside their tiny box in future.

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  • Apologies for the long rant, if you want the short version:

    GPs in the areas mentioned have spent money on vaccines and now pharmacies have been offered the service as well.
    Rather than see this as a positive in the sense that pharmacies are often open MUCH longer hours than surgeries and thus more people would be able to potentially receive vaccines than if the surgeries alone were providing them, they see the money lost from the vaccines they ordered and nothing else.

    They bring no evidence that this is a negative to patient care and no citations that this does not increase availability.

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  • As I work in Staffordshire I now have a surplus of vaccines which I ordered in good faith having agreed the SLA and had this agreed by the Area team, who then pandered to the GPs - any other business and I would sue them for breaking their contract. The reporting system the GPs are so worried about online using Pharmoutcomes ,which were to be communicated to the GPs having logging them. This smacks of loss of income not patient welfare- regularly cited by GPs against us. Angry?, no incandescent more like it

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