Pharmacy Complete’s Deborah Evans and Michael Holden explain to plan, implement, raise public awareness of flu vaccines and improve uptake – and the health and wellbeing of the population
• Engage, inspire and enable your team to support the vaccination service
• Collaborate with other healthcare providers – instead of competing with them
• Plan and run an effective public awareness campaign on flu
Community pharmacies are well placed to have a significant impact on the health and wellbeing of communities through the delivery of a flu vaccination service.
In 2016, 72% of pharmacy contractors in England delivered 950,765 flu vaccinations to eligible groups. This was worth a total of £8.7m in fees to the sector. There was an average of 113 vaccinations per pharmacy, with 38 contractors providing over 500 vaccinations each.1
The community pharmacy seasonal flu vaccination advanced service will continue in 2017/18 and some areas, eg London, have an augmented service with an extended eligible group list. Pharmacy contractors should start planning now to deliver the optimum service.
How to go about it
First, define a purpose and ensure that everyone in the team understands how this fits with their role so that the whole team performs effectively.
Define why the service is important to your pharmacy and the community. There are many benefits including:
•Meeting the needs of patients, the local population and commissioners.
•Reducing hospital admissions and deaths.
• Building patient loyalty.
• Demonstrating local clinical leadership and commitment to a nationally commissioned service.
• Showing you are a credible provider.
• Working as a team to optimise outcomes.
• Collaborating with local GPs to complement each other rather than compete.
• Increasing revenue.
Establish some aims for what you want to achieve. If you delivered the service last year, perhaps you want to increase your uptake, say by 5% or 20%. If this is your first time offering the service, talk to your local pharmaceutical committee (LPC) or pharmacy colleagues to set a sensible target.
Also think about your return on investment following training and setting up the service – what volume would give you a break-even point?
Setting goals and milestones will allow you to measure success and will also help you determine your vaccine order. You should be able to phase your ordering to reduce risk, although there is usually a good returns policy with suppliers at certain key dates. Some LPCs can facilitate orders for you, and also provide marketing support.
Public Health England has outlined a role for pharmacists in its 2017/18 winter flu plan:2
• Educating patients, particularly those in at-risk groups, about the appropriate response to flu-like illness and other illness that might be precipitated by flu.
• Ordering the correct amount and type of vaccine for eligible patients, taking into account new groups identified for vaccination.
• Storing vaccines in accordance with national guidance.
• Ensuring vaccination is delivered by trained, competent healthcare professionals who participate in ongoing development in line with national standards.
• Maintaining regular and accurate data collection using appropriate returns.
• Encouraging and facilitating flu vaccination of their own staff.
Engaging and involving your team
Delivering an effective service is a team effort, so it is important that everyone understands why the service is important to you, your pharmacy and your community. Involve the team early in the process so that they can help to shape the plan, take on responsibilities and feel ownership.
During this process you can identify any concerns that team members may have, such as confidence and how they will find time to provide support. This requires putting aside time to plan together, asking questions and listening actively.
Once everyone in the team is on board, build the plan together and agree who does what and by when, being clear about expectations.
Potential roles in the team include:
• The analyst – perhaps a technician, to identify which patients are eligible or had a flu vaccination in your pharmacy last year (if you have done it before) to target again.
• The organiser – to ensure everything is in place for an efficient service and a great patient experience.
• The campaigner – perhaps a health champion, to plan an awareness campaign both in the pharmacy and in the community, including local businesses.
• The promoters – everyone in the team should be on message to ensure they make every contact count and promote the service as much as possible.
• The administrator – a person to be responsible for completing the pre- and post-vaccination paperwork, entering on the patient medication record (PMR) and on the online data management system.
• The vaccinator – the vaccination and immediate aftercare to ensure patient safety must be done by a pharmacist.
It is also important at this stage to engage the wider healthcare team – local GP practices. The sooner you have a conversation with your local practice(s) the less likely there is to be conflict. You have the opportunity to work together to target eligible groups that they struggle to reach; more on this later.
The General Pharmaceutical Council (GPhC) standards and the NHS flu service specification (yet to be published for 2017/18) will be clear about requirements for provision of this service – see the Pharmaceutical Services Negotiating Committee (PSNC) website for more details as they become available.
However, it is important that the pharmacy has a professional environment including the consultation room and meets all clinical and IT governance requirements.
Pharmacies that are becoming a Healthy Living Pharmacy must have a health promotion zone – this can be used to promote the service. Public Health England has a range of posters and leaflets you can use.3
Capability – the training
All pharmacy staff involved in the provision of the Flu Vaccination Service should receive appropriate training relevant to the role.
The national minimum standards for immunisation training and the core curriculum for immunisation training set out the knowledge and skills that healthcare professionals undertaking vaccination services need to have.
NHS England has determined that pharmacists need face-to-face training for both injection technique and basic life-support training every two years, but you should reflect on your own capability and confidence and undertake training more frequently if you feel you need it.
The whole team needs to know the basics of the flu service – who is eligible for the NHS service and who you might consider for
a private service and what the protocol is.
A number of pharmacies have developed their health champions into flu champions; this resulted in increased uptake in Kensington, Chelsea and Westminster in 2016.
We mentioned earlier the importance of building collaborative relationships with GP practices. One way to start the conversation is to print a list of eligible patients from your PMR based on their age or long-term condition, and take that to a meeting.
Ask what the practice wants to achieve, which patients are they focussing on and which are a challenge for them to reach. Explore how you can give patients flexibility, choice and a better experience to achieve a higher uptake.
Ask your team to start promoting the flu service during the summer in every contact they have with a customer – simply mentioning the service will raise awareness.
Use bag stuffers and stickers, leaflets, posters and displays, direct messages to existing patients (if you have their consent) and social media to make your patients and customers aware of what you have to offer.
It is clear that there is much to be done to implement and deliver an effective flu vaccination service, but many pharmacies have seen both direct and indirect benefits from engaging the team, putting a clear plan in place and executing the plan effectively. Do remember to review progress regularly and celebrate success.
Some pharmacies have built on a successful flu vaccination business to develop a profitable travel vaccinations business.
One thing is certain; it won’t happen by itself so start to define your plan now.
Some messages to help make every contact count
• Flu is unpleasant but can be much more serious for certain people.
• Flu vaccination is the only effective preventive treatment.
• Flu vaccination is important for everyone – but particularly those at increased risk.
• For eligible groups, flu vaccination is available free of charge from the NHS at a pharmacy.
• Every customer if they have had their flu vaccination this year.
• Everyone you see to tell their family and friends about the service.
• Create an impactful campaign involving the whole team.
• Build a display in the pharmacy and go out into the community and local businesses to promote the service.
• Analyse your PMR system for eligible patients and those who had a vaccine from you last year and promote the service to them.
Deborah Evans is managing director and Michael Holden is principal associate at Pharmacy Complete
1 NHS Business Services Authority Advanced service flu report tinyurl.com/flupharmacy
2 Department of Health, gov.uk/government/uploads/system/uploads/attachment_data/file/600532/annual_flu_plan_2017to2018.pdf
3 Public Health England. gov.uk/government/publications/flu-vaccination-leaflets-and-posters