Ian Dalton's swine flu update - vaccination strategy

What should NHS staff be focusing their efforts on?

On 14 September I was delighted to be able to confirm that the negotiations with the British Medical Association GPs committee on how the swine flu vaccine will be delivered had concluded. We are still waiting for the European Medicines Agency to license the vaccines, which will confirm the timings of the delivery, but the key features of the agreement between the department and GPC are:

• It applies only to the 9.5 million people identified as being in the at-risk groups.
• There will be fee of £5.25 per dose of vaccination given.

Vaccination has always been an important element of our resilience strategy.  Delivering an effective vaccination programme will help us to save lives. 

In addition and in recognition of the additional workload practices will undertake to deliver this vaccination programme, and to incentivise practices to achieve the highest possible uptake of the vaccination for those most at-risk patients, the department has also agreed that there should be:

• no change to the quality and outcomes framework during 2010-11.  Recommendations for changes made by the National Institute for Health and Clinical Excellence will be on hold for one year, with the aim of implementation from 2011-12;
• a reduction in the thresholds for the QOF patient experience indicators in 2009-10 if practices achieve high uptake of swine flu vaccination;
• a six week extension for practices to deliver (non-swine flu) childhood vaccinations covering the third quarter of 2009-10. i.e. the third quarter vaccination period will be extended to mid-February instead of the usual end-December date.

This agreement puts us in the best possible position to deliver the swine flu vaccination as it builds on an established model of vaccination delivery, and draws on the experience and expertise of the GP community. 

While levels of swine flu remain low, there has been a very slight increase reported by the Health Protection Agency in the last week. This reinforces our current position that we must prepare for a possible surge in cases in the autumn or winter that could affect large numbers of people and potentially put major strain on the NHS. 

The next steps

In terms of next steps, the Department will shortly issue detailed guidance that will make clear supply and distribution mechanisms, clinical administration and uptake reporting/data collection.  In the meantime, I am asking all NHS organisations to begin the following work:

• Primary care trusts must develop plans to identify, communicate with and vaccinate patients in the at-risk groups, including those not registered with a GP practice. 
• All NHS organisations must develop plans to vaccinate eligible frontline staff.  Vaccination against swine flu will reduce their risk of infection and of transmitting the virus to colleagues, patients and relatives.  These plans need to make access to the vaccine as easy as possible.  Any perceived barriers to vaccination must be considered and removed. 
• All NHS boards have a responsibility to maximise staff participation in the vaccination programme.  I expect every organisation to have a plan for ensuring as many frontline staff as possible take up the offer of early vaccination.  We all know that uptake of the seasonal flu vaccine among NHS staff is traditionally low. It is an NHS board responsibility that we do not find ourselves in this position with the swine flu vaccine. 

I am expecting every chief executive, medical and nursing director to take a visible leadership role across their organisation to ensure their staff are as protected as possible against a potential second wave of the virus.

Progress to date

The HPA have reported that although overall levels still remain low, the rates of flu-like illness and related activity have started to increase in England. The increase was mainly seen in school age children. Further details can be found on the HPA website and we will continue to monitor the situation closely.