I can’t help wincing, reading about the debacle of 111, the pressure on A&Es, the pressure on hospital beds, the pressure on social care and the pressure on General Practice. When the pressure is so high, I can’t help thinking – ‘are we forgetting anything’?
Are we forgetting flu?
The first letter is out. We are being asked to reach or exceed 75% uptake for all groups. This is really going to be a stretch since the immunisation in the aged under 65 at risk groups have stalled at 50% for a couple of years now. The number of immunisations given last year hardly increased by much over the previous year. Oh and we missed the 75% WHO target for the over 65s for the seventh consecutive year.
Last year the NHS delivered an additional 274,279 immunisations to defined at risk groups to virtually stand still. That is hardly surprising at the rate that we are discovering long term conditions. This year, how many additional immunisations are required? If you assume that we need an additional 300,000 to stand still, an additional 1.5 million to hit targets and perhaps 200,000 depending on the immunisation program in pre-school children – then it is a staggering 2 million more.
The letter admits that they need ‘new strategies’ to deliver these levels of achievement, but they believe that the new structures should ‘enable innovative approaches to improving flu vaccine uptake’.
- Public Health England will provide a centre of expert advice and monitoring
- Directors of Public Health in the Local Authority have a duty to ensure plans are in place to protect their population through screening and immunisation. They will bring together key stakeholders to develop multi-agency approach to achieving the targets in their local area. They will inform NHS England of the commissioning requirements. They will also provide independent scrutiny and challenge of the plans that NHS England develops.
- NHS England will commission the flu programme and ensure that robust plans are in place locally – so that means cutting the number of immunisation co-ordinators by half
- Clinical Commissioning Groups will have a ‘duty of quality improvement’ that extends across primary care – General Practice and Community Pharmacy in this example
If you are a Director of Public Health reading this blog – let me make it absolutely clear – as I read the letter, if we don’t hit the targets then it’s your fault! If you don’t collectively persuade NHS England to commission adequate services to deliver 2 million more immunisation doses then it is your fault! That’s between 15% and 20% more than last season.
Near me, community pharmacy delivered 1,400 doses to at risk groups. To people who would not visit their GP practice, were at work and found the appointment system inconvenient, people who had missed the notification and people who were in two minds and wanted to ask a couple of questions before being given the immunisation. To people who visited the community pharmacy every month to collect their medicines and a proportion of the 1.8million people who visit a pharmacy every day were sifted and sorted and offered or reminded about immunisation. I know of a pharmacist who went out with the van driver delivering medicines to house-bound elderly and administering the immunisation at their home. I fear that these 1,400 doses will be lost – not transferred to GP practices (as if they have loads of spare capacity), but these were people who didn’t go to their practice – what evidence have we that they will now?
So it is now July and I have heard nothing about extending or even maintaining the community pharmacy based programme. I thought that the Area Team would be reaching out to community pharmacy by now – confirming the existing programme – asking for more effort – recruiting more pharmacies – putting additional training in place in good time – ensuring PGDs are in place – making sure supplies are coming – spreading innovative and good practice.
There is only three months left to get all the ducks in a row or this will be a staggering failure.
As the letter says – ‘last winter was another quiet flu season for England’, however that was not the case for other countries across Europe. So just when the NHS and the economy is under the biggest strain, the last thing that we actually need is loads more people with flu!