Letter from Dr Peter English, Chair, Public Health Medicine Committee, and Dr Richard Vautrey, Chair, General Practitioners Committee, British Medical Association (FVP0001)
We write on behalf of the BMA’s General Practitioners Committee and the BMA’s Public Health Medicine Committee regarding your Committee’s inquiry into flu vaccines. We welcome the inquiry, and believe it is a timely opportunity to learn from mistakes made during the most recent round of supply and distribution of flu vaccines.
In January the BMA wrote to Professor Stephen Powis, National Medical Director (letter enclosed) to outline our view that using non-adjuvanted vaccine for vaccinating patients aged 65+ would not be an effective use of resource; whereas the use of an effective vaccine will help reduce the burden of influenza next winter and may improve outcomes for older patients. We also called upon NHS England to urgently recommend that all vaccination providers, who have not ordered aTIV for patients aged 65+ changed their orders for the 2018-19 season. In response we were glad that NHS England responded that they would issue such guidance.
While this was a positive outcome, we believe that this situation would not have arisen had better liaison and communication existed between the relevant bodies at an earlier stage. Specifically, we are disappointed that while the Joint Committee on Vaccination and Immunisation (JCVI) recommended in November that adjuvanted influenza vaccine (aTIV) is effective and highly cost-effective in patients aged 65, it was not until the 5th February 2018 that NHS England provided this definitive guidance to general practice and community pharmacies on influenza vaccine for the 2018/19 season.
This delay in the recommendation made by the JCVI being communicated as guidance by NHS England to GPs resulted in practices ordering vaccinations based on previous, now out of date evidence. Subsequently once the new guidance was issued practices were then faced with the challenge of reordering their supplies, with no guarantees of reimbursement for what was effectively an issue caused by NHS England communication delays.
We believe that to address this there must be better liaison and communication between relevant bodies including the JCVI, Public Health England, NHS England, clinicians on the ground and pharmaceutical suppliers well in advance of the order deadline.
NHS England has confirmed to us that due to issues with supply/delivery they will need to provide phased delivery over three months. This will make it very difficult for practices to arrange specific clinics and they will need to triage patients based on levels of vulnerability, leaving many patients unprotected until later in the winter period; when normally they would be able to vaccinate all patients at the start. This clearly presents a very worrying risk to patient safety and could put NHS services under further pressure should there be an early influenza outbreak. In addition, this is also likely to be a widespread issue for pharmacies, who unlike general practices, may not be able to appropriately triage patients further impacting on practices and disadvantaging the most vulnerable groups of patients.
We hope that through your Committee’s inquiry NHS England will consider what it should do to mitigate these risks and in addition ensure that no practice suffers financially or workload-wise, at a time when general practice is already under unmitigated pressure.
7 March 2018
I am writing on behalf of the BMA’s Public Health Medicine Committee. We are concerned that the UK may miss an opportunity in the 2018-19 flu season to vaccinate older people with an effective vaccine. With GPs seeing a 78% increase in consultations for flu-like illness, in the first week of January, it is becoming even more pressing that we do all we can to prevent vulnerable older people from succumbing to the flu virus. We note the recommendation from the Joint Committee on Vaccination and Immunisation that adjuvanted influenza vaccine (aTIV) is effective and highly cost-effective in patients aged 65. In contrast, evidence shows that non-adjuvanted trivalent influenza vaccines (TIV) has little or no efficacy in this age group.
We believe that using non-adjuvanted vaccine for vaccinating patients aged 65+ next year will not be an effective use of resource; whereas the use of an effective vaccine will help reduce the burden of influenza next winter and may improve outcomes for older patients.
We recognise the support from NHS England, and the Chief Medical Officer for Wales, for the use of aTIV instead of TIV in patients aged 65+. However, we are concerned that many GP practices and other vaccination providers will already have made their preliminary vaccine orders without being aware of this recent recommendation, and, may not know that they should, if they can still do so, change their orders to ensure the most effective treatment is made available to patients.
We call upon NHS England to urgently recommend that all vaccination providers, where possible, who have not ordered aTIV for patients aged 65+ change their orders for the 2018-19 season.
18 January 2018