Last review date 01/09/2023

IMPORTANT: The eligibility as defined in the Green Book for seasonal influenza and COVID-19 vaccines is similar but not identical. This has resulted in differences between the underlying code-sets which are used in the Ardens reports for both. This means that whilst you may think some patients should be included in both the seasonal influenza and COVID-19 invitation reports, some patients might just be included in the seasonal influenza invitation reports but not the COVID-19 invitations reports, and vice versa. Some practices may be planning to give both vaccinations concurrently if clinically appropriate.


We are aware that some practices may be planning joint clinics , but the patient would still need separate Flu and COVID invitations, even if they are booked into a single joint clinic. The invitation wording for each vaccine could refer to the possibility of administering both but the individual patient’s eligibility and suitability for either / both vaccinations should be checked prior to vaccination.


Related articles:

Flu Season 2023/24

NHS England has recently changed the dates to bring forward Seasonal Influenza vaccination programme from October to September. This also includes Autumn COVID-19 vaccination in response to urgent BA2.86 risk. 

New dates are as follows:

  • 11th September - vaccination can start for care home residents and care home staff and those who are housebound, to ensure all residents are vaccinated before 22nd October 2023
  • 11th September - Covid-19 and flu vaccinations can commence for those eligible, starting with those who are most at risk, including those who are immunosuppressed
  • 18th September - Other eligible groups can be vaccinated

There is no change to flu vaccination for children, as previously communicated the date is :

  • 1st September - vaccination can start for 2-3 year olds, school age children and children in a clinical risk group

Many vaccination delivery sites have already started to fill scheduled clinics. The BMA has released some guidance that states practices should proceed with any flu clinics that have already been arranged and to continue contacting eligible patients to fill these scheduled clinics.

The eligibility for COVID-19 vaccination has been updated and now is more in line with seasonal flu eligibility.  

Ardens Seasonal Influenza resources have all now been updated in accordance with the latest guidance from the National Flu Immunisation Programme (Public Health England) and the Green Book Chapter 19.

Guidance on PHE immunisation training for the 2023/24 flu season and e-learning

The vaccines used are either egg-free or have a very low ovalbumin content so are considered safe to administer to all except those with severe anaphylaxis to egg which has previously required intensive care. Guidance relating to egg allergies can be found on page 19 of the Green Book.

Practices may under the 2023/24 Seasonal Influenza ES offer their frontline patient-facing staff an influenza vaccination. This forms part of employer occupational health responsibilities and can be provided either by the employing practice or under other arrangements, e.g. through an occupational health provider or influenza voucher scheme with a community pharmacy. Practices will not be eligible for reimbursement for the cost of these vaccines or IoS payment. The only exceptions to this are if the patient is in an at-risk group and is registered at the practice or is a GP Locum.

1. Patient Status Alert

This year we have multiple patient status alerts for seasonal influenza that will take you to the correct page of the vaccination template for your patient.

In previous flu seasons, TPP released a number of patient status alerts for seasonal influenza. having multiple flu alerts can cause confusion. Any alerts to the left of a black vertical line are TPP SystmWide alerts

Practices can decide which alerts are to be visible and go to 'Setup > Data Output > Patient Status Alerts' and remove the tick from the 'Enabled' column.

2. Template

If a patient is eligible for seasonal influenza vaccination, they will have an injection patient status alert icon under their name. Clicking this icon will take you to the vaccination template and to the age-specific page with the correct vaccine type for the patient. On the home page, you will be presented with views that will highlight the reason why the patient is eligible for the seasonal influenza vaccination, along with a view to show you their previous vaccination history including allergies and adverse reactions. 

Further information about how to record vaccinations can be found here.

3. Clinical Reports

All of the influenza reports can be found by going to 'Reporting > Clinical Reporting > Ardens > Vaccinations'.

3.1 Cohorts

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2023 24 | 3 Cohorts'. These are the cohorts as specified in the latest guidance. These are slightly different from last year as they no longer include those aged 50-64 years. We have cohorts for ages 6 months to less than <65 years for patients who are at risk, this excludes all 2 and 3 year-olds who are in a separate cohort.

Close contacts with immunocompromised patients are included this year again.  It isn't possible to report on households so please ensure you add 'Lives with immunocompromised person XaRG1' code to ensure eligibility and payment. This code is available on the vaccination template.

NB: There is often confusion over cohorts and eligibles. Cohorts list patients that match the criteria in each group but there may be reasons why a particular patient shouldn't be vaccinated or they have already been vaccinated. Therefore, your eligible lists will exclude these and will only show patients that are still 'outstanding'. 

3.2 Review before 

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2023 24 | 2 Review before'. It is recommended that practices review the patient lists created from these reports particularly before sending out flu invites. 


3.2.1 Adding PSDs

There are various reports for PSDs which can be found at  'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2023 24 | 2 Review before'. These reports identify patients who have been vaccinated in previous flu seasons.  

Once the report has been run, the patient's record can be opened and checked. The Doctor can then add the PSD by opening the 'Influenza Immunisation' template and clicking the pre-set next to the 'Electronic PSD' box. The appropriate PSD can then be selected and the record saved.  

For clinical safety reasons these reports only include patients who have previously had the vaccination and excludes patients with an influenza allergy or contraindication codes. 

GP mythbuster 19: Patient Group Directions (PGDs)/Patient Specific Directions (PSDs)

We have not published instructions to batch record PSDs as they are patient specific and every patient's record should be checked individually before adding the PSD. This is the only way to ensure that it is safe to administer the influenza vaccination to the patient/s and also providing clinical protection for your staff who will be administering the vaccines.

Most of the 'Review before' reports are self explanatory but these are worthy of particular note;


3.2.2 'Aged <18 + aspirin in last 6m = LAIV contraindicated so offer alternative'

"Because of the theoretical risk of Reye’s syndrome, children age 2 through 17 years on aspirin therapy should not be given LAIV. Instead, they should be vaccinated with the inactivated injectable influenza vaccine". Patients under the age of 18 who are on aspirin therapy are therefore contraindicated for LAIV and should be offered QIVe instead.  

3.2.3  'Check as influenza allergy/anaphylaxis (persistent) mark in error if necessary'

Review records of patients identified to check if the record is up to date and whether the allergy or contraindication is still relevant and if not mark it in error.

3.2.4 'Check if still care home patient / Check if still housebound (permanently)'

Care Home Residents and housebound patients are not included in the main invitation reports. These patients will still however have an alert icon under their name.

To make Care Home Residents appear in the correct reports, please ensure they have been coded with one of the read codes below:

  • Lives in a nursing home - CTV3 13F61 or SNOMED 160734000
  • Lives in a residential home - CTV3 XaImT or SNOMED 394923006
  • Lives in care home - CTV3 XaMFG or SNOMED 248171000000108

To find out how to do this, see here

To make a housebound patient appear in the correct reports, please use one of the codes on the 'Housebound' template:

  • Housebound - CTV3 13CA. or SNOMED 160689007
  • No longer housebound - CTV3 XaXCd or SNOMED 760661000000106

N.B. Add these codes at least 2 days before sending the invitations to ensure that they are included in the invite reports.

3.2.5 For review before ordering and invitations | Check if still pregnant and mark as delivery, abortive, miscarriage if indicated'

Review your list of pregnant patients to ensure that they are still eligible for invitation. Check for any delivery, abortive or miscarriage outcomes that have not been coded or identified by the report.

3.2.6 For review before ordering and invitations | Check medications between 01/09/2020-31/08/2022 Hospital / Other (breakdown by issues > medication type)'

This will include patients who have a drug in the SFIMTRTATRISKDRUG (SF immunosuppression drugs) cluster recorded between 1/9/2020 and 31/8/2022 and are not already eligible due to any other reason. 

Breakdown the report to include 'Medication type', 'Drug' and 'Issue end date' plus any other details required. Sort by the 'issue end date' column to see drugs recorded as Hospital/Other Medications without an end date. Review these patients and if appropriate consider adding these as Hospital/Other medications again or coding 'immunosuppressant drug therapy' (XaXUJ) to make them eligible. For more information on recording Hospital medication see here.

3.2.7 'For review before ordering and invitations | Consider adding 9OX4 after 1/09/2023 if vaccination indicated as coded in previous year + not in age or at risk group'

Patients who were coded with 9OX4 and vaccinated last year should be reviewed this year for a continued requirement for vaccination this year. If required, 9OX4 will need to be coded again this year after 1/09/2023 to ensure payment is claimed.

3.2.8 'For review before ordering and invitations | Immunosuppressant drug on repeat and not issued since 1/09/22 + not in another risk group'

This report will highlight patients who have an immunosuppressant drug on a current repeat which has either never been issued or has not been issued since 1/9/22 (and are not eligible already due to another reason). Review these patients and either -

  • Stop the repeat if not longer required
  • Issue the repeat if required
  • Add the code 'Immunosuppressant drug therapy (XaXUJ)' if the repeat has been recorded for a hospital issued medication that will not be issued by the practice 

3.2.9 'For review before ordering and invitations | Record mobile number as SMS consent but no mobile number recorded'

This report will identify patients who have been recorded with SMS consent but for some reason no longer have a mobile number recorded. Either contact the patient and obtain a mobile number or mark in error the SMS consent.

4. Ordering 

There are a set of reports for ordering which can be found at 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2023 24 | 1 Ordering'. These will give practices an indication of how many vaccines of each type should be considered for ordering.  

5. Eligible

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2023 24 | 4 Eligible'. Here you will find a useful breakdown of all of your eligible patients by age and risk group. These reports include patients who are in the underlying cohort but exclude any patient who has already had the vaccine or has another exception code (like vaccine declined). These are your work to do lists. 

6. Invitations

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2023 24| 5 Invitations | All / Groups' 

Here you will see reports for 1st, 2nd and 3rd invitations which identify patients who are eligible by age and vaccine type. Care/nursing home patients are excluded from the invitation reports. However, so that home visits can be planned, there are reports in 'Flu 2023 24 | 7 Visits' for care home residents and housebound patients. Please see this article about coding residential institutes.  

You can send invites by either SMS, email or post and they have been ordered so they can be:

  • Sent by SMS  - If have SMS consent
  • Sent by email - If they have email consent but no SMS consent
  • Sent by post   - If they have no SMS and no email consent

When you send out your 1st/2nd Invitations and apply one of the codes in the report name the patients will be moved on to the next invitation but won't be visible in the next report until 2 weeks after the previous invitation code was applied. This means that you cant send out the 2nd and 3rd invitations too soon and will be a minimum of 2 weeks apart. 

Some practices will now be using the new 'Communications Annexe' in SystmOne 

N.B. The reports are set up so that the preference is always to send the invite by SMS if possible. When you send out your 1st Invitation and code with one of the codes in the report name the patients will be moved on to the 2nd invitation but won't be visible in the reports until 2 weeks after the 1st Invitation code was applied. 

We understand that every practice runs flu clinics very differently and requires very personalised letters. As in previous years, we have therefore not created an invitation letter for Influenza Vaccinations. Practices can create local versions of letters and use these from the reports. There are pneumococcal and shingles reports too, but rather than sending separate invites, you may wish to just say something on your Flu invites like ‘If you are eligible for the pneumococcal / shingles vaccine, we’ll offer this at the same time’.

7. Patient Appointment Invitations - Online

It has always been possible to allow patients to book appointments online using SystmOnline but TPP have developed some very good functionality which can be used for Flu Clinics. This video is a very good explanation from eGPlearning of a GP talking through how he has set this up in his practice.  
Easier appointment booking with SystmOne - YouTube

8. Barcode NHS numbers

It is possible to add a barcode NHS number merge field to letters in SystmOne.  The merge field can be found under 'Patient Demographics'. 


There are a number of options when you add this merge field, each option is for different character sets. You can use any of the '128.' options. 

9. Review after

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2023 24 | 8 Reviews after'

Here you will find a number of data quality reports that will help you identify data entry issues and potentially increase payment eligibility. Most are self-explanatory but a further explanation for others is below;

9.1 'For Review After Clinics | Consider backdating 'Needs influenza immunisation 9OX4'  as vaccination given 1/9/23 -31/3/24 but not in at risk group'

These patients may have been requested to be vaccinated by a clinician but not normally eligible so by reviewing and recording 9OX4 ensures that payments can be claimed and these patients will be flagged next year. 

9.2 'For Review After Clinics | Consider recording one vaccination in error as duplicate vaccination recorded'

Each year you will find a number of patients who are recorded as having received multiple vaccinations.  These should be reviewed and, unless the patient qualifies for more than one vaccination, multiple vaccinations should be marked in error.

9.3 'For Review After Clinics | Consider recording vaccination contents given as influenza vaccination given 1/9/23 -31/3/24 but recorded as read code'

Occasionally vaccinations are not recorded correctly as a vaccination but instead only as a read code. Staff should be encouraged to record vaccinations correctly in the vaccination node. Review records of patients identified and add a backdated entry as a vaccination and to avoid any possible confusion with duplication mark in error the read coded entry. 

Further information about how to record vaccinations can be found here.

10. Activity

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2023 24 | 9  Activity'

These reports will display all of your activity over the flu season. Further activity reports will also be available under Clinical Reporting > Ardens > Contracts | 2023 24 | CQRS for payment purposes.

11. FP34D Claims 

Flu PPA claims are normally achieved by running the FP34PD Vaccination Report built into SystmOne. This can be accessed from ‘Reporting > Miscellaneous Reporting > FP34PD Vaccination Report’

If you right-click anywhere on the list you can select ‘Table > Open as CSV’ which will put the data into an excel spreadsheet for you.