Flu Season 2024/25

The NHS England guidance for 2024/25 outlines the following dates for this year's flu season:

From 1st September the below cohorts only are to be offered a flu vaccine:

pregnant women
all children aged 2 or 3 years on 31 August 2024
primary school aged children (reception to year 6)
secondary school aged children (year 7 to year 11)
all children in clinical risk groups aged from 6 months to less than 18 years.

From October 2024 (3rd October onwards - Primary Care Bulletin - 13 June 2024 (issue 294)) the below cohorts are to be offered a flu vaccine:

aged 65 years and over
aged 18 years to 64 years in a clinical risk group (defined by the Green Book).
patients in long-stay residential care homes
carers in receipt of carer's allowance, or those who are the main carer of an elderly or disabled person
close contacts of immunocompromised individuals
frontline workers - defined as those in a social care setting without an employer led occupational health scheme, including those working for a registered residential care or nursing home. registered domiciliary care providers, voluntary managed hospice providers and those that are employed by those who receive direct payments direct payments (personal budgets) or Personal Health budgets, such as Personal Assistants.

The vaccinations available for 2024/25 have also had some alterations. The QIV-r vaccination is no longer available and has been replaced by the QIV-HD Vaccine which is licensed to those over 60.

Vaccines that are given for each age range are as follows:

06m to 01y at risk - QIVc (or QIVe)
02y to 03y (on 31/08/24) - LAIV (or QIVc/QIVe)
02y to 17y at risk - LAIV (or QIVc/QIVe)
18y to 59y at risk - QIVc (or QIVe)
60y to 64y at risk - QIVc/QIV-HD (or QIVe)
>=65y (on 31/03/25) - aQIV/QIV-HD (or QIVc)

Ardens have updated the suite of flu vaccination resources for this year to reflect the above changes in guidance. For explanation of reports available see section 3.

Important - Practices may find their eligible patients are slightly different compared to previous flu seasons as historically we built the flu cohorts using the code groups listed in the business rules. After discussing with NHS England leads it was confirmed that these code groups should only be used for payment purposes and not for recall/invite reports as they are known to be both over and under inclusive compared to the Green Book criteria.

All Ardens flu reports for 2024/25 have now been built in line with the Green Book criteria by basing the codes included on the codes used in the department of health/Immform flu return reports (which are built to the Green Book criteria). This means you may have patients showing as eligible this season who didn't in previous years or patients who previously showed as eligible but don't this year.

Using the review before and after reports (explained further below) will help to highlight patients in these scenarios who can then be reviewed and be added to the correct cohorts as appropriate. As always clinical judgment should be taken into account to decide if a patient is eligible for a flu vaccine.

Green Book extract - 'The list above is not exhaustive, and the medical practitioner should apply clinical judgment to take into account the risk of influenza exacerbating any underlying disease that a patient may have, as well as the risk of serious illness from influenza itself. Influenza vaccine should be offered in such cases even if the individual is not in the clinical risk groups specified above'.

1. Patient Status Alert

The green syringe icon is the Patient Status Alert for seasonal influenza that will take you to seasonal influenza 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 but for clarity any alerts to the left of a black vertical line are TPP System-Wide alerts

Practices can decide which alerts are visible at their practice by going to 'Setup>Data Output>Patient Status Alerts>Availability>System Wide' 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 as described above. Clicking the patient status alert in the patient's demographic box will take you to the template.

On the home page, you will be presented with summaries highlighting 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.

You can then select the required page for the patient you are vaccinating depending on their age and eligibility reason.

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

Note - you do NOT need to add a code in SystmOne to record that a vaccination has been given. Adding the vaccine through the red syringe option is all that is required for correct recording.

3. Clinical Reports

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

3.1 Ordering and clinic planning

There are a set of reports for ordering and planning clinics which can be found in 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25 | 01 Ordering and clinic planning'. These will give practices a indication of how many of each vaccines are required. The eligible figures will give you the number of patient's you have left to vaccinate if your practice need to do a top-up order during the season.

3.2 Review Before and PSDs

3.2.1 Adding PSDs

There are various reports for adding PSDs to individual patient records ahead of clinics found in 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25 | 02 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. A prescriber can then add the PSD by opening the 'Seasonal Influenza Vaccination' template and clicking the pre-set next to the 'Electronic PSD authorisation' field. The appropriate PSD can then be selected and the record saved. The clinician administering the vaccine will be able to clearly see the PSD authorisation on the template.

NOTE - For clinical safety reasons these reports only include patients who have previously had a seasonal influenza vaccination and excludes patients with an influenza allergy or contraindication recorded.
GP mythbuster 19: Patient Group Directions (PGDs)/Patient Specific Directions (PSDs)

PSDs should not be recorded in batch 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.

3.2.2 Review Before

These reports can be found in 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25 | 02 Review before'. These reports are crucial to review before sending invites as they will help your practice ensure the cohort groups are as accurate as possible ahead of inviting patients.

Only patients not already eligible for a flu vaccination will be returned in any of the reports but could be found in multiply review before reports.

Most of the 'Review before' reports are self-explanatory but below are a few to highlight. Note - any changes to patients' records as a result of these reports (eg: adding a code to a patient's record) should be done at least 2 days before planning to send invites to ensure the invite reports are updated.

'?Needs alternative vaccine as <18 + aspirin issued in last 6m (LAIV contraindicated)'

"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.

'Check if still influenza contraindicated (persistent)'

Review records of patients identified to check if the record is up to date and whether the allergy or contraindication is accurate. If not and you would like the patient to be included in the invite reports you will need to mark the allergy or contraindication in error.

'Check if still a care home resident' / 'Check if still housebound'

Care Home Residents and housebound patients are not included in the main invitation reports and have their own visit reports instead.

Check the patients to ensure their current residence status is accurate and make any updates as required to endure they are placed in the correct invite/visit reports.

'Check if still pregnant'

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

'?Record immunosuppressed as immunosuppression medication between 01/09/2021-31/08/2023 (breakdown by issues > medication type to view Hospital / Other medications)'

This will include patients who have a drug in the GP Flu immform )Immunosuppression medication codes) cluster recorded between 1/9/2021 and 31/8/2023 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 'Patient immunosuppressed (370391006)' to make them eligible. For more information on recording Hospital medication see here.

'?Record needs influenza vaccination as coded last season'

Patients who were coded with 9OX4 last flu season who should be reviewed to see if they need the vaccination this year. If required, 9OX4 will need to be coded again this year after 1/09/2024 to ensure they are picked up for invites and included in payment reports.

'?Record needs influenza vaccination as vaccinated last season'

Patients who were vaccinated last flu season who should be reviewed to see if they need the vaccination this year. If required, 9OX4 will need to be coded again this year after 1/09/2024 to ensure they are picked up for invites and included in payment reports (any patients in the report above are excluded from this report by default).

This report will potentially include patients who had the vaccination privately last season and so may not be eligible for the vaccination under the enhanced service therefore all records should be check individually for eligibility.

'?Invite household contacts as patient immunosuppressed'

It isn't possible to report on 'households' in SystmOne so this report can be used to highlight all immunosuppressed patients. Please ensure you add 'Lives with immunocompromised person XaRG1' to appropriate household contacts of your immunosuppressed patients so they are added to the appropriate cohort (This code is available on the vaccination template).

3.3 Cohorts

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25 | 03 Cohorts'.

Important - Practices may find these figures are slightly different compared to previous flu seasons as historically we built the flu cohorts using the code groups listed in the business rules. After discussing with NHS England leads it was confirmed that these code groups should only be used for payment purposes and not for recall/invite reports as they are known to be both over and under inclusive compared to the Green Book criteria.

These cohorts have now been built in line with the Green Book criteria by basing the codes included on the codes used in the department of health/Immform flu return reports (which are built to the Green Book criteria). This means you may have patients showing as eligible this season who didn't in previous years or patients who previously showed as eligible but don't this year.

Using the review before reports above will help to highlight patients in these scenarios who can then be reviewed and adding to the correct cohorts as appropriate. As always clinical judgment should be taken into account to decide if a patient is eligible for a flu vaccine.

Note - These reports should not be used for inviting patients as patients can appear in multiple cohorts and therefore could be invited multiple times and will not be removed after adding any invite codes.

There are some additional cohort reports in 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25 | 03 Cohorts | Other'. These are groups that link to NCD management indicators or low uptake groups and are for information only.

Note - There is often confusion over 'cohort' and 'eligible' reports. Cohorts list patients that match the criteria in each group and are effectively your 100% population for each group (These numbers will therefore not change much throughout the season). The Eligible reports list patients who are still 'outstanding' as they exclude all patients who have been vaccinated, declined or should not be vaccinated as they are contraindicated (these numbers will therefore reduce as the flu seasons progresses).

3.4 Eligible

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25 | 04 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 reports but exclude any patients who have already had the vaccine or has another exception code (like vaccine declined or contraindicated).

Further eligible reports are found in 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25 | 04 Eligible' - these correspond to the groups found in the 'Cohort | Other' folder.

3.5 Invitations

This year, we have split the invite groups into five separate folders - 'Sep clinics', 'Oct clinics', 'Consider Method', 'Visits, and '2nd dose'. This is to assist with both inviting patients at the appropriate time and also in using the appropriate method for the patient.

Note - Only invites sent/coded on or after 1st August 2024 will be counted by the reports.

3.5.1 September Clinics

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25| 05 Invites | Sep clinics | All'

These reports give you a list of all patients eligible to have their vaccine in September (under 18 years old or pregnant), broken into 1st/2nd/3rd invites. These lists are further broken down in the 05 Invites | Sep clinics | Groups folder by the different vaccine types required.

Either folder can be used depending on how you decide to manage your flu clinics.

The codes to use to record a patient has had their invite should be the following -

Ya161 - 1st SMS

Y3f86 - 2nd SMS

Ya16m - 3rd SMS

XaZZb - 1st Email

XaZZc - 2nd Email

XaZZd - 3rd Email

XaLHL - 1st Letter

XaLHM - 2nd letter

XaLHN - 3rd letter

We have not included these in the report names as those under 18y may have different contact method requirements due to their ages.

NOTE - Any patient's who will turn 18 years old in September have been excluded from these invite reports as the time margins are slim and you may end up vaccinating an 18 yr old too early and therefore not get paid for the vaccination. If you want to identify who these patients are, there is a report at the top to show all current 17yr olds who have their 18th birthday in September.

Patients that turn 18 in September are included in the October invites instead.

3.5.2 October Clinics

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25| 06 Invites | Oct clinics | All'

These reports give you a list of all patients eligible to have their vaccine on/after 3rd October broken down into broken into 1st/2nd/3rd invites.

Note - As mentioned above these reports include those patients who are currently 17 but turn 18 in october so will therefore be 18 by 3rd October. They also include pregnant patients.

These lists are further broken down in the 06 Invites | Oct clinics | Groups folder by required vaccine and age group.

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

Sent by SMS - If have implied/expressed 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 recorded. This ensures you don't send 2nd and 3rd invitations too soon and will be a minimum of 2 weeks apart.

Note - There is a review after report to highlight any patients that have had 3 invites recorded and still havent been vaccinated (or declined/contraindicated) which can be used to send further invites if wanted.

Some practices will now be using the new 'Communications Annexe' in SystmOne - this can also be set to add a relevant code once a particular invite is sent.

Online invitations and appointments are also used by practices perhaps through SystmOnline. TPP have developed some booking link functionality that can be particularly useful for high-volume clinics like Flu Season. The guide for this process and the set-up required can also be found within SystmOne. Navigate to Help>Support and FAQs>Documents & Training Guides (top left corner)>Appointment Invitations. This video is also a good explanation from eGPlearning of a GP talking through how they set this up at their practice - Easier appointment booking with SystmOne - YouTube.

3.5.3 Consider Method

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25| 07 Invites | Consider Method | All'

We have approached certain groups of patients slightly different this year so that practices can manage these patients individually and decide how they should be invited as appropriate to their personal requirements. This includes patients with Learning Disability, Severe Mental Health, Dementia, Palliative care and patients with a Reasonable Adjustment recorded.

Important - Patients in any of these groups are excluded from the main Sep and Oct clinic invite reports so it is important you run these reports so that these patients are not missed.

To view which of these groups the patient falls into, or what code has added them to the Reasonable Adjustment list, there is a report output that can be used.

Run the required consider invite method report and then right-click>show patients.

Use the 'Select Output' option above patient list to select 'Pre-defined report output' and then select the report output called 'Consider Invite Method - LD/SMI/Dementia/EOL/RA'.

This will then allow staff to work through the list individually and decide how best to contact and/or approach each patient about their flu vaccine. There may be some patients you wish to contact in bulk from this list, and this can be actioned as normal.

3.5.4 Visits

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25| 08 Visits'

Care home residents and housebound patients are excluded from all the invitation reports outlined above. The reports in the 'Visits' folder give you visit lists which can used to help planning these vaccinations.

3.5.5 2nd dose Invites

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25| 09 Invites | 2nd dose'

This report will show children who may require a 2nd dose of influenza as they have had their first dose, are 6m to under 9 years old, are in a risk group and haven't previously been vaccinated before this season.

3.6 Review after

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25 | 10 Review after'

Here you will find a number of data quality reports that will help you identify potential data entry issues and potentially increase payment eligibility.

3.7 Activity

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2024 25 | 11 Activity | All' and 'By Cohort'

The 'All' folder will display all of your activity over the flu season broken down by various administration details (eg: Vaccinations recorded as 'PCN administration) and also by those 'done here' or 'done elsewhere'. These reports include patients who are now deceased or deducted to give you a full activity count for the season.

The 'By cohort' folder will display the number of patients who have been vaccinated this season and are currently in a cohort group. Therefore these reports only include current active patients but can be used to highlight how many vaccines have been given to your current cohorts (The eligible reports can be used to see those who are still outstanding).

Note - The percentage shown in the percentage column in the 'By Cohort' folder has been set so you can quickly and easily see the percentage of each cohort who have been vaccinated.

Further activity reports will also be available under Clinical Reporting > Ardens > Contracts | 2024 25 | CQRS for verifying claims. These should not be used for manual claims evidence as explained in this disclaimer.

There are also some monthly activity Vaccinations and Imms counts in Clinical Reporting > Ardens > Vaccination and Imms Activity. These are useful for looking at stock usage for various vaccine types.

4. 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.

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