• NHS England moves to try to clear up confusion over flu vaccines for next winter
  • Follows concerns that different advice last year could have helped avoid hospital pressures

NHS England has moved to try to clear up confusion over flu vaccines for next winter, following concerns that a better approach last year could have reduced pressure in hospitals.

The national commissioner yesterday wrote to GPs, pharmacies and clinical commissioning groups, telling them to order two specific types of vaccine for next year: for over 65s, adjuvanted trivalent vaccines; and for “at risk” adults under-65, the quadrivalent vaccine.

HSJ recently revealed that last year – when GPs were ordering vaccines for winter 2017-18 – they were advised by NHS England regional and local teams, and by CCGs, not to order the quadrivalent vaccine because of questions about its “cost effectiveness”.

A senior clinician has told HSJ this may have increased flu prevalence and hospital admissions. Flu admissions have been the highest this winter for several years, and are said to have substantially increased pressure in hospitals during December and January.

NHS England wrote to GPs in December highlighting Public Health England guidance which said quadrivalent vaccines were more cost effective for “at risk” adults, and adjuvanted trivalent vaccines were “highly cost effective” and more effective for over 65s.

However, many GPs and pharmacists have already been ordering vaccines for next winter, and HSJ has been told that despite the December advice, some CCGs had still been advising they would not pay for quadrivalent orders.

A spokesman from Sanofi Pasteur, the vaccines division of the major pharmaceutical firm, told HSJ: “So far, it has been the decision of some local policymakers not to reimburse quadrivalent vaccines.”

The British Medical Association last month called for NHS England to provide clearer guidance.

The two letters sent yesterday’s were apparently aimed at clearing up this confusion. One of the two letters is from from NHS England’s medical director and primary care director, one of them is also from Public Health England’s medical director Paul Cosford.

Both letters say: “NHS England is able to confirm that there will be additional funding available in 2018-19, to support the use of adjuvanted trivalent vaccines and quadrivalent influenza vaccine and that suppliers advise they will be able to meet demand. Orders need to be placed by 29 March.”

For GPs who have already placed orders for next year NHS England’s letter states: “If, after review, orders need to be switched to alternative vaccines, we are asking that this is done promptly, meeting the deadlines for ordering.

“If you encounter any difficulties with an individual manufacturer in changing your order to reflect the clinical evidence base, please advise your NHS England local team.

“Where despite this advice, a practice/ pharmacy seeks reimbursement for vaccine other than adjuvanted tri-valent and/or [the quadrivalent vaccine] NHS England may make enquiries to understand how the evidence of clinical efficacy of [both vaccines] was taken into account by that practice when deciding to order other vaccines, and how the clinical judgement to use those vaccines was reached.”

BMA public health medicine committee chair Peter English said: “The BMA is glad that NHS England has listened to concerns we first raised weeks ago and issued new guidance, which will hopefully ensure vulnerable patients receive the most effective flu vaccine for their age group. Influenza is a potentially serious illness and we want to do all we can to protect our patients.

“It is important now for NHS England to ensure that no practice is penalised by suppliers for amending their orders that were made in good faith.”

The Sanofi spokesman continued: “As local NHS decision makers are already preparing for the next season, we hope the letter published by the NHS on 5 February is providing the clarity that healthcare professionals were requesting to have a clear guidance towards the solutions available for each categories of the population.”

Pfizer issued a statement saying it had not been consulted by NHS England and had been ”processing orders from GPs and pharmacists for the seasonal flu vaccine for the 2018-19 influenza season since October 2017 and have manufacturing plans and contracts in place”. It said: “However, given this new NHS England guidance we will honour any changes and cancellations to the orders already placed with us.”

NHS England director of primary care Arvind Madan said: “Flu can have serious health implications, particularly for the most vulnerable people, as well as having a significant impact on NHS services.

“The evidence is clear so the NHS is going further to advise gold standard protection is provided. Importantly, the public in eligible groups, can also play their part by getting their free vaccination again next year.”