With more patients fulfilling the government's eligibility criteria for flu vaccination this year, practices will be making sure they have enough resources and qualified staff to expand their programmes. Given the increased numbers of patients to be vaccinated and the need to take extra precautions to prevent transmission of coronavirus, it's more important than ever to consider the medico-legal risks involved.
Practices will need to consider the most efficient use of staff resources when running flu vaccination clinics, while ensuring they comply with rules on prescribing. The government is also looking to expand the scope of the available healthcare workers who can administer flu vaccines. Previous MDU advice has also looked at how to manage risks when running a flu vaccination clinic offsite.
Legal framework for administering vaccinations
HCAs can administer flu vaccines, provided robust protocols are in place which follow the legal framework for administration. As we explain below, it's necessary to confirm that an assessment of the patient has taken place by the prescriber and that the patient's individual suitability to receive the vaccine has been assessed.
Flu vaccinations are usually prescribed using a patient group direction (PGD). This allows licensed medicines to be supplied or administered by a named health professional to a group of patients who meet the criteria defined in the PGD.
The health professional is responsible for selecting appropriate patients and for obtaining the consent or parental authority. The Medicines and Healthcare Products Regulatory Agency (MHRA) has published guidance on the use of PGDs. Public Health England has also produced PGD templates to support national immunisation programmes.
Assessing patient suitability
Healthcare Assistants (HCAs) are able to administer vaccinations to a named patient or several names patients but can only do so following instruction and assessment from a GP or independent nurse prescriber using a patient specific direction (PSD). As part of the PSD there needs to be evidence to confirm that the patient was considered on an individual basis.
It's important to make a note in the clinical record of the prescriber's written or electronic instruction to the person administering the vaccine. A verbal instruction or letter of invitation to the patient cannot replace this.
Guidance from CQC and NHSE also makes clear that a PSD can be an instruction to administer a medicine to a list of patients, however, each patient on the list must be individually assessed by the prescriber. In order to do this, the prescriber must have knowledge of the patient's health and be satisfied the medicine meets the individual needs of each patient on that list. Where a HCA is running a flu immunisation clinic, the prescriber must review the patients attending the clinic and sign a list of those who they authorise to be immunised.
GP members can come to the MDU for advice and support with complaints, disciplinary investigations, adverse incidents or other issues relating to HCA vaccinations.
If a claim arises in NHS practices in England and Wales, then these are covered by the state indemnity scheme. In Northern Ireland and Scotland, the MDU can provide GP members whose HCA staff administer vaccines with indemnity, provided certain safeguards are in place and that our membership department is informed.
It's worth noting that the state indemnity scheme excludes practices vaccinating their own staff. However, providing immunisations to practice staff is included within the benefits of MDU membership for GP members at no additional charge. It is important that all GP partners have their own indemnity in place in respect of their potential vicarious liability for such services.
Subject to the right safeguards, practices can ensure the efficient running of the flu vaccination programme by involving trained staff, such as healthcare assistants.
A version of this article first appeared on GP online.
This page was correct at publication on 10/09/2020. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.