Leela Barham looks at how to make the most of the flu vaccination service in community pharmacies in England

Flu season has just started, and flu vaccinations are due to be given to most eligible people in October. Community pharmacies can play their part in the public health push alongside GP practices, but how can they make the most of the business opportunity of flu vaccination? 

According to a host of studies, flu vaccination is a cost-effective intervention, so it’s a good use of NHS resources.  Community pharmacies in England delivered almost over 3.5 million flu vaccinations in 2023/24.  

CPE says that accessibility, extended opening times and the option to walk in for flu vaccination have proved popular with people. However, getting a flu vaccination at a community pharmacy is not as popular as it has been in the past. In 2021/22 community pharmacies delivered just over 4.7 million flu vaccinations. COVID-19 might have increased take-up in the past, but perhaps any effect has waned. 

Business opportunity

On the face of it, community pharmacies should be able to make the most of flu vaccination given that they “touch base face-to-face with so many people in the pharmacy”, according to Harry McQuillan, chairman at Numark UK. Many of these are the very same people who are eligible for vaccination, such as pregnant women, those over 65 and those with ongoing health conditions. 

Yet any business needs to be thinking about the marginal cost and the marginal revenue and that looks to be fragile. 

“We’re getting to the point now where given the risks to providing the service, it may not be viable,” explains Mike Hewitson, superintendent pharmacist and MD of Beaminster Pharmacy.

But contractors have to make it work. “Contractors can’t afford not to be making the most of flu vaccination and other services as the traditional dispensing model is increasingly squeezed,” argues McQuillan.

Planning for efficiency 

Efficiency is the watchword. Hewitson says: “With the cost of a pharmacist being £1 a minute, if more than 10 minutes is spent delivering the flu vaccination, then you lose money.”

Achieving that under 10-minute delivery is possible though. “Have a clear plan,” maintains Hewitson. 

That plan needs to include working through the best way for booking slots and doing the homework beforehand. “If you book through the national booking system you can have a clinic list for the day, you can cut and paste NHS numbers into the clinical system, you can avoid having that work to input information,” Hewitson points out. 

McQuillan highlights how contractors can use the face-to-face opportunities that present themselves to “remind people to pop in for their flu vaccination”.

Running clinics focused on specific groups helps too. “Have separate clinics for the over 65s and the under 65s. That avoids the need to change vaccines and just helps the work to flow smoothly,” advises Hewitson. Managing front of house also needs planning. “Clear signage and communication from the front of house team is needed, letting people know how they can help us to run on time,” he believes.

The October starting date is a challenge. “It’s the first time in years that we’ve taken delivery of the vaccine but have to wait for three weeks until we can vaccinate most people,” says Hewitson. “There is a risk that by compressing vaccination, people might be concerned and that means we will face more pressure than in the past,” he adds. Over 1.1 million people got their flu vaccination from a community pharmacy in September 2023 according to Pharmdata. 

Minimise waste 

There is a risk of holding excess stock of flu vaccines. “Some contractors have had their fingers burned in the past. There is a risk in ordering and holding the stock of waste. Wastage can make a massive difference to whether it’s profitable,” Hewitson points out.

McQuillan also raises the issue of wastage: “Contractors buy at risk and it’s something that can drive behaviours. If they were left with a lot in the past, then they are wary about it happening again in the future.”

Staffing model 

Thinking about the staffing model to deliver flu vaccination is a business opportunity according to McQuillan. “We’ve been encouraging contractors to look at how they can grab the opportunity of flu vaccination and that’s through recognising that vaccination is a technical skill. Vaccination can be delivered by a pharmacy technician with the appropriate training,” he maintains.

Yet the opportunity to use pharmacy technicians to deliver flu vaccinations is not set out in the National Health Service England (NHSE) service specification. Instead, the role gets a direct mention only in the Patient Group Directions (PGD). 

“I don’t think it’s helpful how NHSE have done it,” says Hewitson. “Businesses don’t like uncertainty.” 

McQuillan concurs: “Pharmacy and pharmacists are typically conservative with a small ‘c’, so some might want to stay on the safe side and not have their pharmacy technicians vaccinate – particularly where there is dubiety in the English service specification.”

Successful flu season? 

A successful flu season for community pharmacy would be if “people see community pharmacy as the number one place to receive the vaccine,” according to McQuillan. That would, in turn, likely help to minimise waste and could make a material difference to the bottom line. That’s a tempting vision but only time will tell if 2024/25 will be that season.