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Flu Season 2022/23

The 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 2022/23 flu season and e-learning


The vaccines used this year are either egg-free or have a very low ovalbumin content of <0.12 micrograms/ml 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.


1. 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 to the age-specific page with the correct vaccine type for the patient. On the home page, you will be presented with three 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.





2. Patient Status Alert

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


There has been some discussion around the icons we use for vaccinations and how it has become confusing with multiple identical icons. TPP has released a number of patient status alerts for seasonal influenza. 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. 


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 2022 23 | 3 Cohorts'. These are the cohorts as specified in the latest guidance. These are slightly different from previous years. Once again they include those aged 50-64 years and this year. 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.
 

An extension to the school programme has been agreed to include children aged between 4 to not yet 15 years of age. 


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 are your lists of patients that match the criteria in each group but there may be reasons why a particular patient shouldn't be vaccinated. Therefore your eligible lists will exclude these and are your 'Work to Do' lists. 

The service specification states that 50 to 64 year olds should not be offered vaccination before 15th October 2022



3.2 Review before 

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2022 23 | 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 2022 23 | 2 Review before'. These reports identify patients who have been vaccinated in previous flu seasons.  

mythbuster

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.  


N.B.
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 potentially end it or mark 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 in last year Hospital / Other (breakdown by issues > medication type)'

This can be quite a large list of patients but potentially patients who have been prescribed a medication that makes them eligible for a seasonal influenza vaccination. These will be medications recorded as hospital/other which we are unable to directly report on. For more info on this see here.


3.2.7 'For review before ordering and invitations | Consider adding 9OX4 after 1/09/2022 if vaccination indicated as carer + not in another risk group'

If carers are not in another risk group, in previous years these are not included in the CQRS payment reports. We recommend coding them with '9OX4 Needs Influenza Immunisation' otherwise they may not be identified by the payment reports and you will miss out on potential income. This may be different for this year but until the business rules and TPP reports have been released, we can't be certain. For more info about coding carers see this here.


3.2.8 'For review before ordering and invitations | Consider adding 9OX4 after 1/09/2022 if vaccination indicated as Cerebral Palsy + not in another risk group

In previous years certain codes were omitted from the TPP code clusters including codes for Cerebral Palsy. This may be different for this year, but until the business rules and TPP reports have been released, we can't be certain.  These patients should be reviewed and code 9OX4 to ensure they are eligible. 


3.2.9 'For review before ordering and invitations |  Consider adding 9OX4 after 1/09/2022 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 1/09/2022 to ensure payment is claimed.  


3.2.10 'For review before ordering and invitations | Consider adding 9OX4 after 1/09/2022 if vaccination indicated as Multiple Sclerosis + not in another risk group'

In previous years certain codes were omitted from the SF code clusters including codes for Multiple Sclerosis. This may be different for this year but until the business rules and TPP reports have been released, we can't be certain. These patients should be reviewed and code 9OX4 to ensure they are eligible.


3.2.11 'For review before ordering and invitations |  Consider recording splenic disorder if appropriate as infectious mononucleosis'

Infectious mononucleosis (glandular fever) is part of the national immunosuppression cluster as they can have splenic complications. To avoid inviting these patients inappropriately, these patients will only appear in the reports if they have a splenic disorder code recorded.


3.2.14 '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 2022 23 | 1 Ordering'. These will give practices an indication of how many vaccines of each type should be considered for ordering.  


There are two reports for ordering which look at the uptake from 20/21 and 21/22 for 50 to 65 year olds, not at risk.  These may help with deciding on order levels for this age group. 


5. Eligible

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2022 23 | 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 2022 23| 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 2022 23 | 5c 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 recently for COVID which can equally 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 2022 23 | 6 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 1/9/22 -31/3/23 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 reason why patient went elsewhere as influenza vaccination given elsewhere 1/9/22-31/3/23 (event details)' & 'Consider reason why patient went elsewhere as influenza vaccination given elsewhere 1/9/22-31/3/23 (read code)'

Review these patients and consider reasons why they went elsewhere. If the trend continues it could have a big impact on practice income.  


9.3  'For Review After Clinics | Consider recording as no response to invitation 'XaQxM' as 2nd invite sent >2w ago & Consider recording as no response to invitation 'XaQxM' as 3rd invite sent >2w ago'

For QOF it is only a requirement to invite on two occasions but still good practice to send a third invite. These patients should be reviewed and recorded as a refusal / informed dissent.    


9.4 '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.


9.5 'For Review After Clinics | Consider recording vaccination contents given as influenza vaccination given 1/9/22 -31/3/23 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.


9.6 Non QOF codes 

Consider recording vaccination contents given as non-QOF code used 1/9/22-31/3/23

Consider recording vaccination declined 'XaZ0i' as non-QOF code used 1/9/22-31/3/23 

Consider recording vaccination declined 'XaZ0i' as not recognised by ImmsForm 1/9/22-31/3/23 

Review the records and correct coding to ensure patients are removed from reports and don't affect payments. 



10. Activity

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Flu 2022 23 | 7  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 | 2022 23 | CQRS for payment purposes.




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