Protecting patient safety when managing high demand for flu vaccinations and other services

Pharmacy professionals and pharmacy teams have had to manage very high demand for services from patients and the public during the COVID-19 pandemic. We greatly appreciate their hard work to provide quality care in very challenging circumstances.

October 2020

As we head towards winter, and at a time when we are seeing increased numbers of cases of COVID-19 across Great Britain, we expect pharmacy teams may again face very high workloads.

We know that many pharmacists in community pharmacies are already facing very high demand for flu vaccinations. We recognise the huge importance of this work, which will make a major difference to people’s health and well-being this winter. We are very grateful to the pharmacists and pharmacy owners involved, who are already delivering a much higher number of vaccinations than in previous years. We also understand the extra challenges that pharmacists are facing this winter in delivering flu vaccinations, because of the necessary steps they are having to take to reduce the risk of transmission of COVID-19.

Some concerns have been raised with us that pharmacy professionals are sometimes being put under pressure to carry out more flu vaccinations than they believe can be administered safely, while also safely delivering the other services provided by that pharmacy. 

We recognise that in challenging circumstances, pharmacy professionals may need to use their own professional judgement in a particular situation to depart from established procedures in order to care for patients and people using health and social care services. We do, however, expect pharmacy owners and pharmacy professionals to continue to meet our standards and guidance at all times. This will help make sure that all pharmacy services are provided to patients and the public safely and effectively.

Our standards and guidance

The standards for registered pharmacies set out the requirements for the provision of pharmacy services at or from a registered pharmacy.

These include making sure there are enough staff, suitably qualified and skilled, for the safe and effective provision of the pharmacy services provided. Pharmacy professionals must also be empowered to exercise their professional judgement in the interests of patients and the public.

Our guidance to ensure a safe and effective pharmacy team sets out what the pharmacy owner should do to provide safe and effective care and pharmacy services and meet our standards. The guidance sets out how pharmacy owners should set staffing levels with the responsible pharmacist, after carrying out risk assessments, and should respond to any concerns about patient safety raised by staff or others. This includes having systems, evidence and records to show the steps taken to deal with any concerns raised, so patient safety is not compromised.

The guidance explains that pharmacy owners should review staffing levels and the skill mix needed to deliver safe and effective care. Owners need to develop, working with the responsible pharmacist, a staffing plan which takes account of how they manage risks and the individual context of the pharmacy, including the range of services being provided at that time, such as flu vaccinations. Each registered pharmacy should also have a contingency plan for short- and long-term staff absence, whether planned or unplanned.

We recognise many pharmacy professionals may feel apprehension about providing the flu vaccination service this year, particularly if they may be at higher risk in relation to COVID-19 infection, such as people from BAME backgrounds and/or with long-term conditions. Pharmacy professionals should have open and honest conversations with the pharmacy owner about anything which could affect their ability to safely provide the full range of services that the pharmacy provides.

Pharmacy owners and employers should also have already carried out appropriate risk assessments to identify higher risk and vulnerable people within their team.

It is very important that pharmacy professionals are able to raise any personal concerns about the type of work they are undertaking, linked to any particular risk factors or vulnerability to infection, and that employers respond appropriately to these concerns.

Our guidance for pharmacy professionals on raising concerns will support any pharmacy professional who wants to raise concerns.

Carrying out flu vaccinations in locations outside the pharmacy

Flu vaccinations will usually be carried out on the pharmacy premises, but the service specifications for England and Wales this year says they can also be undertaken in other suitable locations. These may include the patient’s home, a long-stay care home, a long-stay residential facility or community venues (for example community centres). In Scotland, flu vaccination is being delivered at an NHS Board level, and the local service specification will vary.

Even with this contractual flexibility, pharmacy owners and pharmacy professionals must make sure that they are still meeting our standards wherever they are providing vaccinations. 

One of the key principles of the standards for registered pharmacies is that the environment and condition of the premises from which pharmacy services are provided, and any associated premises, safeguard the health, safety and wellbeing of patients and the public.

Pharmacy owners and pharmacy professionals must ensure that the setting used for the consultation with the patient and for administering the vaccinations is appropriate, whether it is in the pharmacy or in another location. This includes ensuring patient confidentiality at all times, for example by making sure the consultation with the patient cannot be overheard by anyone else.

We’ve included below an example of good practice by a pharmacy providing flu vaccinations, which includes how they maintain patient confidentiality and reduce risks of COVID-19 transmission to patients and staff.

Good practice: Flu vaccination service

A pharmacist had considered the risks of carrying out pre-vaccination consultation and counselling in person. People booked their flu vaccination appointments online. The confidential booking process captured their personal details to help minimise the amount of time spent in the consultation room. The pharmacy had placed an extra chair at the far end of the consultation room for people to sit on. This allowed the pharmacist to complete the electronic pre-vaccination questionnaire and provide information about the service whilst socially distanced from the person. And they provided assurance and after-care advice during this part of the consultation. 

The person then moved to another chair and faced away from the pharmacist as the vaccination was administered. The pharmacist used hand sanitiser after using the computer and before administering the vaccination. The pharmacy had increased the time allocated for each flu vaccination from previous years to allow for the consultation room to be cleaned between each use. The pharmacy team made a record of the cleaning completed and it completed a deep clean at the end of the day.

Key resources

In England, see the PSNC/ NHSEI Service Specification: Community pharmacy seasonal influenza vaccination advanced service

In Wales, see NHS Wales’  Community Pharmacy Seasonal Influenza Vaccination Service 2020-21

In Scotland, flu vaccination is delivered at an NHS Board Level. Contact the primary care lead at your local health board for more information.

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