Optimizing Influenza Vaccine Ordering for NHS Community Pharmacies

Influenza Vaccine Ordering Incentive Scheme for Influenza Vaccine Ordering Incentive Scheme for Community Pharmacy for NHS Influenza Vaccinations Community Pharmacy for NHS Influenza Vaccinations Applicable for the 2023/24 Influenza Season Applicable for the 2023/24 Influenza Season For London Region use only For London Region use only August August 2023 2023 1 | NHSE London Region, July 26th, 2023 OFFICIAL-SENSITIVE - COMMERCIAL

Summary Summary The purpose of this pack is to outline an approach to reduce the risk associated with higher and earlier Influenza (flu) vaccine ordering by Community Pharmacies, for administration of the vaccine to the eligible cohorts as advised by NHSE, by offering a consistent and regionally supported approach to the underwriting of remaining excess stock at the end of the flu season. Discussions with colleagues have identified key lessons learned from previous flu seasons in relation to blockers and actions required; one of the key take- aways from these discussions is confirmation that London, as a region, consistently under-orders flu vaccine stock, leading to missed opportunities to vaccinate the population, particularly during peak demand times in the season. It is noted that there is concern for both General Practice and Community Pharmacy on over-ordering of vaccine stock, and the resultant cost and wastage, should there be excess stock at the end of the flu season. The underwriting approach for Community Pharmacy outlined in this pack has been discussed and agreed with regional Pharmacy and LPC colleagues. It relates to flu vaccine stock that has been ordered in line with meeting any increased vaccination ambition for the local population, with the underwriting arrangement covering a percentage of stock utilised in the season for NHS flu vaccination cohorts only. The underwriting agreement will be honoured where the generated claim meets the underwriting conditions as outlined. In its simplest form, the underwriting amount will be calculated as below: The regional target for increase in flu vaccinations is 5% on 2022/23 numbers A pharmacy has delivered N vaccinations the previous season The pharmacy may be reimbursed up to N x 5% of surplus stock remaining at the end of the vaccination season, if the underwriting conditions set out further in the pack are met As an example: if a pharmacy has delivered 1000 vaccinations last season, has a 5% increased vaccination ambition this season, has ordered 1050 vaccines in order to meet the ambition, but has only delivered 1020 vaccines, if the underwriting principles are met, the pharmacy is eligible to have 30 doses underwritten, at cost. 2 | NHSE London Region, July 26th, 2023 OFFICIAL-SENSITIVE - COMMERCIAL

Stock ordering Stock ordering an overview an overview Planning Ordering Scheduling Receiving Vaccinating Returning Reimbursements Vaccination starts as In January March at Pharmacies submit Manufacturers/ Orders are generally If needed, some levels At the end of each soon as stock orders the end of each flu stock orders directly wholesalers receive fulfilled beginning of stock may be vaccination season, are received, usually season, pharmacies with manufacturers product orders and September October returned by pharmacies submit in September/ review their uptake (in /wholesalers, ordering advise pharmacies each year. pharmacies directly to stock reimbursement October. Each the current season) the recommended first directly of their manufacturers. Levels claims as per the SBS vaccination event is for each cohort, and choice vaccine variant respective delivery of stock returns that list price, and item of recorded. plan stock orders in for the cohorts the schedules. Delivery will be accepted by service payment to the light of expected pharmacy is planning to schedules are usually manufacturers are London region delivery ambition for vaccinate. Early orders ready by August each stipulated in Sale or Immunisations Team. each year. receive discounts, and year. Return agreements Stock underwriting will orders can generally be which are part of be processed by the amended up to July. manufacturer regional Immunisations Stock orders are paid contracts. Any Commissioning Team, directly by pharmacies. returned stock will be via the BSA, as per the credited as a credit usual process for the note against next London Enhanced 3 | NHSE London Region, July 26th, 2023 year's purchases. Service vaccinations. OFFICIAL-SENSITIVE - COMMERCIAL

Underwriting conditions Underwriting conditions Pharmacies must note the following conditions and meet specific criteria for a claim to be accepted: Across the season the pharmacy must have ordered more doses than in the prior season, as per eligible cohorts and respective eligible products, as per the annual flu letter. The pharmacy must have achieved a higher uptake, of at least 2%, than in 2022/23. All efforts should be made to use existing vaccine stock via usual arrangements, and this should be paid for and organised via usual mechanisms. Providers should only purchase alternative vaccines to the ones recommended if all attempts to secure the recommended first line vaccines have failed. Providers may be asked to provide evidence to show this upon request from their commissioner. This includes use of: o aQIV for >65-year-olds. If not, available next line vaccine is QIVr, and only use QIVc if all attempts to source aQIV and QIVr have been exhausted). o QIVc or QIVr for 18 64-year-olds at risk; QIVe can only be used if all other attempts to source recommended vaccines have failed. The pharmacy must provide assurance that it has continued to proactively vaccinate patients until the end of the flu season which includes working collaboratively with General Practice providers. In the interest of effective use of staff time, and value for money, claims below 100 will not be processed. For any claim above 1k, the practice will need to provide full evidence of stock ordered and stock used, including evidence that all options for Sale or Return have been exhausted. Stock returned as part of Sale or Return agreements will not be eligible for underwriting under the scheme. Pharmacies will be reimbursed at cost for the stock that is being underwritten. 4 | NHSE London Region, July 26th, 2023 OFFICIAL-SENSITIVE - COMMERCIAL

Underwriting process Underwriting process Pharmacies will need to accept the new stock underwriting offer as part of the London Pharmacy Vaccinations Local Enhanced Service at the beginning of the flu season. At the end of the flu season, and up to April 2024, pharmacies will submit any claim to the London region Immunisations Team further information will follow on this process, ahead of the start of next season. Claims will be reviewed by the London region Immunisations Team and processed within ten weeks of submission. Funds for the additional underwriting offer will be provided by NHSE London region. It is understood that the maximum at risk fund will be equal to the pharmacy vaccination target times the increased ambition (which is 5%). 5 | NHSE London Region, July 26th, 2023 OFFICIAL-SENSITIVE - COMMERCIAL

Example regional funding modelling for the scheme Example regional funding modelling for the scheme If a pharmacy has delivered Nnumber of flu vaccinations in 2022/23 and the region s target is to increase flu vaccine uptake by 5% compared to the previous season And the average list price of flu vaccine stock is Y per dose Then the maximum funds required for each pharmacy to deliver this scheme, assuming uptake of greater than 2% on the previous year, and assuming that the Underwriting Conditions have been met, would be equal to: N x 5% x Y For example, If Pharmacy A has delivered 1,000 flu vaccines in 2022/23 The regional ambition for 2023/24 is to increase flu vaccination uptake by 5% And the average list price for flu stock is 12 per dose The maximum amount of funds required to deliver the underwriting scheme in Pharmacy A would be equal to: 1,000 x 5% x 12 = 1,200 6 | NHSE London Region, July 26th, 2023 OFFICIAL-SENSITIVE - COMMERCIAL

Regional Team Next steps Regional Team Next steps Regional Immunisations Team has confirmed funding arrangements with Regional Finance Team, and will facilitate reimbursement procedures Regional team to provide communications to encourage further vaccine stock ordering in Community Pharmacies, working with LPC colleagues to communicate and to promote ICBs are conducting high level local modelling, in line with the agreed regional underwriting approach for General Practice; Community Pharmacy are encouraged to work with PCNs to establish forecasts for next season and to ensure there is positive engagement and collaboration to meet local eligible population needs. 7 | NHSE London Region, July 26th, 2023 OFFICIAL-SENSITIVE - COMMERCIAL