4Vaccine procurement in England
62.We heard that parts of the flu vaccination programme were procured and provided in different ways. All vaccinations for the children’s programme in England are purchased centrally by Public Health England and provided by GPs to 2–3 year olds and in schools for older children.79 Professor Cosford set out the benefits of central procurement for the children’s vaccination programme. He said that the programme was delivered in schools and central procurement of the nasal spray vaccine through local NHS England teams was easier.80 However, GPs and community Pharmacists are responsible for the purchasing and provision of vaccination for all other eligible groups in the NHS vaccination programme.
GP procurement for the flu vaccination programme
63.GPs and pharmacies are responsible for purchasing flu vaccinations, Professor Powis provided information on how this process worked:
It has always been the case that GPs are asked to procure eight, nine or 10 months ahead the vaccines that they believe are most appropriate for their populations of patients. In doing so, they will take into account the guidance that is issued through the annual flu letter, which comes out in March, and the chapter in the Green Book that refers to influenza.
64.We heard that there had been geographical variation in vaccine purchasing for eligible adults in the 2017/18 season. Witnesses agreed that this was a recent development and reflected different vaccinations being available for eligible groups.81 Professor Powis explained that the guidance had now been updated:
This year we have tightened the guidance. Why have we done that? First, because of the evidence base. The costeffectiveness analysis that Public Health England published last year, which was published after the ordering for the current season, would not have been relevant for this winter. Secondly, because of the licensing of the adjuvanted trivalent vaccine in the over-65s. That is an important bit of the guidance that we issued in February, because [ … ] the potential for benefit is very substantial. Thirdly, because we are aware of the possibility of variation in guidance and, as the choice of vaccines becomes more complex, our view, based on advice from PHE, was that it would be preferable to issue stronger, more directed guidance, which is why I said earlier that we are probably in the best of all possible positions for next year, in that we should absolutely see less variation in ordering between trivalent and quadrivalent.82
He went on to say that NHS England had “acted to ensure that next year procurement mirrors the best possible clinical safety and cost-effectiveness advice that we have been given by PHE and JCVI”.
65.One issue reported in response to the changing advice to GPs was that many GP practices had already ordered the vaccinations for the following flu season at the time of our evidence session in March 2018.83 However, Professor Van-Tam reassured us that the Department’s discussions with pharmaceutical companies had ensured that it would be easy for GPs to change their orders:
I feel assured enough to assure you that the manufacturers are making it easy, to the extent that that is possible, for general practitioners who may already have ordered trivalent vaccines to switch to quadrivalent. They are also making it easy for general practitioners to switch to the adjuvanted vaccine in the elderly. This year, we have one supplier for the adjuvanted vaccine. We are working on a weekly basis with that company to monitor how ordering is going, to give us quite a degree of assurance that, by and large, the changes that we require are beginning to happen.84
66.In August 2018, a letter from NHS England to GPs, CCGs and community pharmacists reported that NHS England and the Department of Health and Social Care had been working closely with the manufacturer of the attenuated vaccine to ensure that adequate supplies of the vaccine were available and that these would be supplied in phases from September to November. However, in September, there were reports of vaccine supply shortages in a small number of GP surgeries in London.85 The Medicines and Healthcare Products Regulatory Agency have also advised that where GP practices/pharmacies did not meet the deadline for ordering the vaccines, or where demand exceeds supplies, vaccine stocks can be shared amongst local surgeries and pharmacies.86
Should all flu vaccinations be centrally procured?
67.Flu vaccinations are the only vaccinations to be procured by GPs directly. This issue has come under scrutiny in the past following localised vaccine shortages in the 2010/11 flu season.87 In May 2011, the Coalition Government launched a public consultation asking for views on the procurement of flu vaccination88 but no changes were made to flu vaccine procurement as a result of this.89
68.We heard that while there had been some variation in the past with regards to procurement, there was no need at present to consider changing the procurement system for the flu vaccination programme. Professor Cosford set out the benefits of GPs leading the eligible adults programme, and that it was important for national bodies to ensure they were supported in this:
[...] GPs do a brilliant job in getting high rates of vaccination. Part of that of course is due to the fact they are also within the system of procuring the vaccine. We are looking to make sure that we can provide every possible support to help them to know which are the best vaccines for their population, and to know that without having to go through very detailed processes of understanding the detail of the evidence, which is best looked at a national level. We would have to think carefully about any changes in the system of procurement, because the last thing we want to do is to remove the incentives that get our programmes to the best possible level. If we were to change the procurement system, we would have to be very cautious about making sure that was done with the complete engagement and support of GPs and that the systems to value their input were absolutely there.
69.Professor Powis agreed that GP procurement of flu vaccination had its advantages and reported that the vaccination programme was very successful internationally. However, he said that if there was any evidence of variation in provision in the future, the procurement of vaccines could be reviewed.90
70.There are different procurement processes for flu vaccination programmes in the UK. We see no reason why this arrangement should change. There has been geographical variation in previous flu seasons with regards to vaccine purchasing but we were reassured that action had been taken to address this variation in vaccine provision in the 2018/19 season. We welcome that GP practices were able to change their orders following a change in advice on flu vaccination. Co-operation in this way between GPs, Public Health England, NHS England and flu vaccination manufacturers should continue.
83 GPs told to order two different types of flu vaccines amid efficacy fears, Pulse, 5 january 2018
85 Flu jab supply problem leaves GP practices facing loss of thousands of pounds, GPonline, 11 September 2018
86 NHS England, LOCAL ACTIONS TO ENSURE aTIV IS OFFERED TO INDIVIDUALS AGED 65 YEARS AND OVER, 24 September 2018
87 The National Archives, Department of Health, The seasonal influenza immunisation programme. Consultation: a review of the procurement of seasonal vaccine, accessed 16 October 2018
88 The National Archives, Department of Health, The seasonal influenza immunisation programme. Consultation: a review of the procurement of seasonal vaccine, accessed 16 October 2018
89 HC Deb 17 June 2014 c562W
Published: 18 October 2018