A delay to the flu vaccination season will have significant implications for cash flow, workforce and patient relationships, community pharmacy contractors have told The Pharmacist.

This morning NHS England (NHSE) confirmed to The Pharmacist that the NHS adult influenza vaccination programme would begin in October this year instead of on its usual September start date.

But Community Pharmacy England (CPE) told The Pharmacist no final decision had been communicated to the sector’s negotiator. And CPE said that it was 'continuing to press for common sense to prevail' and for the service to start from September.

The Pharmacist spoke to two community pharmacy owners to understand what impact any delay to the service would have on their business and their patients.

Sri Kanaparthy, who owns five community pharmacies in County Durham and the Lake District, told The Pharmacist that changes to the service would result in thousands of wasted vaccines for his business alone.

He said that in planning for the service, he had forecast for full capacity across the whole season. Last year, his business delivered 400-500 vaccinations each week.

Mr Kanaparthy said that he was already getting patients wanting to book for September, and would have to ring them to cancel and rearrange appointments, leading to extra workload for his team.

Based in a less affluent demographic area, he said it was ‘unlikely [that eligible] patients would be prepared to pay to go private’ in order to receive the vaccination before October.

‘We have had zero success in trying to convert NHS qualifying patients to private flu vaccines,’ he said.

With a shortened NHS vaccination season, he said that his business was unlikely to be able to create additional capacity to run more appointments than planned after October.

And because pharmacies purchase the flu vaccine privately and then are reimbursed for those they give to eligible patients, this would result in an estimated 10% of his stock being wasted.

‘There's no protection for wasted vaccines,’ he said.

And while he has contacted other local pharmacies to see if they want to take his unused vaccines, he has found that other contractors are ‘all in the same boat’.

‘They all want to give some, rather than take some because everyone's planned ahead. And now it's backfired on careful planning.’

‘I will lose income because of this,’ Mr Kanaparthy told The Pharmacist.

And he said that in the short term, delaying the programme until October would have a cash flow implication for his business, amid ongoing challenges around medicines price increases.

‘We’re still getting orders from the wholesalers at the time we've ordered [the vaccines to arrive], and we have to pay the bills on time.

‘Whereas we can't administer any of these vaccines until a month later. And then by the time that payment kicks in, it will be a couple more months. So, we do have some cash flow implications as well, because of this,’ he said.

He also raised concerns about the impact of having to stand down additional staff hired for the vaccination season.

‘At the minute, workforce is a big problem. Booking and cancelling is not going to reflect good on pharmacy businesses because it ruins relationships,’ he said.

‘Then there won't be any guarantee next year they'll take our bookings, because they might think [that] pharmacies might just cancel [the] booking.’

And he said that the delay could impact that pharmacy’s relationship with its patients too.

‘From a patient's perspective, they won't see everything that's happening with NHS England, and the delay they have done,’ he said.

‘From the patient's perspective, it would be a failure on the pharmacy’s part because they'll only see what the pharmacy is doing, they don't actually realise everything that's going on.’

And he said that community pharmacies were struggling to understand the clinical reasoning behind the delay.

‘Where did [NHSE] get this evidence, all of a sudden?’ he asked.

‘For years, they have been saying [the September start is] all evidence based, and then all of a sudden, they change it with little or no notice,’ he added.

‘People queue outside as soon as vaccines are available’

Meanwhile, Raj Patel, who owns 16 pharmacies in the North West of England, also told The Pharmacist that patients have already been asking about booking their flu vaccination for as soon as possible.

And he said that in previous years, the pharmacy has given patients a date, usually in the first week of September, when the vaccines will be available. ‘And honestly, people have been queuing outside, just saying, “I need my vaccine”,’ he said.

He added: ‘It's reputational damage to our pharmacy, because we can't give them that vaccine, even though we've got them in our fridge. And it's just complete disarray, to be honest.’

He also said that a more concentrated flu vaccination season would impact on the other services that pharmacies were able to provide during their busiest quarter of the year.

‘It's always been from September to end of November, that's the busiest time [for flu vaccinations],’ he said.

‘That time has been concentrated, it just means pharmacists are going to be so busy with everything that they have to do, in addition to a more concentrated [flu season], and that's just not fair on patients, not fair on pharmacists, and it's not fair on the general public. Because obviously, there'll be affected. If we're doing flu vaccination, we can't be in two places at one time,’ he said.

And he raised concerns that vaccinating people later in the season would have an impact on virus circulation and hospitalisation rates.

‘It just seems so last minute. When you've got millions of people to inoculate, it just seems to me there is no strategy, there is no forward thinking within the NHS,’ said Mr Patel.

‘You can't say a month before that we're going to extend or we're going to delay the flu vaccines. I cannot see a cogent reason for that. And if they wanted to do [flu vaccinations alongside] Covid in October, why not just start Covid in September?’ he said.

Co-administering Covid and flu jabs won’t save much time

Both Mr Kanaparthy and Mr Patel also said that co-administering the Covid and the flu vaccinations would not save time equivalent to the reduction in fee for the service, as recently announced.

‘The clinician would still have to go through the set of questions for each vaccination, make sure they're both clinically appropriate. There might not be an awful lot of time saved, there might be a very minute element of time saved on the administrative side of things, but [on the] clinical side of things there isn’t,’ said Mr Kanaparthy.

And Mr Patel added: ‘These are two different vaccines which require two different [duties] of care to patients.’