Intended for healthcare professionals

Rapid response to:

Letters Delay in flu vaccine supplies

Pharmacies giving flu jabs further disintegrates general practice

BMJ 2019; 367 doi: (Published 31 October 2019) Cite this as: BMJ 2019;367:l6269

Rapid Response:

Re: Pharmacies giving flu jabs further disintegrates general practice

I would like to address some of the concerns raised in your letter of the week (BMJ 2019; 367:l6269), regarding the provision of flu vaccinations in community pharmacies.

I work as a locum community pharmacist in several pharmacies which provide this service. NHS England has been very clear that pharmacists need suitable training in order to give flu vaccinations; we have to attend face-to-face training at least every three years (I have attended a course on basic life support and one on flu vaccination), and we have to complete several online training packages. Every year we are asked to make a declaration that our knowledge and skills are up to date, before providing the vaccination service. The full service specification for the current year is freely available at

Pharmacy premises must also meet strict standards in order to offer flu vaccinations. This includes having emergency IM adrenaline to hand in case of an anaphylactic reaction. Having immediate access to full resuscitation equipment (such as a defibrillator, or airways) would be unnecessary as this equipment is not typically involved in the emergency treatment of anaphylaxis.

Regarding the provision of vaccine batch number and expiry date information to GP surgeries – this is unnecessary for patient care and would only increase the work burden for GP surgeries. If there is a recall or safety concern, it would be the responsibility of the administering pharmacy or NHS England to contact the affected patients.

Dr Clayton claims that the opportunity to assess whether patients need extra health vigilance is lost if they attend a pharmacy for their flu jabs. I can assure her that pharmacy staff perform health vigilance every day, especially for our vulnerable patients, and are often the driving force behind getting a patient to see a GP for an appropriate issue.

It is true that the flu vaccines were made available to community pharmacies first this year, whereas in other years the GP surgeries have received them first. When different healthcare settings receive stock weeks apart whilst trying to fulfil the same demand, this does not help anybody plan well, and it confuses patients.

Providing flu vaccination to housebound patients or those in residential homes will always have an increased cost. Nobody should expect GP surgeries or community pharmacies to provide this service at a financial loss.

Patients are very pleased that pharmacies offer the flu vaccination service, and results have shown that making flu vaccination available this way increases uptake. These are great outcomes.

If you are a GP who feels reduced professional satisfaction as a result of delegation of vaccination services, I encourage you to make contact with your local pharmacies and initiate discussions about how we can all work together to improve the uptake of the flu vaccination, particularly in people with liver disease (who neither GPs nor pharmacists have been particularly successful at vaccinating). Pharmacists are only a phone call away, or you can walk into a pharmacy and speak to one, often without having to wait.

Competing interests: No competing interests

10 November 2019
Sarah D A Friend
Locum Community Pharmacist (former doctor)