016 Seasonal Influenza searches
This collection of searches has been designed to support Practices running a call/recall programme for their seasonal influenza campaign. Built in line with the Enhanced Service criteria, searches are grouped by eligibility cohorts to assist in prioritising groups of patients to invite, and then to monitor uptake across each of the cohorts. A data quality folder offers searches to highlight missed or incorrect coding to ensure that all activity will be funded following the monthly CQRS extracts.
A) Cohorts
The cohorts folder underpins the recall, uptake, and activity folders. The cohorts have been written to reflect the groups specified in the national guidance document.
- All patients at risk - every patient found in one of the at risk cohorts.
- Over 65 - all patients born before 01/04/1960. Some patients will be aged 64 when they receive the vaccine, but they will have turned 65 by 31st March 2025.
- AT RISK 18-64 - patients born on or after 01/04/1960 and aged over 18. These patients have a clinical at risk condition making them eligible to receive a vaccine (or they are currently pregnant). Inclusion in this cohort is dependent on coding defined by the Seasonal Influenza Enhanced Service. This means anybody invited and/or vaccinated using searches based on this search will be counted (assuming correct vaccination coding) in the monthly CQRS claims.
- Under 18 - this search encapsulates all patients from the 5 cohorts below.
- AT RISK under 18 - patients under 18 (but older than 6 months) who have a clinical at risk condition and do not appear in any of the other cohorts below.
- Children 2-3 - all children born between 01/09/2019 and 31/08/2021. These children fall under the scope of the Childhood seasonal influenza seasonal influenza vaccination programme enhanced service. They are eligible for a nasal flu spray administered by the surgery.
- AT RISK primary school age - all children in Reception to Year 6 inclusive (ie: those children born between 01/09/2012 and 31/08/2019) who have a clinical at risk condition. These patients are not a priority for primary care to vaccinate - this is the responsibility of the schools teams - but if they miss vaccination at school it is possible for the surgery to vaccinate. Staff may choose to refer to this cohort to confirm whether an individual child is eligible.
- AT RISK secondary school age - children in Y7-Y11 who have a clinical at risk condition. These children are primarily the responsibility of the schools programme for all secondary school children this season, meaning GP Practices may only want or need to follow up where an at risk patient has not received a vaccination.
- HEALTHY school age - children in Reception to Y11 inclusive who do not have a clinical at risk condition. This cohort is shown for reference in case patients attempt to obtain a flu vaccination at the surgery. Primary Care has no remit to vaccinate any patient in this cohort.
- Patients NOT at risk - any adult patient between the ages of 18 and 49 who do not have a clinical at risk condition.
The cohort searches should NOT be used for any exercise in inviting patients for vaccination.
The cohort for healthy patients aged 50-64 has been removed for 24/25 as the annual NHS letter does not reference this group.
B) RECALL
The searches in this folder follow a similar structure to those in the cohorts folder. The recall searches do not include any patient who has a declined/contraindicated code since 1st September, or a vaccination; it is therefore essential to ensure that all events are coded accurately and as soon as possible.
Never base invitations on SIV-B00 or SIV-B40.
Practices may wish to re-run the searches during their main vaccination drive and review patients appearing in SIV-B43 and SIV-B44. These school age cohorts are the responsibility of the schools teams, but Practices can still vaccinate and claim for patients at risk who for whatever reason have not been able to have a dose under the schools programme.
In addition to the searches based directly on the cohorts, SIV-B11 is a subset of over 65 patients who also have a clinical at risk condition. If Practices wish to target a second invitation later in the flu season to 'mop up' missed patients, this search in particular may help to prioritise those patients with higher clinical risk including those patients who would have previously appeared in QOF flu indicators (CHD / COPD / Diabetes / Stroke).
C) UPTAKE
These searches display every patient who has received a flu vaccination anywhere. In addition to your own vaccination activity it includes vaccinations done by pharmacies, hospitals, midwives, schools. This folder only works if all reports of vaccinations are filed or coded accurately in a timely fashion. This folder more than ACTIVITY (the next folder) influences what patients are shown in the RECALL folder.
Accurately coding vaccinations done elsewhere is important to ensure the enhanced service extraction doesn't unintentionally pick up activity for payment which your Practice did not do.
D) ACTIVITY
The ACTIVITY folder displays the vaccinations which have been done by your organisation. There are only 4 valid codes for use (Administration of first inactivated seasonal influenza vaccination; Administration of second inactivated seasonal influenza vaccination; Administration of first intranasal seasonal influenza vaccination; Administration of second intranasal seasonal influenza vaccination). These are the only codes recognised by the two enhanced services for payment of activity.
The report SIV-D00 can be used to review all vaccinations given. For such a review it would be best to export the results and view in Excel. The report contains columns for the vaccinating staff member, as well as batch number and expiry date. Filtering by staff member may help to identify codes added by (admin) staff who would not normally be found to add vaccinations with their login. In the event of a product recall, the batch number will quickly help to identify affected patients.
All cohorts are shown, and consider that SIV-D45 (healthy school age) and SIV-D99 (adults not at risk) should be close to zero. For SIV-D99 in particular keep a regular eye on the search to monitor new patients added to the search, possibly weekly at the height of the vaccination campaign; it may be appropriate to add the code 'Needs influenza vaccination' to some patients after a clinical review, while the remaining patients may serve as a learning exercise for staff to understand how to avoid ineligible patients being vaccinated.
Q) DATA QUALITY
Staff running the Practice's vaccination programme should pay regular attention to this folder. Some of the searches found in the Data Quality folder will highlight activity which may need to be reviewed or corrected before the beginning of the month, to support the CQRS extracts.
SIV-A21: This search drives all of the at risk inclusion or exclusion used in the cohort folder. It is based entirely on the CQRS business rules for seasonal influenza, and should not be edited. It is possible to use the Check Patient feature against patients found in Population Included to understand why they might be eligible. See also SIV-A22.
SIV-A22: The criteria defined in SIV-A21 may not be as broad as many Practices are used to allowing, so there may be patients from this cohort who present and say they have received a flu vaccination in previous years. The Check Patient feature may help to understand why the patient may be eligible to receive a vaccination. Clinical staff can add a code of "Needs influenza vaccination" on an annual basis, either using PCIT's flu protocol or retrospectively by looking at patients in SIV-D99.
Many patients are likely to be included in other clusters, or more narrowly defined clusters in SIV-A21. The list of conditions in SIV-A22 are:
Epilepsy; COPD; rare genetic/metabolic/autoimmune conditions defined for COVID-19 risk; CHD; dementia; respiratory conditions defined for COVID-19 risk; MS; MND; AF; PAD; RA; asplenia; Addisons disease; cerebral palsy; history of venous thromboembolism; systemic lupus; thalassaemia/sickle cell anaemia/spherocytosis; polio; adrenal insufficiency.
Practices may find that patients identified by the searches are not eligible by the Green Book; the searches are written against the business rules so it identifies codes in the records rather than the patient's individual needs.
We are aware that patients who have been pregnant in the past 9 months will appear even if they have delivered, miscarried, or had a termination. This is exactly how the business rules work, as identifying patients who have not delivered/miscarried/terminated a pregnancy is very difficult both in terms of the codes required and the timeframe in which they might be added; currently there is a wide variation in how this data is recorded in electronic medical records. Primary Care IT has been working on a set of searches which attempt to achieve this, but it was not ready for deployment in August 2024.
We are aware that patients who have been pregnant in the past 9 months will appear even if they have delivered, miscarried, or had a termination. This is exactly how the business rules work, as identifying patients who have not delivered/miscarried/terminated a pregnancy is very difficult both in terms of the codes required and the timeframe in which they might be added; currently there is a wide variation in how this data is recorded in electronic medical records. Primary Care IT has been working on a set of searches which attempt to achieve this, but it was not ready for deployment in August 2024.
Patients with cancer are not automatically eligible for a flu jab based on the Green Book and CQRS business rules. Patients with a history of a blood cancer will always be eligible, but patients being managed for other types of cancer will only be eligible if they have had specific codes added (or drugs issued) in the last 12 months:
- Chemotherapy
- Radiotherapy (if it has an immunosuppressing effect)
- Biologic/biosimilar therapy
The absence of such coding will mean patients are not picked up by the invitation reports, and if they are vaccinated the activity may not be recognised for payment unless another code such as 'Needs influenza immunisation' is added around the time of the vaccination.
SIV-Q00: Three searches identify patients who have been vaccinated by the surgery using one of the 4 primary vaccination codes. This search has been improved for 23/24 by ignoring patients who had a vaccination at a previous surgery before registering with the current surgery. The search and its children, which subdivide activity into injection and nasal spray, may be used as a rough guide as to how many vaccinations of each type have been administered.
If vaccine manufacturer information has been correctly recorded against the codes (possible when using a protocol), data the report SIV-D00 can be manipulated in Excel to establish a breakdown of each type of vaccine.
If vaccine manufacturer information has been correctly recorded against the codes (possible when using a protocol), data the report SIV-D00 can be manipulated in Excel to establish a breakdown of each type of vaccine.
Patients who have deregistered during the flu vaccination season are NOT included in these searches.
SIV-Q01: Counts the patients who were not originally eligible, but has been flagged following clinical review as being eligible to receive a vaccination. This code is essential on non-eligible patients (by the definition of the business rules) to ensure payment. Consider clinical review and coding "Long term indication for seasonal influenza vaccination" to save having to add a code every year.
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SIV-Q06: Another data quality search to root out coding issues. This can be used in two ways; one to pick up where staff double code during the same encounter, and when using the report it is also possible to pick out codes added on separate dates, perhaps as a result of other healthcare providers sending data twice.
SIV-Q07: Patients who have a medication issue for a flu jab but the episode is not coded are still counted for a CQRS claim, but nothing will appear on the patient's vaccination summary. If a patient were to request a vaccination history, a complete summary would need to show every jab which means the event must be coded.
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X) Declined or Contraindicated
In addition to an overall search to count the number of patients who declined (with no subsequent flu vaccination), the declined codes are broken down into the various eligibility cohorts. This feature request may be of interest to Practices who want to understand how different groups of patients respond to invitations.
A single search SIV-X100 shows the number of patients who have a permanent contraindication for a flu vaccine. This search does not feature as an exclusion from the main recall searches as it picks up any adverse reaction or allergy to a specific flu vaccination. Newer types of vaccination may mean the patient could received a flu jab. In the event that a patient is called in, coding Seasonal influenza vaccination declined or contraindicated will remove the patient for the remainder of the flu season.
SIV-X101 was introduced in to separate out expiring contraindications. These are where the Practice has coded Seasonal influenza vaccination contraindicated or ...not indicated since 1st April of this contract year. Patients appearing in this search will be removed from the searches in the recall folder
Coding
Flu vaccinations
Administration of first inactivated seasonal influenza vaccination [985151000000100]
Administration of first intranasal seasonal influenza vaccination [884861000000100]
Seasonal influenza vaccination given by other healthcare provider [955651000000100]
Seasonal influenza vaccination given by midwife [1066171000000108]
Seasonal influenza vaccination given by pharmacist [955691000000108]
Seasonal influenza vaccination given while hospital inpatient [955701000000108]
Seasonal influenza vaccination given in school [1239861000000100]
First inactivated seasonal influenza vaccination given by pharmacist [1037351000000105]
First inactivated seasonal influenza vaccination given by midwife [1066181000000105]
First intranasal seasonal influenza vaccination given by other healthcare provider [955661000000102]
First intranasal seasonal influenza vaccination given by pharmacist [1037311000000106]
Declined
Seasonal influenza vaccination declined [822931000000100]
First intranasal seasonal influenza vaccination declined [885971000000103]
Second intranasal seasonal influenza vaccination declined [886011000000103]
No consent for seasonal influenza vaccination [868491000000103]
Contraindicated
Seasonal influenza vaccination contraindicated [822971000000103]
Seasonal influenza vaccination not indicated [822951000000107]
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