016. Seasonal Influenza searches overview

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.

There are 7 main folders (categories):

Click on the links to jump to the relevant section within this support article.

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.

A00) All patients at risk - every patient found in one of the at risk cohorts.
A02) Care home patients - anybody coded as living in a care home (based on PCN DES EHCH01 logic). These patients are excluded from appearing in other cohorts (eg: Over 65) as Practices are likely apply a different approach to managing them, perhaps by a scheduled visit to the care home.
A03) Housebound patients - similar to care homes, any patient not living in a care home who has a code indicating that they are currently housebound. These patients are excluded from appearing in other cohorts.
A10) Over 65 - all patients born before 01/04/1962. Some patients will be aged 64 when they appear in the search results, but they will have turned 65 by the end of this season's flu campaign.
A20) AT RISK 18-64 - patients born on or after 01/04/1962 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.
A40) Under 18 - this search encapsulates all patients from the 5 cohorts below.

A41) AT RISK under 18 - patients under 18 at the time of running the search, who have a clinical at risk condition and do not appear in any of the other cohorts below.
A42) Children 2-3 - all children born between 01/09/2022 and 31/08/2024. 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.
A43) AT RISK primary school age - all children in Reception to Year 6 inclusive (ie: those children born between 01/09/2015 and 31/08/2022) 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.
A44) AT RISK secondary school age - children in school years Y7-11 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.
A45) HEALTHY school age - children in school years 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.

A50) Homeless patients aged 16+ - patients coded as homeless without a more recent housing code. At present there is no guidance from NHS England on how to identify and recall homeless patients, although the cohort is defined as "rough sleepers and those using homeless hostels or night-shelters, rather than the broader definitions of homelessness". Our cohort searches therefore exclude anyone explicitly outside of this cohort - e.g. sofa-surfers, living temporarily with family/friends - but will pick up some patients who have been coded as generically "homeless". Therefore it is advised to review this cohort before invitation. These patients are excluded from appearing in other cohorts.
A99) 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 homeless patients was introduced into the national flu programme and Green Book criteria in the 2026/27 Amendment to national flu immunisation programme 2026 to 2027 letter

B) RECALL

The searches in this folder follow a similar structure to those in the cohorts folder. The recall searches exclude any patients who have a declined/contraindicated code recorded since the beginning of the current campaign (1st September), or have had a vaccination recorded. It is therefore essential to ensure that all events are coded accurately and as soon as possible so that these patients are not re-invited.

Never base invitations on SIV-B00 or SIV-B40 - the individual recall searches for each cohort should be used

Patients living in care homes are only found in SIV-B02 to minimise the chance of inappropriate invitations. Practices who do not look after care homes should still check this search as any included patients will not receive an invitation. If appropriate, consider adding a code to record that the patient no longer lives in a care home.
Patients who are housebound are only found in SIV-B03, giving an opportunity to send a tailored invitation which may put them on a list for a home visit or district nurse visit.
Patients who are coded as homeless are only found in SIV-B50, giving an opportunity to send a tailored invitation to an outreach clinic or communicate with the patient via an alternative method

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 D) ACTIVITY, influences what patients are shown in the B) RECALL folder.

Accurate coding of 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 (985151000000100);
Administration of second inactivated seasonal influenza vaccination (985171000000109);
Administration of first intranasal seasonal influenza vaccination (884861000000100);
Administration of second intranasal seasonal influenza vaccination (884881000000109)

These are the only codes recognised by the two enhanced services for payment of activity.

The search SIV-D00 can be used to review all vaccinations given. Use the right-click option to Breakdown Results for deeper review of administered vaccinations, e.g. Event Details > Event done by to see the vaccinating staff member, or Vaccinations > Vaccination batch number. Filtering by staff member may help to identify codes added by staff who do not administer vaccinations. In the event of a product recall, the batch number will quickly help to identify affected patients.

All eligible cohorts are shown. 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 / exclusion used in the cohort folder. It is based on the eligible at risk cohorts for seasonal influenza as outlined in . It is possible to use the Check Patient feature against patients found in Population Included to understand why they might be eligible.

SIV-Q00: This search identifies patients who have been vaccinated by the surgery using one of the 4 primary vaccination codes (see D) ACTIVITY above for these codes). This search looks only for events entered "here" (i.e. by the 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 brand has been correctly recorded, using Breakdown Results on the searches joined to SIV-D00 can 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 have been flagged following clinical review as being eligible to receive a vaccination via the addition of either Requires influenza virus vaccination (698353005) or Needs influenza immunisation (185903001) to their record during this current flu campaign. 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 (935351000000106) to save having to add a code every year.

---------------

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 two, 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. These patients are still counted for a CQRS claim, but nothing will appear on the patient's vaccination summary. If a clinician were to check historic vaccinations, or the patient were to request a vaccination history, it would appear incomplete. Patients appearing in this search must also be coded as having the flu vaccination administered.

---------------

SIV-Q11: Finds patients who have been coded as living with an immunocompromised person in the last year. This search is requires manual review as it may not be complete depending on how consistent coding is in practice of household contacts of immunocompromised people, particularly if that person is not a patient at the same practice.

SIV-Q13: Identifies patients who were manually coded as needing an influenza vaccination last year but are not in an at risk group this year. This search flags patients who are not in an at risk cohort this year, but who were flagged as at risk last year. Patients in this list should be manually reviewed to assess whether their clinical situation has changed since last year. Patients found to be requiring a vaccination this year should be coded with either Requires influenza virus vaccination (698353005) or Needs influenza immunisation (185903001) if their condition is short term - they will need reassessing again next year - or with Long term indication for seasonal influenza vaccination (935351000000106) if the patient will require vaccination every year.

SIV-Q14: Patients appearing in this search have been included in SIV-Q14-1 (wider list of possible at-risk conditions) but have not been coded as receiving a vaccination this year. The search is not included in the RECALL folder since some patients are not likely to be considered eligible. If SIV-Q14-1 has already been reviewed and actioned at the beginning of the flu campaign, SIV-Q14 is unlikely to require re-review.

SIV-Q14-1: The criteria defined in SIV-A21 may not always align with a clinician's perceived clinical judgement of need. There may also be patients from this cohort who 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 this search.

We recommend running SIV-Q14-1 at the very beginning of the flu campaign and provide a list to a clinician to review prior to any invitations being issued. Adding "Needs influenza vaccination" (dated after 1st September) adds patients to the recall searches in folder B, and guarantees payment at the end of the month of vaccination.

Many patients are likely to be included in other clusters, or more narrowly defined clusters in SIV-A21. The list of conditions in SIV-Q14 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.

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 during the current flu campaign season.

V) Joint vaccination (flu + COVID)

These are covered in a dedicated support article. Click the following link to view: Combination Flu and Covid Clinics searches

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.

At the bottom of the individual cohort searches, SIV-X99-1 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 (822931000000100) or contraindicated (822951000000107) will remove the patient for the remainder of the flu season.

SIV-X99-2 was introduced in to separate out expiring contraindications recorded this year only. These are where the Practice has coded Seasonal influenza vaccination contraindicated (822951000000107) or ...not indicated (822971000000103) 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]

Links

Influenza: the green book chapter

National flu immunisation programme plan 2026 to 2027

All influenza vaccines marketed in the UK for the 2026 to 2027 season