016 Seasonal Influenza 2023-24

016 Seasonal Influenza 2023-24

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.


       



This year there are 6 folders of searches available to use.

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.
  1. All patients at risk - every patient found in one of the at risk cohorts.
  2. Over 65 - all patients born before 01/04/1959. Some patients will be aged 64 when they receive the vaccine, but they will have turned 65 by 31st March 2024.
  3. AT RISK 18-64 - patients born on or after 01/04/1959 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. The IIF business rules for VI-02 are slightly different, so an additional supporting search exists in the Data Quality folder to pick up extra patients. Some patients won't be immediately eligible for a flu vaccination (although they are likely to have received one before), and eligibility can be confirmed for Enhanced Service payment by adding certain groups of code:
                         Health care workers
                         Long term indication for seasonal influenza vaccination
                         Needs influenza vaccination
                         Lives with immunocompromised person
  4. Under 18 - this search encapsulates all patients from the 5 cohorts below.
  5. 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.
  6. Children 2-3 - all children born between 01/09/2018 and 31/08/2020. 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.
  7. AT RISK primary school age - all children in Reception to Year 6 inclusive (ie: those children born between 01/09/2011 and 31/08/2018) 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. 
  8. AT RISK secondary school age - children in Y7-Y11 who have a clinical at risk condition. We have kept this cohort separate like last year, although the lack of coverage from the schools programme this season means they will be the responsibility of the surgery. We recommend inviting them at the same time as patients in the AT RISK under 18 cohort. 
  9. HEALTHY school age - children in Reception to Y6 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.
  10. 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 23/24 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 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.


Some Practices may wish to customise searches in this folder to avoid inviting patients who are already booked in for a vaccination. See below for guidance.

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. 

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.
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. 
---------------
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.
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.
---------------
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.

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 are contraindicated for a flu vaccine, either 'persistently' due to a previous adverse reaction to a flu jab, or due to an 'expiring' code of Seasonal influenza vaccination contraindicated or ...not indicated which needs to have been coded at least once in the previous 12 months.


 

Adapting the searches for use within your own surgery

The searches provided are influenced entirely by codes and medication issues. We know that to make the RECALL searches the most effective, another exclusion rule needs to be added. Unfortunately as a third party we are unable to provide this because the rule is based on your organisation's appointment book. If the Practice's Appointment Book uses specific slot types for flu clinics, it is possible to factor any future booked appointments into the search to save inadvertently inviting patients who are already scheduled to receive a vaccination.

If a flu clinic slot type is created then any cohort searches can be joined to this locally so that future appointments booked within these clinics are excluded.

 



    • Related Articles

    • 011 Prescription Management - Prescription claims

      High volume drugs are: Influenza Pneumococcal Meningococcal B Hepatitis A Hepatitis A + Typhoid (combined) Hepatitis A + B (combined) Hepatitis B Meningococcal ACWY Typhoid The above list is only for vaccines purchased by the Practice for NHS work ...

    • FP34D and Personally Administered Items Checker (HP207)

      Background: FP34D The FP34D form is used by practices to claim for certain high-volume personally administered vaccines. The high-volume personally administered vaccines that can be to the form are (or a combination of these): influenza typhoid ...