Flu Protocols

Flu Protocols

We're really pleased to release our toolset for the 2023/24 flu season. This article covers protocols, while a separate article covers the searches
There are 3 protocols described below, HP247, HP248, HP249. Each performs a specific function throughout the flu season.

HP247 Eligible for flu vaccination

Staff can add this protocol to their personal F12 pick list for use whenever the have a discussion with a patient about booking a seasonal influenza vaccination. The protocol will flow through eligibility and advise what action should be taken. Below are most of the instructions shown to users:

The first 4 instructions below terminate without letting the user continue to book an appointment.








In this final example the patient does not meet the age or clinical risk criteria for vaccination, even if they have received an influenza vaccination in previous years. A clinician would need to review the record and add the code 'Needs influenza vaccination' to ensure payment, but it will still not be possible to run HP247 on the patient. 


Eligible patients who are housebound will also terminate with this alert. If the alert appears, consider whether housebound coding is correct.

Many Practices maintain a visit list for flu jabs, either administered by District Nurses, or Practice staff who go out to visit housebound patients. If your Practice follows a different process, inform all staff who will use HP247 what they should do instead.

Once eligibility has been confirmed, users are asked if the patient wants to book an appointment.


These next instructions show after confirming that the patient wants to book an appointment now.






After pressing OK on the display text box, a diary entry is automatically added (which will be automatically completed when the HP248 Flu administration protocol is used), and then the Book Appointment screen opens.

If the patient didn't want to book an appointment immediately, a simple prompt is shown to the user. No further action is taken, and any red box eligibility alerts will continue to show.



If the patient is not interested in having a flu jab, Seasonal influenza vaccination declined [822931000000100] will be added to the record. This helps by removing the patient from searches for recall or further prompts by clinicians checking the red box. Declining a patient may also support the Practice's/PCN's achievement of IIF flu indicators by removing the patient from the denominator population. 


HP248 Flu vaccination clinic

Primary Care IT has produced a single flu administration protocol for the 2023/24 seasonal influenza season (HP248).  Our protocol has been built as a one-stop resource to manage flu administration for all age groups, which is to be launched from F12. This year we have again not included the additional elements of smoking status, shingles vaccination, COVID vaccination, pneumococcal vaccination, dementia screening, or AF screening.

There are some steps you need to go through to set up this protocol prior to first use.

Configuring batch numbers 

The base version of the protocol contains nodes to cover all types of influenza vaccination for this season (aQIV, QIVc, QIVr, QIVe, LAIV). Each type of influenza vaccination launches a separate protocol which should simplify the process for updating batch numbers.
There should be no reason to modify HP248, unless the Practice wants to remove a specific type of influenza vaccination that is not used. Caution must be exercised if this is to be attempted as the lines flowing from the Multiple Choice Question (MCQ) do not update, so the lines must be redrawn.

There are 5 'sub protocols' which contain the batch data


When editing the protocols, use the overview in the upper right corner to move around or zoom in/out 


Configuring injection protocols

The 4 injection forms (aQIV / QIVc / QIVr / QIVe) are laid out in an identical way. Take care to ensure that batch number and expiry information is only added into the relevant protocol.
Each MCQ repeats the type of vaccine to reinforce the original selection. If a user realises they selected the wrong option, they should press Esc and start again from F12.
  1. Open the first Multiple Choice Question

  2. Select the top 'ADD here' and press Edit. Type in the first batch number then press Enter
  3. If necessary, repeat for the other two options. Practices may prefer to delete lower options, or change the name to 'Not in use'
  4. Press OK to close the MCQ
  5. Follow the first option across, through "Which arm for jab?" MCQ to the Add Coded Data nodes. Double click the top node to edit

  6. Enter the Manufacturer and Batch Number into the first node.

    Do not change the Injection site or Default date settings!
  7. Click on Add qualifier, and add an Expiry Date.

    It is possible to record just a month and year by typing mm/yy and then Tab for it to change (eg: 12/23 to December-2023)
  8. Press OK
  9. Repeat steps 6,7,8 on the second node
  10. If more than one batch number is in use, follow the lines through the 2nd MCQ to the next pair of Add Coded Data Nodes
  11. Double click on the Add a Drug node on the right hand side of the protocol to edit it
  12. Select an Authorising Clinician, then press Update

Configuring nasal spray protocol

  1. Open the first Multiple Choice Question

  2. Select the top 'ADD here' and press Edit. Type in the first batch number then press Enter
  3. If necessary, repeat for the other two options. Practices may prefer to delete lower options, or change the name to 'Not in use'
  4. Press OK to close the MCQ
  5. Follow the first option across, through concept CT02211 and MCQ for First and Second, to the Add Coded Data nodes. Double click the top node to edit

  6. Enter the Batch Number into the first node.

    Do not change the Default date settings!
  7. Click on Add qualifier, and add an Expiry Date.

    It is possible to record just a month and year by typing mm/yy and then Tab for it to change (eg: 12/23 to December-2023)
  8. Press OK
  9. Repeat steps 6,7,8 on the second node
  10. If more than one batch number is in use, follow the lines through the 2nd MCQ to the next pair of Add Coded Data Nodes

General configuration observations

  1. The Add Coded Data nodes do not contain an Expiry date as EMIS requires entering an actual date. It was felt that adding a fictitious date presented a risk to data quality if a Practice forgot to edit it.
  2. The GMS qualifier has not been added. This is largely a legacy of when Practices submitted their own claims, and there were fewer codes. CQRS is able to identify whether a patient is eligible by their age or coded conditions, and the correct use of flu vaccination procedure codes.
  3. Adding a drug for the flu injections will assist in completing monthly FP34D claims.
  4. As Fluenz is centrally procured, there is no node for Add a Drug on the LAIV protocol.
  5. Children under 9 will trigger an extra MCQ compared to older children on the LAIV protocol. The Green Book recommends that children under 9 with a clinical risk who have never received a flu vaccination before should be offered a one-off second seasonal dose. A compromise had to be made due to protocol size constraints set by EMIS, which prevented us from including concepts to check clinical risk or history of previous vaccination.
  6. We strongly recommend not deleting any unused nodes as these may become useful later on.

Configuring Multiple Choice Questions 

Practices may prefer to customise the wording of MCQ options, perhaps to describe the vaccinations by their brand name rather than potentially confusing variations of QIV. To edit the MCQ box in HP248, you must double click the node. You can rename/edit each of these with something staff will recognise such as Flucelvax and Supemtek.

If you are definitely not using a certain type of vaccine it is possible to delete the entry, but this may mean you have to reconnect all of the lines below the deleted entry. Check thoroughly every line before saving the amendment.

Within each sub protocol for the type of influenza vaccine, You might consider adding the batch number to the line - this may become essential later on... 

After the protocol has been updated and saved (and activated for Resource Publisher sites), anybody logged on to EMIS Web will need to open a new instance to see the changes. For this reason, try to avoid making changes to the batch numbers mid-clinic.

Using HP248

The flu vaccination administration protocol works for any patient irrespective of age or more importantly whether they fall into one of the clinical risk cohorts based on codes on their record. When used with patients who are not eligible, users will see the popup below. After a clinical decision that the patient may be eligible, the code  Needs influenza vaccination can be added to the record after which the protocol will work.
Once the protocol has finished coding the vaccination and the drug, it will complete any diary entries for a flu jab, and then remind staff to check OneMonitoring for outstanding items. 

HP249 65ED correction

65ED (Seasonal influenza vaccination) was the code used for a number of years to document vaccinations done in Practice. This has been superseded but some users still select it if they are not using an up-to-date template or protocol. The code should not be used if Practices want to be paid for all activity. The protocol only works on patients who have not already got a valid flu vaccination code on their record this season (from 1st September until 31st March).

This protocol should be configured to trigger when the record is updated with a flu code:

HP249 will then automatically add the most common correct code (Administration of first inactivated seasonal influenza vaccination), irrespective of age so children given Fluenz will still have this code added.
The protocol has been enhanced for 2023/24 by alerting the user to their mistake, instead of running quietly in the background and allowing the user to continue making the same mistake.


As this protocol is only functional during the flu season, we recommend setting a reminder to deactivate it by the end of March.



These protocols contain concept rules which are specific to the 2023/24 influenza vaccination season. Do not attempt to utilise these in subsequent years - updated versions will be made available for overwriting the previous protocols.

Updated 11th October 2023 

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