The Shingles National Immunisation Programme

Make sure you regularly check for all newly-eligible patients, such as those who have a relevant birthday coming up, or those with changes to their medication that may mean they become severely immunocompromised.⁴ Remember, the shingles vaccine can be offered at any time of the year, so there is no need to restrict it to certain seasons like some other seasonal vaccines.²

Also, keep a look out for any eligible patients who have previously been missed or declined the vaccination, and encourage them to come in and get vaccinated.

Keep reading for some tips to help increase patient uptake of vaccines.

It’s important to remember that many people may not be aware or fully understand the risks, seriousness, and potential long-lasting complications of shingles – some may not even be aware there is a vaccination available. Here are some tips to tackle this.

Implement an effective call/recall service⁵

• When implementing the call phase of your service and reaching out to your patients, try to contact them through their preferred communication method – whether that be text, call, or email
• Remember, all patients should be proactively offered routine vaccinations as they become eligible – something for everyone to be aware of with the shingles eligibility criteria changing
• Ensure eligible patients who fail to receive the vaccine following the initial call are recalled. Inviting them to have their vaccination when running a dedicated shingles clinic at a time and location convenient for them might help
• For patients who don’t respond, recall at least two times to help increase uptake. Still unresponsive? Encourage them to have a face-to-face or phone conversation with you to discuss any concerns they may have and try to encourage them to book an appointment
• As SHINGRIX is a 2-dose vaccine, an effective recall system is critical to ensure eligible patients are completing their vaccination course. Please note, the national guidance for administration of the second dose as part of the National Immunisation Programme differs from the SPC.

Check back in with us soon, the illuminate team will be developing best practice case studies on effective call/recall services.

Create searches or alerts for shingles on your clinic's system

• Your patients’ Electronic Health Records (EHRs) can be used to flag eligible or soon-to-be eligible patients by using their information to set up alerts relevant to their profiles
• Generating a pop-up for patients who are suitable for the vaccination means they can be asked about the vaccine proactively when booking another appointment
• You can also use EHRs and search parameters to filter out patients with contraindications to the vaccination, those who are allergic to the vaccine’s components, or patients over the eligibility age range

Additional opportunities to maximise vaccine uptake^4,7

Patient appointments can be a great opportunity to discuss vaccinations and make new appointments – but don’t rely on opportunistic vaccinations. They are a great way to increase uptake, but they should support, not replace, an effective call/recall service. SHINGRIX can be given concomitantly with the following vaccines:

• Unadjuvanted inactivated seasonal influenza vaccine, removing the 7-day interval that was previously recommended
• 23-valent pneumococcal polysaccharide vaccine (PPV23)
• 13-valent pneumococcal conjugate vaccine (PCV13)
• Reduced antigen diphtheria-tetanus-acellular pertussis vaccine (dTpa)

Don’t forget that the vaccines should be administered at different injection sites though!

• It is important to recognise that not all eligible people can visit the practice, so be sure to reach out to care homes, ask during home visits, or contact health services for the homeless, to help increase uptake of under-served populations who would otherwise not receive the vaccine

Increase vaccination awareness

Making patients aware of the vaccine can help improve vaccine requests or just increase familiarity with it, so it is less of an unknown when they are offered it. To help achieve this you can:

• Distribute leaflets, have posters on the walls, or show short videos on the waiting room TV
• Include the information on your practice website – examples of assets which are free to order can be found on the UK government website⁸
• Other resources you can order include vaccination cards, which can be found on the GSKpro website⁹

Plan your vaccinations

• When planning your vaccine stocks, take into account any vaccination appointments that have been booked, any upcoming dedicated vaccination clinics, and the likely number of opportunistic deliveries. The benefits of having a dedicated vaccination clinic allow you to know the exact number of vaccination appointments booked, meaning you can plan the amount of stock that is required
• Dedicated vaccination clinics are a great way to deliver a significant number of vaccinations in a short time, but also require careful consideration around the number of vaccines needed. The amount will likely differ depending on the number of appointments booked in, time and day, but also the location, such as a routine clinic in your surgery, a small coffee morning in a care home, or a clinic held in a community centre
• To avoid waste, it’s important to appropriately stock and order at least every 1–2 weeks according to need¹⁰
• For the National Immunisation Programme, shingles vaccines are to be ordered via ImmForm,¹¹ at no cost to the practice

Dedicated vaccination clinics provide several benefits.

Efficient and streamlined vaccination process

Dedicated clinics help eliminate many of the delays and bottlenecks associated with the opportunistic delivery of vaccines in practice, such as reducing the need to share time, appointments, and resources across multiple vaccinations or treatment decisions. Having a single focus with everything in one location offers the most streamlined and efficient process for the vaccination of numerous patients.

• The best place for clinics is often within the GP practice, as it is familiar for patients and all the resources are already available on site. However, they can be held in a variety of locations, such as places of worship and community centres, that support improved access and convenience. This could mean holding them in a central location at the weekend to help working people who find it difficult to get to the practice during working hours or in areas that have a community that is difficult to reach and subsequently have a low uptake

Specific resources and specialised staff

Setting up a dedicated clinic can help with improved storage facilities and waiting areas for patients.

• Selecting staff who are knowledgeable about vaccines and allowing them to focus solely on administering the vaccine can help optimise quality of care and give patients confidence
• Pre-planning is needed to ensure your clinic is appropriately manned. You may want to have one or more practice nurse on site, as they will be experienced in administering vaccines and can support other staff members – although it is essential that all staff administering vaccines have received at least the mandatory NHS training on immunisation¹²

Complete immunisation records

Regardless of where the vaccination clinic is held and if a patient accepts or rejects the vaccine, it is essential to record the following information:⁷

• Informed consent
• Vaccine batch number and expiry
• Vaccine date of administration and route/site of each vaccine in circumstances where two or more have been administered close together

Record SNOMED codes

SNOMED codes should also be used to support collection of relevant vaccination data. From September 2023, data will be collected for both immunocompromised and immunocompetent patients.

The following codes for the SHINGRIX® vaccine can be used:²

Immunocompetent and severely immunocompromised

First dose: 39756611000001109, 39655511000001105, 38737511000001105 or 38736811000001106

Second dose: 1326111000000107

Administering the second dose

Here’s some tips to help ensure people come in for their second vaccination:¹³

• Communicate the importance of completing the two dose vaccination schedule
• Encourage planning: Let patients know when and where they will receive their second dose to increase follow-through
• Use prompts: Stamped vaccine cards serve as a valuable reminder and proof of vaccination
• Book quickly: If possible, book patients in for their second dose as they are having their first, via another scheduled dedicated shingles clinic
• Send reminders: Let people know that their second dose is due soon and to make an appointment. This can be delivered via SMS, email, letter, or phone call
• Give long-term perspectives: Frame their overall goal as having maximum protection by receiving both vaccinations

Not familiar with CQRS? Don’t worry – you can access CQRS training which includes job aids and tutorials to help your practice with tracking and monitoring.¹⁵

The shingles vaccination attracts quality and outcomes framework (QOF) points.¹⁶ Payment claims for the shingles programme are made monthly, and practices are only eligible for payment in the following circumstances, where all requirements are achieved:¹⁷

• The GP practice is contracted to provide vaccine and immunisations as part of additional services
• All patients in respect of whom payments are being claimed were on the GP practice’s registered list at the time the vaccine was administered, and all of the following apply:
  • The GP practice administered the vaccine to all patients in respect of whom the payment is being claimed
  • All patients in respect of whom payment is being claimed were within the cohort (as per the service specification section) at the time the vaccine was administered
  • The GP practice did not receive any payment from any other source in respect of the vaccine
  • The GP practice submits the claim within 6 months of administering the vaccine (commissioners may set aside this requirement if it considers it reasonable to do so)