National clinical audit 2018/19 – Flu vaccination for people with diabetes
National clinical audit 2018/19 – Flu vaccination for people with diabetes
Contractors must undertake a clinical audit each year, the topic of which they choose. In addition to this pharmacy-based audit, they must also complete an audit on a topic that has been determined by NHS England.
On 24th October 2018, NHS England published the paperwork for the 2018/19 national clinical audit; this must be completed by all pharmacy contractors.
The focus of the audit is the provision of advice to people with diabetes on the importance of them receiving an annual seasonal influenza vaccination. The audit has been timed to take place during the flu vaccination season, so that people with diabetes can be encouraged to be vaccinated and where they have not yet been vaccinated and the pharmacy offers the NHS flu vaccination service, they can be offered a vaccination at the pharmacy.
The purpose of the audit
Choosing a national topic allows the audit to focus on a priority issue for the NHS, in this case improving the care of people with diabetes. People with type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs and diet-controlled diabetes are all eligible for an NHS seasonal flu vaccination from a community pharmacy or their registered general practice. The Community Pharmacy Contractual Framework (CPCF) includes a requirement that opportunistic healthy lifestyle advice and public health advice will be provided to patients receiving prescriptions who appear to have diabetes; this advice could include providing information about the benefit of receiving a flu vaccination.
We know that, of the identified clinical at-risk groups for flu vaccination (i.e. the eligible cohorts aged 18-64, that are not based on age criteria only), adults with diabetes have the highest flu vaccination uptake levels (65.2% in 2017/18), however this still falls short of the long-term ambition of a minimum 75% uptake rate for all eligible adults, recommended by the World Health Organization.
The audit will be largely focused on patients collecting medicines and supplies for management of their diabetes, although any person with diabetes who visits the pharmacy during the audit period could participate in the audit.
The aims of the audit are:
a) To assess the frequency of provision of public health advice to people with diabetes on the importance of them receiving a flu vaccination; and
b) To determine why some people with diabetes are not vaccinated against flu, so that this insight can help inform future work by NHS England and individual community pharmacies to increase the vaccination coverage of this group in future years.
The audit standard is:
70% of people with diabetes identified by the pharmacy staff during the dispensing of a prescription or in another way, are offered public health advice on the importance of them receiving a flu vaccination
When should the audit be completed?
The audit should be conducted during October, November or December 2018 (by 16th December 2018) and the duration should be one week, or if required, a longer period in order that a minimum of ten patients per community pharmacy are covered by the data collection.
The audit will be conducted during this period as it is an ideal time to ensure that people with diabetes are reminded of the importance of receiving a flu vaccination, potentially at the pharmacy, if the Community Pharmacy Seasonal Influenza Vaccination Advanced Service is being provided.
The audit paperwork
You can download a copy of the audit guidance document and the data collection sheet from the NHS England website.
What to do next
1) Choose a week in October, November or December 2018 when you will commence the data collection (data collection must conclude by 16th December 2018);
2) Download copies of the audit paperwork via the NHS England website;
3) Follow the instructions in the audit guidance on completion of the audit; and
4) Submit your collated audit data to NHS England by visiting https://pharmacy-flu2018.nhsdatacollection.org/ and entering your data from the data collection sheet onto the web-based form.
This PSNC guide explains how to submit your audit data to NHS England.
The data must be submitted by midnight on 30th December 2018.
Actions to be taken following the submission of your data
Once you have submitted your audit data to NHS England, pharmacy contractors should:
- consider your compliance with the audit standard and whether there are changes to your processes which could improve compliance levels for provision of advice on flu vaccination to people with diabetes; and
- consider the information provided by NHS England (see below) on trends in relation to people with diabetes that did not previously have a flu vaccination and potential actions which pharmacy contractors could take ahead of the 2019/20 flu vaccination campaign to increase vaccination uptake in that patient group. The contractor should then consider whether there are any changes to their procedures which could be made.
A record of these actions can be made using the template in Annex A of the audit guidance document.
Once all pharmacies have submitted their audit data, NHS England will:
- examine data from PharmOutcomes, Sonar & ImmForm on community pharmacy administered flu vaccinations for people with diabetes, to assess if there has been any change in vaccination uptake via community pharmacies in 2018/19 compared to 2017/18; and
- examine the data on the reasons given for why patients did not get vaccinated in 2017/18 to identify any trends and potential actions which NHS England, Public Health England (PHE) or pharmacy contractors could take ahead of the 2019/20 flu vaccination campaign to increase vaccination uptake in that patient group. The findings will be communicated to pharmacy contractors and will also be discussed with PHE to inform planning for the 2019/20 season. NHS England hope to be able to communicate these findings in spring 2019.
Q. Do pharmacies have to undertake the audit?
Yes, undertaking the audit is a contractual requirement. If a pharmacy does not undertake the audit it is a breach of their contractual responsibilities.
Q. My pharmacy does not provide the NHS flu vaccination service. Do I still need to complete this audit?
Yes; all English community pharmacies must complete the audit. If you identify a person who is eligible for a flu vaccination, but has not yet had one, they can be referred to another pharmacy providing the flu vaccination service or their general practice for vaccination.
Q. Why has this topic been chosen?
The audit topic has been chosen because improving the care of people with diabetes is a clinical priority for NHS England and community pharmacies can contribute to that aim by providing lifestyle advice to this group of patients, including on the importance of being vaccinated against flu.
Q. How much work will the audit be?
PSNC has worked with NHS England to ensure the audit paperwork is straightforward to complete and most pharmacies will only need to undertake the audit during a one week period. Feedback from the pharmacies involved in piloting the audit suggests that it should not take up a significant amount of time to complete.
Q. What do I do if I have no people with diabetes using my pharmacy during the audit period?
In the unlikely event that no people with diabetes use the pharmacy during the initial one-week audit period, the pharmacy should extend the duration of data collection until a minimum of ten patients are covered by the audit.
Q Do distance selling pharmacies have to undertake the audit?
Yes, all pharmacies must undertake the audit.
Q Why is the audit being undertaken now?
The timing of the audit has been chosen to coincide with the flu vaccination season, so any people identified via the audit as being eligible for flu vaccination can be vaccinated by the pharmacy or be referred to another pharmacy or their general practice for vaccination.