Operationalising updated JCVI advice - Spring boosters and 5-11 year old vaccination


This note sets out the operational actions systems must now take to deliver Spring boosters from 21 March 2022 and 5-11-year-old vaccination from 4 April 2022. This note should be read alongside our 5-11 vaccination letter from 18 February and planning letter from 23 February.

Spring Boosters: JCVI advice is available here. The Green Book Chapter 14a has been updated here. No changes to the Patient Group Direction (PGD) or National Protocols are required.

5-11s:  JCVI advice is available here. The Green Book Chapter 14a has been updated and PGD and National Protocol will be published by 25 March.

Please note that further operational guidance will be provided to support vaccination of 12 year olds in Year 7 with Comirnaty® 10 micrograms/dose Concentrate (“Comirnaty® 10 micrograms/dose”). This change is not expected to be implemented until April and no action needs to be taken now.

ACTIONS NOW REQUIRED: SPRING BOOSTERS

All systems are now asked to work with providers to determine the local delivery model mix to offer a Spring booster to those who will be eligible from w/c 21 March 2022, with this phase of boosters expected to be largely completed by 30 June 2022.  

Note: Spring booster vaccinations should not be administered prior to 21 March.

Spring Boosters for those who are aged 75 years and over: the offer should include those who will have turned 75 years by the end of the Spring Booster campaign on 30 June 2022.

Spring boosters for all residents of older adult care homes: consenting should commence now so visits can commence from 21st March.  As usual, visits should be an opportunity to offer vaccination to new residents who have not yet received a full primary course or are in need of a booster as well as to care home staff who have not yet received a full primary course and a booster.

Spring boosters for eligible housebound individuals: providers should utilise support such as St John Ambulance to ensure those who are eligible and housebound can be offered a vaccination in a timely way.

Spring boosters for immunosuppressed people aged 12 years and above: this cohort is defined in the Green Book Chapter 14a Table 3 and 4.  Please note, some immunosuppressed people who will be eligible for a Spring booster will not have a letter from their clinician.  Therefore, sites will need to ensure they have plans in place to facilitate boosters for this group, either through a clinical conversation or the provision of evidence of their condition or therapy demonstrating their immunosuppression. The clinical assessment framework for assessing immunosuppressed patients has been updated to support vaccination teams and is available here.

For action: all sites delivering Spring boosters

  • Managing capacity and booking vaccination appointments: the NBS will be available for booking from 21 March. This will be supported through national call/recall activities. Sites can already add booster appointments to their calendars and are asked to upload capacity to at least the end of April by Wednesday, 16 March 5pm.
  • Workforce: sites should roster staff to meet capacity from the w/c 21 March. There are no additional workforce training requirements associated for the delivery of the Spring booster. 
  • Vaccine supply: as many sites as possible should be assured for all vaccine types by the end of March to support flexibility and resilience. PCN Groupings and Hospital Hubs/Hospital Hubs+ who have not previously been assured for Spikevax® should commence the assurance process as soon as possible. Please see SPS guidance on multiple vaccines assurance available here.

For Local Vaccination Services: supply ordering process remains via log in to Foundry to order vaccine supply through the Ordering Platform.

For VCs, HH/HH+s: from 18th March, all sites are expected to place orders through the Ordering Platform only. The Ordering Platform will be made available to access smaller 'pack down' sizes of vaccine from SPLs. VCs and HH/HH+s can continue ordering Comirnaty® 30 micrograms/dose and Spikevax ® supply from Immform until 18 March.

  • Recording booster vaccinations: POC systems currently present the last booster dose in an individual’s vaccine history, the recording of subsequent boosters does not overwrite previous vaccination records. The warning messages will be updated in due course.

For all PCN-led local vaccination services (LVS)

  • The General Practice COVID-19 vaccination Enhanced Service Specification will be updated shortly and will be available here [Coronavirus » Enhanced Service Specification: Phase 3 coronavirus vaccination (england.nhs.uk)].
  • The General Practice enhanced service specification includes the following updates:
    • The ES will be extended to 30 September 2022.
    • It will be possible for some sites to pause post April i.e., temporarily stop delivering COVID-19 vaccinations but being on standby should there be a surge. Further detail will be published shortly.
    • The additional supplement of £10 per dose in addition to the item of service fee continues to apply for all vaccines delivered to older care home residents or to those eligible patients classed as housebound.
  • Where PCN Groupings can provide capacity for Spring boosters, they should advise their local commissioner. Continued participation in the programme is contingent on practices being able to deliver core primary medical services.
  • The GP Dashboard will be updated to reflect changes to eligibility to enable local call and recall. 

For all community pharmacy-led LVS

  • The Local Enhanced Service specification for CP ledLVS will be updated shortly to allow contractors to vaccinate after 31 March and will be available here [https://www.england.nhs.uk/coronavirus/publication/community-pharmacy-local-enhanced-service-specification-phase-3-coronavirus-vaccination/].
    • The LES will be extended to 30 September 2022.
    • The amendments within the LES allow pharmacy contractors and regional teams to agree to a flexible offer of vaccinations or to pause their involvement and re-engage with the programme if patient demand increases.
    • The additional supplement of £10 per dose on top of the item of service fee continues to apply for all vaccines delivered to residents of older adult care homes or to those eligible patients classed as housebound.
  • Sites should agree the weekly capacity they can offer for Spring boosters with their Commissioners, taking into account capacity for vaccinating 5-11-year olds and evergreen offer.
  • Pharmacy contractors need to accept the terms of the LES extension by writing to their regional team. Continued participation in the programme beyond 31 March is contingent on pharmacy contractors being able to deliver core Community Pharmacy Contractual Framework terms of service. 

Vaccination Centres and Hospital Hub/Hospital Hub+ (HH/HH+)

  • All acute trusts should offer Spring boosters in line with guidance set out in the planning paraments. The NHS Standard contract will be updated to reflect JCVI advice. Vaccination Centre providers should confirm with their system and regional teams before offering Spring boosters.  Trusts providing community or MHLDA services should offer spring boosters to eligible people particularly on, for example, inpatient Older Adult Mental Health and intermediate care wards.

ACTIONS NOW REQUIRED: 5 to 11 Year Olds

All systems are now asked to work with providers to determine the local delivery model mix to offer 5-11 year old vaccination, with first vaccinations starting from 4 April 2022, ensuring as much capacity as possible is available over the Easter holiday to maximise opportunity.

This will not be an in-school offer, except where SAIS providers are used to provide vaccinations in special educational needs (SEN) schools. However, there may be instances where it is appropriate to commission SAIS providers to deliver some of these vaccinations, subject to regional approval and assurance.

The August to September 2022 systems return will be used to capture those sites who will opt in/out of the 5-11s offer. Regions will then have a window of opportunity to confirm by 18th March (a) which sites already delivering to 5-11s at risk will expand to offer to all 5-11s and (b) which new sites will be opting in and have already completed checklist A, B and C.

Assurance and planning:

No further assurance is required for sites currently offering 5-11s at risk.  New sites opting in to offer a service to this cohort should complete Children’s Self Assessment Checklist (Part A, B, C) and the vaccine assurance checklist for Comirnaty 10 micrograms/dose COVID-19 mRNA vaccine. New sites need to follow the correct assurance processes, ensuring appropriate regional or superintendent  Pharmacist and national approval, as per the relevant delivery pillar.

For Community Pharmacy

  • Community pharmacy-led sites vaccinating children under 12 years of age can claim a one-off payment of £1,500 per site to ensure training and assurance can be carried out in a timely manner. Regional commissioners and finance teams should work together to agree named contacts and defined activities to support payments to pharmacy contractors according to the usual Reasonable Additional Claims process once the regional commissioner has confirmed that the site is assured and marked as such on Foundry.
  • The Local Enhanced Service (LES) specification is being amended to reflect this funding change and to extend the end date to 30 September 2022.
  • Community pharmacy-led sites are eligible for a £10 supplement in addition to the Item of Service fee for vaccinations administered to children aged 5-11 years old who are not in a clinical risk group. We will provide guidance in due course on how this payment will be triggered.
  • Where current sites are limited by size, further CP sites may be identified that can offer a pop-up clinic off-premises for the initial weeks of the vaccination.
  • Sites should check with their indemnity providers before commencing vaccinations for this age group. 

For Practices and PCN Groupings

  • PCN groupings that deliver the offer must consider taking on additional appropriately trained staff to support this cohort and continue to maintain their core areas of work caring for their populations.
  • GP practices working inPCN Groupings may in some cases be commissioned to vaccinate 5 to 11 yearolds who are not in a risk group, where:
    • Systems have assessed that there is a need to ensure coverage and/or equity of access, and this has been agreed with the region.
    • The practice agrees to vaccinate this cohort.
    • The practice has considered taking on additional, appropriately trained staff for vaccination this cohort; and
    • The practice can demonstrate that they can continue to maintain their core areas of work, caring for their populations.
  • Where practices are vaccinating 5 to 11 year olds for other catch up vaccinations (such as MMR), consent and Green Book Chapter 14a co-administration guidelines should be followed.
  • PCN groupings should continue to identify and vaccinate 5 to 11-year olds in a clinical risk group or who are household contacts of someone who is immunosuppressed.
  • There may be times when it is appropriate forPCN groupings to vaccinate children aged 5-11 years old who are not in a clinical risk group, where they are otherwise not commissioned to do so. These include, but are not limited to:
    • If a 5 to 11 year old in a clinical risk group has a sibling that is not in a clinical risk group or family member who the family would like to get vaccinated at the same time (subject to usual rules around consent).
    • If vaccine would otherwise be wasted.
    • If there is a belief that turning away a child may lead to that family not receiving vaccination or negatively impacting the family’s view of immunisations.
  • There may be other scenarios where a prescriber wishes to vaccinate before the start date of 4 April. Where a prescriber deems this necessary, they can vaccinate under PSD.
  • Practices are eligible for a £10 supplement for vaccinations administered to children aged 5-11 years old who are not in a clinical risk group. We will provide guidance in due course on how this payment will be triggered.

Vaccine supply Comirnaty® 10 micrograms/dose

  • Regionally assured providers will be supplied with Comirnaty® 10 micrograms/dose vaccine in late March for the vaccination of 5 to 11 year olds and will be allocated in the same way as other vaccines are currently.
  • Ordering Comirnaty® 10 micrograms/dose will be the same across all delivery models. This may involve changes to existing processes for some sites:
    • Approved Local Vaccination Service (LVS) sites continue using the ordering platform.
    • Approved VCs and HH+s will be required to order Comirnaty® 10 micrograms/dose using the ordering platform. All VC/HH+ sites ordering Comirnaty® 10 micrograms/dose will receive full training on how to operate the ordering platform and information will be shared shortly. 
  • The Specialist Pharmacy Service (SPS) Standard Operating Procedures for handling the Comirnaty® 10 micrograms/dose is available here.

Training and creating a positive environment

Consent

  • Consenting this age group is the responsibility of each provider and systems need to capture and process consent.
  • Information for parent /guardians and children will be provided through national call and recall.
  • Those with parental responsibility will be provided with guidance that they should be contactable at the time of vaccination to give consent, if they are not intending to attend with their child.

Booking systems

  • The National Booking Service will open on 2 April 2022 for booking for all children aged 5 to 11.
  • Assured sites will be able to add appointments to the 5 to 11 service line (Comirnaty® 10) from the week commencing 28 March and national call and recall will be released over April.
  • For sites that have a secondary 12-15 site calendar, please be aware that the 5 to 11 vaccine type will be added to the primary NBS site (16+). The 12-15 site calendar will remain separate until later in April when we expect to add 12-15 as a new vaccine type to the primary site.
  • NBS will be updated to allow for 10-minute appointments and does not currently support group bookings.
  • Families with more than one child may attend together and no eligible child should be turned away.
  • Walk-ins for 5 to 11 year olds may commence from day one.
  • The NBS will direct children (mostly likely ‘at risk children’) who received a fractional dose of Comirnaty® 30 micrograms/dose for their first dose, to their GP to complete their primary course.
  • Children over 5 who have received a vaccine overseas will be able to get their record updated within the National Immunisation Management System (NIMS) through the overseas vaccinations recording service from 2 April.

Post-vaccination observation

Children with specific risk factors will need a period of observation as detailed in table 5 in the Green Book (here).