GP mythbuster 89: Immunising people with an underlying medical condition

Professional guidance

Public Health England (PHE) immunisation schedules for the UK population. They are based on recommendations of the Joint Committee of Vaccination and Immunisation. There are specific recommendations for immunisation of people with an underlying medical condition.

PHE and the Department of Health and Social Care update The Green Book regularly. It includes chapters on principles of immunisation and on each vaccine-preventable infection. Chapter 7 deals with immunisations for people with an underlying condition.

The Patient Group Direction (PGD) provides guidance on eligible groups for each vaccine. This includes vaccination of people with asplenia and sickle cell disease. It also includes conditions such as diabetes and chronic respiratory disease.

GP practices must explain the benefits clearly when offering vaccination to patients. They need systems to identify relevant patients. Practices should make sure these patients are vaccinated following current recommendations. Search the clinical records system regularly for patients who may be eligible for vaccines due to a new diagnosis or treatment. Relevant diagnoses in incoming clinical correspondence should be coded appropriately. This makes sure data retrieval is accurate.

When we inspect

We use these Regulations when we review if the practice is safe, effective, responsive, caring and well led. When we inspect, we look at the safety of immunising people with an underlying medical condition. This relates to:

• Regulation 12 (Safe care and treatment)
• Regulation 18 (Staffing)

GP practices need to take extra care that immunisations they carry out are right for people with an underlying medical condition.

We consider how GP practices support the immunisation programme. We consider whether staff providing immunisations are trained and competent to do so. This relates to key lines of enquiry (KLOE):

• E3 Staff skills and knowledge
• E5 Supporting people to live healthier lives

We expect GP practices to:

• have a reliable system for adding appropriate clinical codes to patient records. For example from correspondence when a new relevant diagnosis is made
• carry out regular searches using clinical codes. This is to make sure vaccination and boosters have been offered to relevant patients
• follow PHE guidance on ordering, storing and handling vaccinations
• make sure nurses who are not qualified as independent prescribers are using Patient Group Directives (PGDs) and ensure they use them appropriately.

All immunisers must:

• have received specific immunisation training, based on PHE national minimum standards and core curriculum for immunisation training
• stay up to date with current practice in immunisation, including new recommendations
• have access to PHE’s monthly publication Vaccine Update
• know how to contact local PHE immunisation staff for advice.