Guidance

Flu immunisation training recommendations for 2020 to 2021

Published 5 August 2020

With the ongoing global COVID-19 pandemic, it is more important than ever that this year’s annual flu vaccination programme is safely and effectively delivered to as many of those eligible as possible in order to protect those at risk. It is therefore crucial that those giving flu vaccine are confident, competent and have up to date knowledge about the vaccine(s) they are giving.

Immunisers access annual flu training in a variety of different formats including webinars, e-learning and attending face to face teaching sessions. With social distancing measures currently in place however, it is likely that many of the usual planned face to face classroom-based training sessions will not be able to take place for the forthcoming flu season. In addition to this, with potential expansion of the immunising workforce in order to maximise uptake, there may be more new immunisers this season who have not previously undertaken any flu immunisation training.

Public Health England (PHE) have therefore examined the National Minimum Standards for Immunisation Training and consulted with experienced trainers. This document sets out recommendations for flu immunisation training for the 2020 to 2021 flu season. It describes what flu immunisers need to know and various ways in which they can obtain training.

1. The importance of flu training

Ongoing public and professional confidence is critical to the success of the annual flu immunisation programme. A high level of knowledge and a positive attitude to immunisation in healthcare practitioners are widely acknowledged as being important determinants in achieving and maintaining high vaccine uptake. It is therefore vital that immunisers are confident, proficient and have a sound and current knowledge of the vaccines and the vaccine programme that they are delivering.

The purpose of training is to facilitate safe and effective vaccination. It is not intended that the recommendations included in the training standards documents or guidance in this document impose an onerous requirement on immunisers or demand on service providers, and they should not be seen as a barrier which prevents timely immunisation. However, the flu programme requires that different vaccines are given to different groups of patients.

Flu vaccination should therefore never be undertaken without specific training and training should be seen as essential to a successful programme. The NHS England core service specification for the national immunisation programme requires it is supported by suitably trained staff and Patient Group Directions (PGDs) for the supply or administration of flu vaccines can only be used by competent, qualified and trained practitioners.

2. What needs to be included in flu training

The National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners and the National Minimum Standards and Core Curriculum for Immunisation Training of Healthcare Support Workers describe the minimum training, assessment and supervision that should be provided to those with a role in advising on or delivering immunisations.

Flu training should cover the topics in the Core Curriculum relevant to the immuniser’s specific area of practice, the flu vaccine(s) that they will deliver and their role in delivering the flu vaccine programme. It is acknowledged that with a significant expansion to the flu programme this year, a larger immunising workforce may be required to maximise the delivery of the flu vaccine. It may be necessary to train people who have not vaccinated for some time or who have not previously given a vaccine in order to increase flu vaccine uptake in a short time period. A summary of training requirements by workforce group for flu vaccination is provided in Appendix A.

Those delivering flu training should aim to cover the topic areas in a way that supports understanding and application of knowledge in practice. For ease for those with a responsibility for delivering flu training and for those undertaking training to ensure they have covered the relevant areas, an adapted flu-specific curriculum is available in Appendix B. Knowledge to meet the learning objectives can be acquired through a combination of theoretical and work-based training.

Many of those delivering the flu programme will be experienced immunisers and will only need to update their knowledge. Areas they should specifically look to update on include:

1. groups recommended to receive flu vaccine in the forthcoming flu season
2. the different flu vaccines available
3. which vaccine should be given to which groups
4. any new advice for this flu season
5. maximising uptake and delivering vaccines safely in the current pandemic situation
6. issues to consider if delivering flu vaccine away from usual premises (such as adequate facilities and equipment to monitor and maintain cold chain, management of anaphylaxis or adverse events)

3. Supervision and assessment

In addition to acquiring theoretical knowledge, new immunisers need to develop clinical skills in immunisation and apply their knowledge in practice. A period of supervised practice to allow observation of, and development of clinical skills and application of knowledge to practice is essential. Supervision for new immunisers and support for all immunisers is critical to the safe and successful delivery of the flu immunisation programme and work-based learning is a vital component of all immunisation training. The supervisor must be a registered, appropriately trained, experienced and knowledgeable practitioner in immunisation.

All new flu immunisers should complete a competency assessment such as the one in Appendix C for formal assessment and sign-off of their clinical competency. The assessment in Appendix C has been adapted from the competency assessment tool in the training standards documents to contain competencies specifically relevant to those who give or advise on flu vaccination.

The competencies required will depend on the individual service area and the role of the immuniser but the tool is suitable for use in all areas. Additional competencies, as required by locality or service area, can be added or adapted as necessary. Many of those new to flu immunisation will have transferable knowledge and skills, such as anaphylaxis training and giving an IM injection, even if they have not immunised previously. They should be supervised administering the vaccine until both they, and their supervisor or trainer, feel confident that they have the necessary knowledge and skills to administer vaccines safely and competently.

The competency assessment tool is also useful for more experienced flu immunisers to self-assess and identify if there are any areas where they need to update or further their knowledge and skills.

4. What flu training is available?

A flu specific e-learning programme is available free of charge with open access for all on the e-Learning for Healthcare (eLfH) website. Anyone who gives or advises on flu vaccine can undertake this elearning programme which consists of a core module and separate sessions on the inactivated and live flu vaccines.

New flu immunisers are likely to require additional training (for example in vaccine administration, storage and legal issues) if they have not administered vaccines before, depending on what their role in delivering the flu programme is going to be. They could obtain this by undertaking the relevant sessions in the general eLfH immunisation e-learning programme.

PHE slide sets for the childhood flu immunisation programme and the national flu immunisation programme will be available on the PHE flu programme webpage.

Both the slide sets and e-learning programme will be updated for the 2020 to 2021 flu season.

Webinars may be available locally, either geographically within the area of practice or within the specific setting (for example within the local health or social care setting for peer vaccinators).

In many areas, training arrangements are well-established and plans are being made to adapt training so that what cannot be delivered as a face to face session will be modified to an online meeting or webinar. Any existing training organised at local level should be utilised and those responsible for organising or providing training should consider how training can be delivered most effectively within their locality. There are multiple benefits in offering local training where possible as it allows both for any specific local needs or arrangements to be covered and the potential for smaller group interactive online learning which could incorporate a question and answer session.

5. Additional considerations

Immunisers have a personal and professional responsibility to ensure that they are knowledgeable, confident and competent to administer flu vaccine and to inform their employer if they identify a need for further training.

It is important that adequate protected and dedicated study time is given to those that need to undertake flu training. Consideration should also be given to the fact that new flu immunisers will require more time for training than those who are updating knowledge acquired in previous flu seasons. In addition, immunisers should be given access to relevant technology to enable them to undertake e-learning and participate in online training sessions.

Employers should ensure that in addition to immunisation specific training, anyone involved in administering flu vaccine has undertaken any additional core training required to enable them to carry out their role safely. This may include Basic Life support (BLS), management of anaphylaxis, safeguarding, infection prevention and control and information governance.

6. Remaining up to date

Flu immunisers should ensure they are familiar with all the latest relevant information available about the flu programme. This includes:

• Green Book Influenza chapter
• annual Department of Health and Social Care ((DHSC)/PHE/NHS E&I flu letters
• PHE ‘Information for Healthcare Practitioner’ documents
• other PHE flu programme guidance

They should also ensure they remain up to date throughout the flu season by subscribing to the monthly PHE publication Vaccine Update and reading any subsequent letters and information materials from DHSC, NHS England/Improvement and PHE that become available. Updating should be seen as a continuous process rather than purely as a one-off requirement at the beginning of the flu season.

7. Contact information

Even with the most comprehensive training, questions will arise as the flu immunisation programme is underway. It is important that immunisers know who to contact for advice if they are unsure about eligibility for flu vaccine, which flu vaccine to give or what to do if a vaccine error occurs. This may be their local Screening and Immunisation team, PHE Health Protection Team, other locally available immunisation lead, Medicines Management team, Occupational Health lead and Lead Pharmacist, for example. Those responsible for flu programmes are requested to make this information available to flu vaccine providers.

8. Summary

This year, it is more crucial than ever that the flu immunisation programme is effectively delivered to as many of those eligible as possible. This will require confident, competent immunisers. It is vital that flu immunisers are given the time and opportunity to undertake the training they need and that they are supervised and supported in practice as required.

The comments and suggestions from expert training colleagues in the writing of this statement are very gratefully acknowledged.

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