NHS England (London)
(Organisation Name)
General Information
This Agreement is made between NHS England London (The Commissioner) and the
above organisation (The Provider).
 The Organisation: This is the contractor as listed on the pharmaceutical list held by
NHS England
The Service:
Services provided by the Organisation, as specified in this
The Commissioner: NHS England
Purpose and Period of the Agreement
The purpose of the Agreement is to set out the responsibilities of both the
Commissioner and the Service provider.
The Agreement is effective from September 1st 2013 – February 28th 2014
unless terminated earlier in accordance with the provision below, or varied in
accordance with provision below.
Service Specification
The Service will be known as the Influenza Vaccination Community Pharmacy
Enhanced Service.
The Service to be provided is as set out in the Service Specification in
Schedule 1.
Responsibilities of NHS England
To provide funding, as set out in the Service Specification.
To provide agreed information within mutually agreed time scales.
The Professional Pharmacy Advisors , named in Schedule 3, will work with the
designated lead officer of the Organisation for the purpose of monitoring the
level and quality of service provided under the terms of this Agreement.
Flu Immunisation Community Pharmacy Enhanced Service 2013/14
To provide an authorised Patient Group Direction for the administration of
seasonal influenza vaccines by community pharmacists for the 2013/14
Responsibilities of the Organisation
To run and manage the Service effectively and efficiently.
To ensure that suitable staff/volunteers are recruited and trained.
To satisfy quality and performance standards as set out in the service
To provide monitoring and financial information to the appropriate The NHS
England Head of Immunisation Service, or delegate officer.
To advise The NHS England, via the Professional Adviser, of any difficulty in
relation to this Agreement e.g. where the Service falls below target levels or
major staffing problems occur such as prolonged sickness absence, or
potential SUIs.
To consult with The NHS England before any significant changes to the
structure, function, staffing or duration of the Service.
To provide agreed information within mutually agreed time scales.
To comply with all statutory and other provisions to be observed and
performed in connection with the Services and indemnify the NHS England
against all actions, claims, demands, costs, charges and expenses
whatsoever in respect of any breach by the Organisation of this Agreement.
Any litigation, resulting from an accident or negligence on behalf of the
organisation, is the responsibility of the organisation who will meet the costs
and any claims for compensation, at no cost to the NHS England.
Funding is for a specific period as set out in Schedule 2.
The NHS England has the right to suspend funding in the event of:
7.2.1 The Organisation failing to attain the agreed level of activity of service.
7.2.2 A cessation of the Service
7.2.3 A failure on the Organisation’s part to fulfil the terms of this Agreement.
Flu Immunisation Community Pharmacy Enhanced Service 2013/14
7.2.4 Commissioned services support or assist activities which are political or
of an exclusively religious nature or which may bring The NHS England
or any funders into disrepute.
It is a requirement of the Agreement, that the Organisation immediately
informs the NHS England via designated lead officer, of any significant change
in its financial or managerial circumstances, which may materially affect the
ability of the Organisation to supply the Service covered by this Agreement.
The Organisation will employ appropriately qualified and experienced
staff/volunteers to maintain the Service to the agreed specification.
The organisation will have in place agreed employment policies such as: Terms and Conditions of Employment, Grievance and Disciplinary, Health and
Safety, Equal Opportunities, Recruitment and Retention and any other
appropriate policies necessary. Copies of policies will be provided to the NHS
England on request
The Organisation will maintain and operate good employment practice
ensuring that full Job Descriptions and Contracts of Employment are issued to
all members of staff.
Staff should be offered suitable training and support to enable them to carry
out their role effectively.
It is the responsibility of the Organisation to take appropriate measures to
protect the public when recruiting staff/volunteers. All employees will have
been appropriately vetted by the Organisation and hold accredited
qualifications where appropriate. References and police checks where
appropriate, will have been taken up in all cases. It is the responsibility of the
Organisation to judge the suitability of applicants on the basis of such
procedures. The Professional Advisor will have the right to make random spot
checks on behalf of The NHS England to ensure that the procedure of vetting
is being carried out.
Contract Monitoring by NHS England
NHS England will conduct contract monitoring visits in accordance with the
Community Pharmacy Contractual Framework. Pharmacies failing to achieve
standards required for essential services may not continue to provide
enhanced services.
Following a monitoring visit, the designated officer will write to the
Organisation detailing any areas of concern arising out of the visit, and any
further action required by the Organisation.
NHS England reserves the right to carry out any additional monitoring of the
Organisation and the Service, as is deemed necessary to ensure that the
Flu Immunisation Community Pharmacy Enhanced Service 2013/14
standard of the Service complies with the specification in Schedule 1 of this
The Organisation is required to arrange adequate insurance cover consistent
with the Service provided. This must include Public Liability and Employers
Liability Insurance, evidence of which will be required.
Complaints Procedure
The Organisation will have a written procedure for dealing with complaints in
line with the current NHS England Complaints Procedure. These procedures
must include a record of all complaints and the action taken on them. The
record will be available at any time for inspection by the appropriate NHS
England Associate Director. The complaints procedure must be prominently
displayed for patients/clients and easily accessible.
Equal Opportunities
The Organisation is required to have an Equal Opportunities Policy outlining
principles of Equal Opportunities and is expected to demonstrate its
effectiveness in this area, particularly in relation to the provision of the Service
covered by this Agreement.
The Organisation will ensure that their recruitment procedure for any new
staff/volunteers involved in the project adhere to equal opportunities policy.
The Organisation is required to have a written policy on Health and Safety,
covering the Service and this should be made available on request. The
policy should include:
Reporting, recording, investigating of accidents
Fire precautions and evacuations procedures
First aid arrangements
Training of staff in Health and Safety matters.
Update health and safety policy when needed.
The Organisation and its staff/volunteers may be receiving personal and
confidential information from service users.
The Organisation’s
staff/volunteers must not disclose any information which comes into their
possession in the course of providing the Service except as may be required
by law, or where the express consent of the individual concerned, has been
obtained. This includes information acquired through complaints procedures.
Flu Immunisation Community Pharmacy Enhanced Service 2013/14
The Organisation will ensure policies/procedures are in place to prevent
unauthorised disclosures. Disclosure of information which has not been
authorised will be considered as a serious breach of the terms of this
Memorandum of Agreement and could result in the termination of the
Agreement as outlined in paragraph 20.1
The organisation must be compliant with the NHS Information Governance
Toolkit v9 (April 2013).
All communications with General Practice must be secure via SONAR or
WEBSTER, or a secure messaging system via an N3 connection for audit
Statutory Requirements
The Organisation shall conform to all existing and new legislation, which may
be applicable to this Agreement.
Major Incidents and Business Continuity Planning
The Organisation is required to have an effective Business Continuity Plan.
Variations in the Terms of the Agreement
Variations in the terms of this Agreement will be agreed by both parties and
confirmed in writing by the NHS England Variations will normally require at
least one months notice.
Breach of the Agreement
If the Organisation believes that the NHS England has broken the terms of this
Agreement it will submit written details of the alleged breach and, unless the
matter is otherwise resolved, a meeting will be arranged between the
appropriate the NHS England (London Region) Head of Immunisations and
the Organisation to discuss the alleged breach.
If there is Agreement that a breach has taken place, action to be taken to
remedy the breach and the time scale for such action will be agreed and
confirmed in writing by the NHS England
If there is no agreement, the alleged breach will be referred to the Head of
Public Health and Health in the justice System at NHS England (London
Region) for a suggested resolution. This will be agreed with the Organisation
and confirmed in writing by the NHS England.
Breaches by the Organisation will be dealt with as set out in either Section 20
or Section 21 depending on the nature and severity of the breach.
Shortfalls or Deficiencies in Service Provision
Flu Immunisation Community Pharmacy Enhanced Service 2013/14
20.1 Where shortfalls or deficiencies in service provision have been identified or
where other conditions of this Agreement are not being met, the Organisation
will be notified and a meeting will be arranged between the Organisation and
the appropriate lead officer. If a breach has occurred, a course of action to
rectify the breach will be agreed; this will be confirmed in writing by the NHS
20.2 Where there is a failure to rectify the shortfall or meet the conditions within the
agreed time-scale, the matter will be referred to Director of the NHS England
to decide what further action should be taken.
20.3 If there is persistent and serious failure to fulfil the terms of the Agreement
then the designated lead officer will refer the matter to a Director with a view to
terminating the Agreement.
Termination of the Agreement
21.1 The Agreement may be terminated immediately in the event of any of the
21.1.1 A permanent cessation of the Service
21.1.2 A persistent failure to fulfil the terms of the Agreement
21.1.3 A serious breach of the terms of the Agreement
21.1.4 The performance of the services is unsatisfactory and documented to
be so.
21.1.5 There is a substantial change to the service, which the NHS England
has not approved.
21.2 The Agreement can otherwise only be terminated by either party on written
notice of six months. However, in fairness to both parties to this Agreement,
and at the first indication of any such possibility, the implications of not being
able to fulfil their obligations should be discussed without prejudice at the very
earliest opportunity.
21.3 Where the Agreement is terminated following notice under paragraph 21.1 the
rights accrued by either party at the date of termination are not affected and
there shall be a full accounting between the parties at that date or within three
months of the date.
Additional Notes
22.1 NHS England must protect the public funds it handles and so may use the
information the Organisation have provided under this Agreement to prevent
and detect fraud. The NHS England may also share this information for the
same purposes, with other organisations that handle public funds.
22.2 Publicity: The Organisation is expected to consult with the NHS England
officers about any publicity, whether adverse or positive, for any work funded
through the NHS England SLAs. The Organisation is expected to take full
Flu Immunisation Community Pharmacy Enhanced Service 2013/14
advice on the handling of such matters from The NHS England’s
communication team.
Schedule 1
Community Pharmacy Seasonal Influenza Vaccination Enhanced Service
The Aims and Objectives of the Service:
The aim of the service is to provide influenza immunisation for patients aged 65 years
and over and those under 65 years in other at-risk groups. This is to reduce the
serious morbidity and mortality from influenza by immunising those most likely to
have a serious or complicated illness should they develop influenza. This can avert
the need for the patient to be hospitalised.
The objectives of the service are:
1. To increase access to influenza immunisation
2. To offer patients choice of provider for their annual seasonal
influenza immunisation;
3. To decrease morbidity and mortality rates from incidences of
seasonal influenza;
4. To increase uptake of influenza vaccination in frontline health
and social care staff employed in London.
5. To include at-risk groups covered by this service are those
who are listed in the Inclusion Criteria of the NHS England
Patient Group Direction for the Administration of the 2013/14
Seasonal Influenza Vaccines by Community Pharmacists.
6. Those living in care homes, long-stay residential or other
long-stay facilities and halls of residence, predicated upon
exceptions requests by authorisation by NHS England.
7. Undertaking the service in prisons is being considered.
8. Those who are in receipt of a carer’s allowance, or those who
are the main carer for an elderly or disabled person whose
welfare may be at risk if the carer falls ill. Register Carers, at
GP practice, to be prioritised in this programme
9. Local Authority carers are not, at this juncture, covered.
10. Pregnant women at any stage of pregnancy;
Flu Immunisation Community Pharmacy Enhanced Service 2013/14
Description of Service:
1. Service Provider
Organisations will be authorised to provide the service based on the following criteria:
1.1 The service will be provided in an approved pharmacy with a designated
consultation room/area or provide the service in alternative premises.;
1.2 The service will be provided by an accredited pharmacist, working for the
Pharmacy Contractor (service provider), who has completed the training
detailed below and signed an authorised copy of the NHS England Patient
Group Direction for the Administration of the 2013/14 Seasonal Influenza
Vaccines by Community Pharmacists ;
1.3 Vaccines must be stored in a suitable ‘fridge with the storage capacity and
temperature monitoring systems described below;
1.4 The service may only be provided from the pharmacy premises on the
pharmaceutical list that meet the requirements set out below, with the
exceptions also set out below.
1.5 The service provider must ensure that the pharmacist has access to at least 2
ampoules of Adrenaline 1:1000, including the necessary syringes and needles
required for administration. Where this is provided as “Epipen” then there must
be at least 2 “Epipens” available. The provider should also ensure that a copy
of the most recent version of the Anaphylaxis Algorithm, produced by the
Resuscitation Council (UK) is available (can be downloaded from )
1.6 The service provider will not assign the whole or any part of the Agreement or
sub-contract the supply of services without the previous consent in writing of
the commissioner, unless special conditions are included elsewhere in the
2. Pharmacist Accreditation
Pharmacists providing this service must meet the following criteria:
2.1 The pharmacist providing the service is registered with the GPhC.;
2.2 The accredited pharmacist works regularly for the contractor at a pharmacy that
meets the premises criteria specified in this agreement;
2.3 The pharmacist is able to vaccinate at least 20 persons during the relevant period;
2.4 The pharmacy contractor will ensure that any pharmacist who is involved in
administering a vaccine has successfully completed a training course that meets
Flu Immunisation Community Pharmacy Enhanced Service 2013/14
the requirements of the National Minimum Standards for Immunisation Training
(published by the Health Protection Agency).
Pharmacist can access
resuscitation update via e-learning module, PHE e-learning module (On-line
immunisation training modules is available Skills for Health Core Learning: and NPA
e-learning module or approved alternative update training.
Training providers that meet the National Minimum standards for immunisation
training and that have been approved by NHSE include;
Burrage Ayres
Charles Bloe Ltd
The Pharmacy Training company
Clockwork Medical Health Centre
2.5 Training must provide pharmacists with the skills necessary for administering
intra-muscular injection, including:
a. Needle length and needle bevel – research findings on the significance
of this;
b. Body mass and choice of needle length;
c. Intramuscular sites and the rationale for this choice;
d. How to administer an intramuscular injection, including patient
assessment, side effects and contraindications to influenza
e. Anaphylaxis – recognition and treatment.
2.6 The pharmacist has completed and passed a recognised Basic Life Support
(BLS) training course in the past 12 months, or approved alternative update
training (BLS training must be updated every 3 years);this can be face to face or
via e-learning.
2.7 The pharmacist has signed an authorised copy of the NHS England Patient Group
Direction for the Administration of the 2013/14 Seasonal Influenza Vaccines by
Community Pharmacists
2.8 Pharmacists should maintain clinical knowledge appropriate to their practice by
attending relevant study days, courses and making themselves aware of
appropriate literature;
2.9 Pharmacists providing this service should be aware of having f up to date hepatitis
B vaccination. (according to local arrangements)
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Staff Training
The pharmacy contractor will ensure that all members of pharmacy staff are trained
on the operation of the scheme and full details will be made available to locum
3. Vaccinations
Flu Vaccines will be procured and manage by licensed wholesalers or from
manufacturers and NHS England will pay for the vaccine invoice and
anaphylaxis (1:1000 Adrenalin) costs
NHS England will Fund any exceptional clinical waste contract which cannot
align to existing contracts or dovetail into another scheme.
4. Fridge Storage Capacity and Temperature Monitoring Systems
All pharmacists providing this service must be aware of and meet the
requirements of the NPSA Rapid Response on Vaccine Cold Storage
(NPSA/2010/RRR008) and any subsequent alerts in relation to vaccine storage;
All contractors must have their contemporaneous Standard Operating
Procedures on ordering, storage, stock control, disposal and procedures for
remedial action to the NHS England prior to commencing the service.
All contractors must ensure that they have sufficient cold storage
capacity to ensure the proper storage and integrity of the vaccines.
5. Suitable Premises
6.1 The pharmacy shall only provide this service from an NHSE/PCT approved
private consultation area.
6.2 The pharmacy shall also have in place the following systems:
Safe storage of vaccines, ensuring that the cold chain is maintained.
Fridges used for the storage of vaccines must be monitored for minimum,
maximum and actual temperature on each working day, and a record kept
according to GPhC guidelines (ref. Fridge Temperature Monitoring).
b. Safe disposal of sharps and clinical waste only for use in the provision of
an NHS commissioned service (small 5L sharps bins).
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Hold an injectable form of adrenaline on site for the management of
anaphylaxis (e.g. EpiPen)
Effective prompt management and follow-up in the event of a needle-stick
injury (in work hours consult the Health Protection Unit for advice or
present at an A&E department if out of hours or at weekends.
6.3 Appropriate infection control
6.4 Vaccinations should only take place in a consultation room which is large enough
to allow:
a. The vaccination to be administered safely;
b. Sufficient workspace to allow for preparatory work, easy access to the sharps
container, and easy storage of any paperwork;
c. Immediate access to anaphylaxis pack and anaphylaxis algorithm; In the event
of a severe anaphylactic reaction the pharmacy shall have a facility to call for
ambulance assistance immediately without leaving the patient unattended
d. The individual to be vaccinated to, where necessary, remove and store any
garments, with privacy and dignity, to allow safe vaccination;
e. The management of any anaphylaxis or patient collapse, including putting a
person into the recovery position and/or carrying out Basic Life Support.
f. Before vaccinating, the pharmacist makes sure that a member of staff is aware
that the pharmacist will be administering a vaccine, and the pharmacist has
made arrangements to contact that member of staff to call for help if
Under certain circumstances, the NHS England may agree to vaccinations being
undertaken in alternative premises, for example within a care home. The contractor
should ensure that the environment within which vaccination will take place meets the
above criteria. The contractor should contact the NHS England to request permission
to undertake vaccinations at an alternative location with infection control, waste
collection and data collection must be satisfied.
With infection control, waste collection and data collection must be satisfied.
6. Recording
7.1 The identified pharmacist will complete all necessary data recording to enable
monitoring and evaluation of the scheme;
7.2 The contractor must develop and maintain a record of patients to whom the
influenza vaccine has been offered / administered. Data should include:
a. Any refusal of an offer of vaccination, with reason;
b. Where an offer of vaccination was accepted:
c. details of the consent to the vaccination or immunisation,
d. the batch number, expiry date and title of the vaccine,
e. the date of administration of the vaccine,
f. any contraindications to the vaccination or immunisation,
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g. any adverse reactions to the vaccination or immunisation;
7.3 Data can be recorded via the individual contractor’s electronic PMR (patient
medication record) system, or “SONAR” and other e-platforms can report, Client
records must be kept by the accredited pharmacy contractor for 8 years;
7.4 Where provisions have been made by the NHS England, the pharmacy will
comply with using and transmitting information electronically, and will maintain
software suitable to support the IT system;
7.5 To minimise the risk of patients receiving double immunisation, contractors must
ensure that details of those who have been immunised are returned to the
patient’s GP within 24 hours of immunisation. Pharmacists must also inform GPs
of patients who decline immunisation; Information must be transmitted or provided
in a secure manner via IT platform agreed on.
7.6 The pharmacist will provide additional data to NHS England for audit purposes on
request if required to do so.
7. Patient confidentiality
The patient must sign the declaration form that they consent to information being sent
to the GP and to the NHS England.
8. Service Promotion
In general, all at risk patients should be encouraged to attend their GP practice
for immunisation in the first instance;
It is considered good practice for each service provider to meet with their local
GP practice(s) to inform them of their participation in the scheme and discuss:
a. Details of the scheme
b. Eligible patient population
c. Direction of patients between practice and pharmacy. In some cases
GPs may wish to provide their local pharmacy with a list of patients who
have failed to attend for immunisation.
It is a requirement that the pharmacy contractor develops a proactive
approach to offering these immunisations to identified target patients;
It is a requirement that the contractor actively participates in any National or
local Flu health promotion campaigns and maintains an adequate stock of
promotional materials to give to patients.
9. Monitoring
All contractors delivering this enhanced service will be expected to comply with
requests for audit information from NHS England as appropriate throughout the year.
Progress with enhanced services will be discussed at planned NHS England
/Pharmacy annual and any other review meetings on an on-going basis.
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10. Adverse Incidents
In the event of an adverse incident (significant clinical events, dispensing errors,
adverse drug reactions), or near miss, the pharmacist will fill in an incident reporting
form and forward a copy to the NHS England within seven days.
11. Quality Specification Required
The pharmacist should be able to demonstrate that standard operating procedures
for operation of the scheme, documentation of consultations and monitoring of the
standards of service provision can be achieved.
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Schedule 2
Financial Specifications
Payment arrangements under the scheme will apply to all over 65s and under 65s
in other at risk groups who are immunised between the 1st September 2013 and
28th February 2014;
NHS England shall, in consideration of the pharmacist providing the services, pay
the pharmacist the appropriate fee, for the activity carried out;
Payment to the pharmacist by NHS England will be made on a monthly basis on
receipt of fully completed claims;
NHS England shall notify the pharmacist as soon as practicable if it considers a claim
submitted by the Pharmacist is incorrect or that the stated services have not been
provided in accordance with this Agreement and in such circumstances the NHS
England shall be permitted to withhold any payment due.
Contractors will be paid a fee of £7.51 per vaccination administered plus the cost of
the vaccine reimbursed at £5.90 per vaccination plus VAT at the prevailing rate.
Contractors will be also be reimbursed for the purchase of two Epipens and two
Epipens JR at current list price plus VAT at the prevailing rate and for their
replacement costs should it be necessary to use either preparation for the purposes
of the NHS flu vaccination service”.
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Schedule 3
Lead Officers for Agreement
The Professional Adviser for the NHS England and the address for mailing invoices and
monitoring forms are as follows:
Kenny Gibson
Head of Early Years, Immunisations and Military Health (NHS England, London
Email: [email protected]
The lead officer for the Organisation is:
Telephone: ……….…………………………
Signing of the Agreement
This document and the attached notes comprise the Agreement concluded between NHS
England and the pharmacy named above.
Signed: ……….…………………………
Date: …………...….….
Signed: ……….…………………………
Date: …………...….….