Flu Vaccinations 23/24

Influenza Vaccinations -Ensuring you minimize losses

Dr Philip Koopowitz – Hexagon6With the debacle about when the Flu jab “season” begins and when NHSE were willing to start paying for flu jabs given, now seems to have been resolved and all flu jabs administered before 1 October will be reimbursed and count towards the DES so that practices can claim £10.06 per vaccination that they administered for those patients 65 and over and those patients in the At-Risk group.

The At-Risk Group includes:

  • those aged 65 years and over
  • pregnant women
  • those in long-stay residential care homes
  • carers in receipt of carer’s allowance, or those who are the main carer of an elderly or disabled person
  • close contacts of immunocompromised individuals
  • frontline workers in a social care setting
  • those aged 6 months to under 65 years in Clinical Risk Groups

The Clinical Risk Groups are set out in the Green Book

Clinical risk category
Chronic respiratory disease
Chronic heart disease and vascular disease
Chronic kidney disease
Chronic liver disease
Chronic neurological disease
Diabetes and adrenal insufficiency
Asplenia or dysfunction of the spleen
Pregnant women
Morbid obesity (class III obesity)


From the Greenbook Chapter 19:  “The list above is not exhaustive, and the medical practitioner should apply clinical judgment to take into account the risk of influenza exacerbating any underlying disease that a patient may have, as well as the risk of serious illness from influenza itself. Influenza vaccine should be offered in such cases even if the individual is not in the clinical risk groups specified above.”

Many practices would have ordered their flu jabs in anticipation that the 50–65-year-olds would also be eligible for a flu jab, but NHSE and the JVCI have decide that they are no longer in an At-Risk group. In addition, Community Pharmacy is gearing itself up to deliver the flu jabs to both the At-Risk groups and privately for those patients not in the At-Risk groups who request a flu jab.  This means that potentially some practices will have ordered an excessive amount of flu jabs. Most companies will allow a 10% return, but many practices will need to brace themselves for writing off a large debt for paid for, but unused flu jabs.

Most practices have been able to get a small discount on their flu jabs and this means that they will make approximately 50 pence profit per jab, along with the Dispensing Fee of about £2.30 per item. Practices can still administer flu jabs to those patients not in the At-Risk groups and claim the Reimbursement and Dispensing Fees for those via the FP34D Bulk Vaccination claims – they will of course not get paid the £10.06 DES fee, unless they deem the patient to be “At-Risk”. Practices cannot provide private flu jabs for their own NHS patients.

Despite all the above, administering flu jabs remains a financially viable option.

To work out profitability on flu jabs, you will need to ensure you take into account that the VAT equivalent reimbursed by NHSBSA equates to less than 20% as the VAT equivalent is paid on the Basic Price Minus the clawback.


Flu jabs –              Basic Price £10.00

Assume Discount 15%

Reimbursement (excluding Dispensing Fee)

= Basic Price Minus Clawback plus VAT Equivalent (on Basic price Minus clawback)

= (10.00 – 1.18) + {20% x (10.00-1.18)}

= 8.82 + (20%x8.82)

= 8.82 + 1.76

= 10.58


Cost = Basic price minus Discount plus VAT (on Basic price minus Discount)

= 10.00 – (15% x10.00) + {20% x Discounted price)

= 8.50 + (20% x 8.50)

= 8.50 + 1.70

= 10.20

Profit = Reimbursement Minus Cost

= 10.58 – 10.20

= 38 pence per flu jab (excluding Dispensing Fee)

This only works out if ALL flu jabs administered are recorded via the clinical system and the correct amount of flu jabs are claimed for reimbursement on the Bulk Immunisation section of the FP34D (these MUST be claimed as the particular brand administered and not generically). It is always worth counting the number of flu jabs left at the end of each month and reconciling with the number of flu jabs claimed to ensure all flu jabs administered have been correctly entered into the clinical system.

The following flu jabs are available for the 2023/34 season:

Brand Manufacturer Category Licensed Age groups Basic Price
Quadrivalent  influenza Sanofi QIVe From 6 months £8.00
Adjuvanted Quadrivalent Influenza Seqirus aQIV From 65 years £13.50
Cell based quadrivalent Influenza Seqirus QIVc From 2 years £12.50
Influvac sub-unit Tetra Viatris QIVe From 6 months £9.94
Supemtek Sanofi QIVr From 18 years £16.00