Guidance

Flu immunisation training recommendations

Updated 8 August 2023

Applies to England

As social contact returned to pre-pandemic norms, the number of flu cases in the 2022 to 2023 flu season was higher than levels observed during the COVID-19 pandemic flu seasons (2020 to 2021, 2021 to 2022), returning to the levels seen pre-pandemic.

Seasonal flu vaccination remains a critically important public health intervention and a key priority for the 2023 to 2024 flu season is to reduce morbidity, mortality and hospitalisation associated with flu at a time when the NHS and social care will be managing winter pressures whilst continuing to recover from the impact of the COVID-19 pandemic.

It is therefore crucial that those giving flu vaccines are confident, competent and have an up-to-date knowledge about the vaccines they are giving in order to effectively promote high uptake of flu vaccination and administer the flu vaccines to those who need them.

This document sets out recommendations for flu immunisation training for the 2023 to 2024 flu season, which are based on the National Minimum Standards for Immunisation Training. It describes what flu vaccinators need to know and various ways in which they can obtain training.

The importance of flu training

Ongoing public and professional confidence is critical to the success of the annual flu vaccination programme. A high level of knowledge and a positive attitude to vaccination in healthcare practitioners are widely acknowledged as being important determinants in achieving and maintaining high vaccine uptake. It is therefore vital that vaccinators are confident, proficient and have a sound and current knowledge of the vaccines and the vaccine programme 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 vaccinators or demand on service providers, and they should not be seen as a barrier, which prevents timely immunisation.

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 (including annual updating) should be seen as an important necessity to a successful programme. All healthcare professionals who are involved in administering flu vaccine must have the necessary skills and training, and mechanisms to supply and/or administer flu vaccines such as patient group directions (PGDs) and protocols can only be used by competent and trained practitioners.

What needs to be included in flu vaccination 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 vaccines that they will deliver and their role in delivering the flu vaccine programme. 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 vaccinators and will only need to update their knowledge. Areas they should specifically look to update on include:

  • groups recommended to receive flu vaccine in the forthcoming flu season
  • the different flu vaccines available
  • which vaccine should be given to which groups
  • any new advice for this flu season
  • maximising uptake and delivering vaccines safely

Supervision and assessment

In addition to acquiring theoretical knowledge, new vaccinators 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 vaccinators and support for all vaccinators 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 vaccinators 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 vaccinator 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. Alternatively, the Immunisation Knowledge and Skills Competence Assessment Tool published on the Royal College of Nursing website can be used.

Many of those new to flu vaccination will have transferable knowledge and skills, such as anaphylaxis training and giving an intramuscular (IM) injection, even if they have not vaccinated previously. They should be supervised administering vaccinations until both they, and their supervisor or trainer, feel confident that they have the necessary knowledge and skills to administer vaccines safely and competently.

Those who have been trained specifically to give COVID-19 vaccines but have not previously given flu vaccine before should complete flu-specific training and the flu-specific competency tool before giving flu vaccine.

Any flu vaccinators returning to vaccination after a prolonged interval should also complete flu-specific training and the flu-specific competency assessment. As the circumstances and training needs for individual practitioners returning to vaccination will vary, there is no defined time interval for ‘prolonged’ but vaccinators and their supervisors need to be assured of their competence before they deliver this year’s programme.

The competency assessment tools are also useful for more experienced flu vaccinators to self-assess and identify if there are any areas where they need to update or further their knowledge and skills. A signed and dated competency assessment tool may be required to work to the flu vaccine PGDs and protocols.

Theoretical flu training

E-learning

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 e-learning programme which consists of a core module and separate sessions on the inactivated and live flu vaccines.

New flu vaccinators 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.

Training slide set

A slide set, designed for use by trainers, about the national flu vaccination programme is available on the UKHSA annual flu programme webpage.

Webinars

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 training is now delivered through online meetings or webinars in addition to face to face training. 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 face to face local training (through classroom-based sessions or webinars) where possible as it allows both for any specific local needs or arrangements to be covered and the potential for smaller group interactive learning which could incorporate a question and answer session.

Practical skills

In addition to acquiring theoretical knowledge, it is vital that new vaccinators develop clinical skills, competency and confidence in vaccination. Consideration should be given as to how this training can most effectively take place.

The importance and benefits of work-based training and experience should not be underestimated and a period of supervised practice to allow observation of, and development of clinical skills and application of knowledge to practice is essential. Work-based supervision will enable sign-off of practical competencies by the supervisor.

Additional considerations

Vaccinators 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 vaccinators will require more time for training than those who are updating knowledge acquired in previous flu seasons. In addition, vaccinators 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, for example, basic life support (BLS), management of anaphylaxis, safeguarding or infection control, information governance.

Remaining up to date

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

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

It is important that an effective method of updating all those involved in giving flu vaccine is identified and utilised. Local cascade systems for flu vaccinators should be used (or developed if not currently in place).

Contact information

Even with the most comprehensive training, questions will arise as the flu immunisation programme is underway. It is therefore important that vaccinators 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 NHSE Screening and Immunisation team
  • their local UKHSA Health Protection Team
  • other locally available immunisation lead, Medicines Management team, Occupational Health lead, Lead Pharmacist, and so on

Those responsible for flu programmes are requested to make this information available to flu vaccine providers.

Summary

Flu vaccination is one of the most effective interventions to reduce harm from flu and pressures on health and social care services during the winter. It has been shown to reduce the risk of flu illness, hospitalisation and flu-related death.

It is therefore crucial that the flu immunisation programme is effectively delivered to as many of those eligible as possible. This will require knowledgeable, confident and competent vaccinators. It is vital that flu vaccinators are given the time and opportunity to undertake the comprehensive 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.