Guidance

Increasing flu immunisation uptake in preschool children: best practice for GPs

Updated 3 September 2025

Protecting our population against flu

Flu vaccination for children

All children aged 2 and 3 years old on the 31 August of the current flu season are offered flu vaccination via their GP surgery.

GP surgeries continue to offer flu vaccination to children in at-risk groups aged between 6 months and less than 18 years of age, although at-risk children of school age will usually be vaccinated at school.

Rationale for the programme

The programme will help to protect children against flu which can, although rarely, cause serious complications. By having the flu vaccination children are less likely to pass the virus on to friends and family, and the wider community.

Evidence and best practice examples (see articles from the BMJ Open and Family Practice journals) demonstrate that certain key strategies can improve vaccine uptake. This document provides a summary of those strategies that will help to increase flu vaccine uptake among children aged 2 and 3 years old.

Pre-season preparation

All eligible patients should be vaccinated before flu starts circulating (which is usually December). Following vaccination immune responses take about 2 weeks to fully develop. Advanced preparation is vital for a successful programme to achieve high vaccine uptake. Clinical judgement should be used to assess whether to vaccinate beyond December, particularly if it is a late flu season.

Staff responsibilities are:

• every practice should have a lead member of staff with responsibility for running the flu immunisation campaign
• all staff should know who the lead person is
• all staff should understand the reason for the programme, have up-to-date training and access to UK Health Security Agency (UKHSA) resources
• every member of the practice should know their role and responsibilities
• all staff are involved in promoting the vaccine message to parents
• regular meetings are held so that all staff know the practice plan and progress
• health visitors, midwives, pharmacists and other healthcare professionals linked to your practice in your planning are included
• registered staff delivering the flu programme under a Patient Group Direction (PGD) should have read and understood the content and signed the document prior to administering flu vaccination
• staff who are delivering flu vaccination under a Patient Specific Direction (PSD) should have completed the necessary training and have been assessed as competent to undertake vaccine administration

Practice goals are:

• set a higher goal than the previous season
• create computer searches to measure uptake and assess progress towards the goal
• calculate practice income depending on uptake – each extra 1% of uptake = £xxx income
• advertise the practice goal and have a ‘Blue Peter’ style ‘Totaliser’

To identify eligible children:

• the lead member of staff should identify eligible children
• check the accuracy of searches and coding to ensure all eligible children are identified
• make sure the correct flu vaccination codes are in your system and that staff are aware – don’t let hard work go unmeasured
• create IT-system reminders so that opportunistic immunisation happens
• create a system for opportunistic identification of eligible children attending the practice for other clinics or with parents and siblings – use flags or sticky notes to alert staff (don’t send a child away unimmunised)

To invite and contact parents:

• send a personalised invitation to eligible children before the end of October – use the parent’s and child’s names, sign your name at the bottom (template invitation letters are available to download)
• phone calls can be more effective than letters – try text messages for reminders
• ensure that staff phoning parents have a script but can also answer questions and address concerns
• plan phone calls after 4pm when more working parents might be available
• send letters if telephone contact is not possible
• be tenacious – make multiple contacts until child is immunised or an active refusal is received

To order vaccines:

• centrally procured flu vaccines for children will be available to order from ImmForm
• the live attenuated influenza vaccine (LAIV) should be offered unless it is medically contraindicated or otherwise unsuitable (including objection to LAIV on the grounds of its porcine gelatine content) – in such cases, an alternative injectable vaccine should be offered
• order small and frequent quantities of flu vaccines, throughout the flu vaccination period
• remember that you can order weekly and receive weekly deliveries
• hold no more than 2 to 3 weeks stock in your practice fridge to reduce the risk of stock loss through cold chain failures or expiry before use
• remember that stock ordered later will have a later expiry date
• ordering will be subject to controls and the most up-to-date information on these will be available on ImmForm news throughout the ordering period

Clinics and appointments:

• plan to have completed all routine immunisation activity before Christmas
• use time after Christmas to mop-up unimmunised children, particularly children in at-risk groups – if clinically indicated, vaccination can be given up to the end of March
• decide whether you will give timed appointments, run an open access clinic or invite parents to make appointments
• allow online booking for appointments
• consider family-friendly clinic and appointment times, such as after school 3.30pm to 6:30pm, Saturday mornings or October half term, consider health fairs or parties, incorporating flu vaccination with other vaccines, health checks and health-visitor advice
• create a child-friendly environment, including room for pushchairs
• consider other clinics and busy waiting rooms

Promote the vaccination offer to parents by:

• ensuring every parent has a personalised invitation for their child
• displaying UKHSA child flu immunisation posters and leaflets in the reception and waiting rooms – these can be ordered for free
• creating attractive displays in waiting rooms – consider posters or banners outside the practice, on a notice board, walls or even on the roof
• placing prominent information about the child flu immunisation programme on the practice website
• engaging with the local primary school – ask if they can give leaflets to parents with pre-school age children and/or display posters on school and parent notice boards
• engaging with local pre-school nurseries, children’s centres, libraries, toddler groups in your area – ask staff to put up posters and issue leaflets to parents of 2 and 3 year olds (highlight the benefits of their children being immunised to these preschool groups and nurseries)

During the flu season

Increasing resources in-season is difficult, so comprehensive preparation and planning is critical. There are things you can do to help sustain efforts and uptake including:

• reviewing your uptake against your goals and financial plan – celebrate and promote success as the programme progresses
• remaining tenacious, re-running searches for eligible children
• continuing to offer vaccination, even once you have achieved your practice and campaign goals
• keeping staff engaged and enthused – consider incentives, promoting staff competition
• ensuring all practice staff have their flu jab – it is powerful to be able to say to patients “I’ve had mine”

Post season

Post season actions are:

• reviewing your campaign, measuring and celebrating success – thank everyone involved
• sharing the review of your campaign with your stakeholders, patient focus groups and partners who helped you achieve your goals
• capturing lessons learnt and adapting next year’s plan – aim for higher uptake next year

References and resources

NICE guidelines on increasing flu vaccine uptake

Training slides and resources from the UKHSA

Vaccine update is a regular newsletter describing the latest developments in vaccines, and vaccination policies and procedures.