Last review date 04/09/2023

There has been a considerable change to the Shingles vaccination programme this year. 

From the 1st of September 2023, anyone who is severely immunosuppressed and aged over 50y will be able to get two doses of the Shingrix vaccine. 

NB: Extract from 'General Practice Shingles Vaccination Programme Technical Guidance'

It is not possible to exactly extract data in accordance with the Green Book definitions for the shingles immunocompromised cohort which has therefore been developed in the GPES extract to be largely over-inclusive for payment purposes and will include some patients who do not strictly meet the Green Book shingles definition for severe immunosuppression. The reason the GPES extract is largely over-inclusive is to support clinical discretion and reduce the need for manual payment claims that would otherwise be required if the GPES extract was not over-inclusive. However, there are also some areas of under-inclusion where technical and coding limitations mean it is not possible to fully identify all eligible patients (for example dose of steroids or a combination of drugs). Practices wishing to use the GPES immunocompromised logic to identify eligible patients for call and recall should be mindful of the over-inclusive and under-inclusive nature of the count and review the patient list accordingly to offer vaccination to eligible patients only.

Those turning 65y and 70y between 1st September 2023 and 31st August 2028 will also be able to get the vaccine after their birthday, and they stay eligible until they are 80y. This is Stage 1 of the catch up invites.

From 1st September 2028 and 31st August 2033 everyone turning 60y and 65y will be eligible. This is Stage 2 of the catch up invites.

The latest guidance also states that, while stocks of Zostavax last, these can be used for those patients aged 70-79 and immunocompetent. 

Review Before

There have been some significant issues regarding the immunosuppressed cohort. So In October 2023, we made some updates to our reports following a meeting that we had with the Vaccination & Immunisations team of NHS England.

The takeaway from the meeting was that as long as a practice can demonstrate and evidence a method for reviewing patients from the wider GPES payments criteria to ensure eligibility, then there will be no consequences for practices.  Patients falling outside the Greenbook eligibility, a PSD would be required.

We have therefore created some 'review before' reports which can be found under 'Shingles | 2 Review Before' as seen below.  These reports will look at each of the categories in the GPES extraction and allow for a clinical review to be conducted.  If the patient needs to be vaccinated, then the Requires vaccination against shingles 'Y406b' code can be added to the patients record. 

The 'For review before ordering and invitations | Shingrix Part 1 | For planning - All turning 65y or 70y in next 6m' report is useful to run as this will show patients that will drop into the eligibility in the future but can't be invited now, so practices can forward plan who will be invited in.

The 'For review before invitations | Previously vaccinated with Zostavax outside of national programme + eligible for Shingrix' report shows patients that have previously received the vaccine outside of the national programme. These patients are eligible for the vaccination under the national programme, however you may wish to invite them differently to other patients. Patients will only come out of this report once they've had either an exclusion (such as a decline) or a vaccination recorded. These patients still appear in the main invitation reports.

Please Note: There is no code to add that will remove patients from the review before reports if they are assessed as not needing the vaccine. Therefore these patients will still appear in the search results.

Shingles Invitation Reports

To identify patients who may be eligible for a Shingles vaccination, go to 'Clinical Reporting > Ardens Ltd > Vaccinations '. The invitations reports have been split out into folders for part 1, part 2 and those eligible for a Zostavax while stocks last, These are all broken down so that you can send invitations out by email, SMS or post.

The 'Part 1' folder has been built to show those requiring a 1st, 2nd or 3rd invitation who are either 'routine' or 'catch-up' turning 65y or 70y between 1/9/23 - 31/8/28'.  

The 'Part 2' folder will look for all patients who need Part 2.

There is now a separate folder for patients who may require visits to have their Shingles vaccination - these are listed in the 'Shingles | 4 Visits' folder. This will include any patient that has been coded as living in a Care Home or Housebound. These patients will not appear in the 'Shingrix Part 1'  and 'Shingrix Part 2' invitation folders mentioned above.

Please Note: For severely immunosuppressed individuals over 50, the second dose should be given 8 weeks to 6 months after the first dose. For the immunocompetent individuals over 60, the second dose of Shingrix may be offered 8 weeks after the first dose but for operational reasons a longer interval is being used with an interval of 6 months to 12 months between the 2 doses.

Please Note: For any patients that may have already been vaccinated in the GPES Extraction group and need to be clinically reviewed, allowing for the correct timeframe between 1st and 2nd dose, we have created a report in the Shingles 5 | Review After folder named:

For review after vaccination | Shingrix Part 1 recorded and in immunocompromised group without 'requires shingles' - review record and code as appropriate

The 'Data Quality' folder provides one report to find patients where the 'Vaccination offered' code (Xaam1) has been used instead of the invitation codes (as shown in the invitation reports). Practices should re-code these patients with an appropriate invite code. 

Administering the Shingles vaccination

When you open up a patient's record who may be eligible for the Shingles Vaccination, you will see this icon under their name. Click this to open the Shingles template.

There is a 'Check Contraindications' button to check the patient's record for a potential contraindication to Zostavax, such as immunosuppression. This will then show one of the pop-up messages below. On here are links for further information about the contraindications from The Green Book and RNHRD.  When Zostavax stocks have been exhausted, this will be removed as there are very few contraindications to Shingrix.