Realising the value of adult flu vaccination: an exploratory study looking at adults aged 18-64 considered clinically at-risk from complications of flu

The PMA recognise the pivotal role Practice Managers and their teams play in successful implementation of flu vaccination programmes. We very much value the insight and experiences of those at the ‘coal face’ in supporting the ongoing policies on prevention.

The PMA facilitated a novel nationwide survey from 13 June to 14 July 2019 that sought the views of those working in general practice potentially responsible for flu vaccination programmes. This survey formed part of a larger study, conducted by Health Economics Consulting (HEC). The results of the study are now available, and we are delighted to share the following summary.


Flu is an acute respiratory viral infection that for many healthy people is unpleasant but will usually clear up in a week. For those who are over 65, women who are pregnant or for those with underlying health conditions and have weakened immune systems flu can be more serious with complications including pneumonia and, in some cases, death.

The flu virus changes rapidly, which means that a new vaccine is needed each year. Flu vaccination in the UK has been recommended since the 1960s, but there have been concerns expressed about uptake of the flu vaccine in recent years. In 2017/18 there was a high disease burden and high hospitalisation rates for flu.


An exploratory study ran from May to July 2019 to describe the current uptake situation, identify barriers to reaching target flu vaccination rates, recognise potential strategies to increase flu vaccination rates and inform future research. Throughout the focus was on those aged 18-64 who are at-risk in England.


The study adopted a multi-methods approach to explore enablers and barriers to flu vaccination for those at-risk aged 18-64, including:

• A rapid review of published papers, an environmental scan of policy documents, and a review of published statistics on flu vaccination in England.
• A number of statistical analyses: from descriptive analysis to linear regression analysis to explore the burden of flu in the NHS in England.
• Two case studies: Greater Manchester (GM) and the Eastern region (ER) of England. The case studies used qualitative one-to-one interviews with 11 staff working in practices or at a regional level, a research day with ten staff working in practices in GM, and contextual data and publicly available documents. Thematic analysis was undertaken of the research day discussion and telephone interviews.
• A national online survey of those working in general practice, conducted from 13 June to 14 July. Full details of the survey are included at the end of this summary. Please see full details of the survey here.

The study offered a pragmatic rapid review undertaken in three months in 2019 to provide an up-to-date snapshot of the current state of flu vaccination uptake among the 18-64-year-old at-risk groups in England.

Conclusions and discussion

The study has illustrated the impact of flu on patients and the NHS. The study found a link between flu vaccine effectiveness and flu-related NHS hospitalisations. It also found a link between flu vaccine uptake and use of the NHS. Further research could explore the links between vaccine uptake and use of the NHS using more granular level data.

Improving uptake of flu vaccination is a common agenda for the NHS across England: even the best performing areas are below the long-term target of 75 per cent, and many are below the interim target of 55 per cent.

There are common themes for barriers (denoted -) and enablers (denoted +) to increasing uptake of the flu vaccination amongst those at-risk aged 18-64:

– Patient attitudes –and staff attitudes -can be a barrier to take-up.
– Practices need to vaccinate more people over time.
+ Practices are seeking to engage staff and patients on flu vaccination and recognize the importance of planning. Some have not yet got all the components in place to optimize engagement and communication.
– People who are morbidly obese are less likely to have their flu vaccination and are a growing population to vaccinate. Practices may not be confident in engaging with those who are morbidly obese.
– The policy landscape focuses upon the supply side and should also look to how demand can be improved.
– Not all practices use NICE guidance (NG103) on increasing uptake of flu vaccination.
– There can be frustration with support from the ‘centre’, for example there is a perception that communications are not always timely.
+ Manufacturers can help raise awareness of flu vaccination. Vaccine supply is also crucial.

Further research is needed to understand the drivers behind patients declining the flu vaccine, and how best to communicate with patients.

There could also be exploration of specific support for practices on engaging with those who are morbidly obese, and in other hard to reach groups, to promote the flu vaccine in this group. This should involve Practice Managers given their role on flu campaign and delivery.

Practice Managers and their colleagues in general practice could also be targeted in communications on NICE guidance (NG103). Fresh communications could focus on how the guidance is made operational; it can be used as part of a checklist for practices.

Points to note on scope

The scope of this study was just on those at-risk aged 18-64, there may be complementarities between approaches to vaccinate children and those aged over 65. The scope also did not include direct engagement with patients, nor with the wider NHS system such as those working in secondary care, community pharmacy and other settings so it does not provide a complete picture of all the opportunities for flu vaccination. Those who engaged with this research are also likely to be different to those who did not.

The online survey was only available to those with access to the internet and it is not able to probe respondents to ensure an appropriate understanding for free-text responses. It was a strength that the survey was filled in by PMA members as these are professionals currently working in practices.


Health Economics Consulting (HEC) is a fully owned subsidiary of the University of East Anglia (UEA) and forms part of the Health Economics group at the Norwich Medical School, UEA. This research was funded by Seqirus. HEC worked with the Practice Managers Association (PMA) to elicit views and policies to support this research. HEC had full editorial independence for this policy briefing.

For more detail on the study please follow up with HEC. Contact information for HEC can be found here.