What immunisations should I offer? Can I offer immunisations not on the national immunisation schedule?

Procuring vaccines can be challenging

For the odd vaccine you can try your local pharmacy where either the patient can obtain the vaccine with a prescription that you have written, or you order it directly using a signed order. This document is a formal document requiring your practice details on headed paper along with a signature and details of the vaccine you are ordering.

You can also order vaccines from directly from wholesalers such as AAH or Vaxishop but you will need to set up an account with them.

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How to store the vaccines?

There is strict compliance around the cold chain storage of vaccines from source, including transport, storage and pathway to administration.  If you store vaccines you will need to have a serviced fridge which must be kept at a strict temperature and you will need to demonstrate that this is checked daily.

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National Immunisation Protocols

You may be asked to administer vaccines for national immunisation protocols from any country. People living in the UK sometimes want to ensure that the protocol from their country of origin is followed.

• Protocols for the US can be found https://www.cdc.gov/vaccines/index.html
• Protocols for Australia can be found https://www.health.gov.au/health-topics/immunisation/when-to-get-vaccinated/national-immunisation-program-schedule.

You may be asked to give vaccines to UK patients who do not want to follow the UK immunisation protocols.  Any decision that you make in relation to this should be very clearly documented and you should be sure that any course of action is defensible.  Single mumps measles and rubella vaccines are still sometimes sought.  The JCVI have advised that these are best avoided and the MMR vaccine given instead in order to give full protection as early as possible.  Also the single dose vaccines are not manufactured in the UK and are imported from overseas and there are concerns about the cold chain during transportation.

Recently pharmacies are giving more of the straightforward immunisations and private GPs find they are being asked to give vaccines for specific reasons such as early measles vaccine (from 9 months) and so you will need to be familiar with all the vaccines that you might need to administer.  The Green Book is a very valuable resource for anyone undertaking immunisation and can be bought in hard copy or downloaded https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book#the-green-book.

You may decide that some vaccines not available on the immunisation schedule are worth offering to your patients such as Chickenpox Hep B and Pertussis where there is a strong evidence base which you may wish to consider.