Non-digital pathways

View the table below for information on the conditions that are not included in the digital cohort.

People with these conditions may be identified locally by their GP clinical system, and could be invited by local GP led call and recall for flu vaccination.

Centrally held data sources do not contain complete medical records. It is therefore anticipated that the digital patient cohort will not have captured a percentage of the patients identified within the clinical policy.

If you believe you are entitled to an NHS flu vaccination and you have not been included in the digital cohort, you can visit the NHS website on the flu vaccine.

Chronic respiratory disease

Description	Conditions following a non-digital pathway
Asthma that requires continuous or repeated use of inhaled steroids or systemic steroids.	Prescribing data for systemic steroids is not held centrally in a format whereby duration and dose of treatment can be ascertained. People solely identified because they are on asthma treatment with systemic steroids, may not be included in the digital cohort unless the GP Practice has added a SNOMED CT administrative code to indicate eligibility for flu vaccination.
Asthma with previous exacerbations requiring hospital admission.	Coded data held in GP records does not reliably contain coded data on hospital admissions, so people whose eligibility is solely based on hospital admission data may not be included in the digital cohort unless the GP has added a SNOMED CT administrative code to indicate eligibility for flu vaccination.
Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).	All conditions included in digital pathway.
Children who have previously been admitted to hospital for lower respiratory tract disease.	Coded data held in GP records does not reliably contain coded data on hospital admissions, so people whose eligibility is solely based on hospital admission data may not be included in the digital cohort unless the GP has added a SNOMED CT administrative code to indicate eligibility for flu vaccination.

Chronic neurological disease

Description	Conditions following a non-digital pathway
Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers).	Conditions where respiratory compromise is variable (such as in multiple sclerosis and cerebral palsy), where the GP has not indicated respiratory compromise in coded data in the GP records, may not be included in the digital cohort unless the GP has added a SNOMED CT administrative code to indicate eligibility for flu vaccination. Clinicians should offer immunisation, based on individual assessment, to clinically vulnerable individuals including those with cerebral palsy, learning disabilities, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.

Description

Conditions following a non-digital pathway

Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers).

Conditions where respiratory compromise is variable (such as in multiple sclerosis and cerebral palsy), where the GP has not indicated respiratory compromise in coded data in the GP records, may not be included in the digital cohort unless the GP has added a SNOMED CT administrative code to indicate eligibility for flu vaccination.

Clinicians should offer immunisation, based on individual assessment, to clinically vulnerable individuals including those with cerebral palsy, learning disabilities, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.

Diabetes and adrenal insufficiency

Description	Conditions following a non-digital pathway
Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes. Addison’s disease, secondary or tertiary adrenal insufficiency requiring steroid replacement.	All diabetes conditions are included in digital pathway. People solely identified because of Addison's disease on systemic steroids prescribed by their GP or hospital may not be included in the digital cohort, unless the GP Practice has added a SNOMED CT administrative code to indicate eligibility for flu vaccination.

Immunosuppression

Description	Conditions following a non-digital pathway
Immunosuppression due to disease leading to immunosuppression, bone marrow transplant, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder).	NHS England clinicians have worked hard to include all conditions that may cause immunosuppression. As there is no clinically agreed list of these conditions, the code clusters may not be complete. Some people with immunocompromise due to diseases may not be included within the digital cohort unless the GP has added a SNOMED CT administrative code to indicate eligibility for flu vaccination. It is difficult to define at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of influenza and should be offered influenza vaccination. This decision is best made on an individual basis and left to the patient’s clinician. Immunosuppression due to treatment leading to immunosuppression, including patients undergoing chemotherapy and individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age), or for children under 20kg, a dose of 1mg or more per kg per day. Coded data held in GP records does not generally identify people on chemotherapy. People who are immunosuppressed due to current or recent chemotherapy treatment may not be included in the digital cohort unless the GP has added a SNOMED CT administrative code to indicate eligibility for flu vaccination.
Asplenia or dysfunction of the spleen. This also includes conditions such as homozygous sickle cell disease, hereditary spherocytosis, thalassemia major and coeliac syndrome that may lead to splenic dysfunction.	NHS England clinicians have worked hard to include all conditions that may cause asplenia or splenic dysfunction. As there is no clinically agreed list of these conditions, the code clusters may not be complete. Some people with asplenia or splenic dysfunction due to diseases may not be included in the digital cohort, unless the GP has added a SNOMED CT administrative code to indicate eligibility for flu vaccination.

Description

Conditions following a non-digital pathway

Immunosuppression due to disease leading to immunosuppression, bone marrow transplant, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder).

NHS England clinicians have worked hard to include all conditions that may cause immunosuppression. As there is no clinically agreed list of these conditions, the code clusters may not be complete. Some people with immunocompromise due to diseases may not be included within the digital cohort unless the GP has added a SNOMED CT administrative code to indicate eligibility for flu vaccination.

It is difficult to define at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of influenza and should be offered influenza vaccination. This decision is best made on an individual basis and left to the patient’s clinician.

Immunosuppression due to treatment leading to immunosuppression, including patients undergoing chemotherapy and individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age), or for children under 20kg, a dose of 1mg or more per kg per day.

Coded data held in GP records does not generally identify people on chemotherapy. People who are immunosuppressed due to current or recent chemotherapy treatment may not be included in the digital cohort unless the GP has added a SNOMED CT administrative code to indicate eligibility for flu vaccination.

Asplenia or dysfunction of the
spleen. This also includes conditions such as homozygous sickle cell disease, hereditary spherocytosis, thalassemia major and coeliac syndrome that may lead to splenic dysfunction.

NHS England clinicians have worked hard to include all conditions that may cause asplenia or splenic dysfunction. As there is no clinically agreed list of these conditions, the code clusters may not be complete. Some people with asplenia or splenic dysfunction due to diseases may not be included in the digital cohort, unless the GP has added a SNOMED CT administrative code to indicate eligibility for flu vaccination.

Pregnancy

Description	Conditions following a non-digital pathway
Pregnant people at any stage of pregnancy (1st, 2nd or 3rd trimesters).	On the advice of NHS England, pregnant people, where pregnancy is the only criteria with which they qualify for a flu vaccine, are not included in the digital pathway. Pregnant people will be invited for flu vaccines through ante-natal clinics and GP practices.

Description

Conditions following a non-digital pathway

Pregnant people at any stage of pregnancy (1st, 2nd or 3rd trimesters).

On the advice of NHS England, pregnant people, where pregnancy is the only criteria with which they qualify for a flu vaccine, are not included in the digital pathway.

Pregnant people will be invited for flu vaccines through ante-natal clinics and GP practices.

Last edited: 20 September 2023 1:44 pm

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Rule logic

Chronic respiratory disease

Chronic neurological disease

Diabetes and adrenal insufficiency

Immunosuppression

Pregnancy

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