How do I order private immunisations?

Where to buy vaccines

Chapter 3 of the Green Book says vaccines outside the centrally supplied NHS programme are ordered direct from manufacturers or through pharmacies and wholesalers. In practice, private GPs use:

• Pharmaceutical wholesalers, such as AAH or Phoenix. You open a trade account, and the wholesaler will check that you are entitled to buy prescription-only medicines. Ask how it delivers in a cold chain.
• Manufacturers, for some vaccines. This can suit products you use in volume, such as flu vaccine.
• A local pharmacy, for occasional vaccines. Ask whether it can supply your practice and how it will keep the cold chain.

Compare delivery days, minimum order values, returns policies and how each supplier handles shortages. Keep your first orders small until you know your demand.

Never use NHS stock

Vaccines supplied centrally for the NHS programme, ordered in England through ImmForm, may only be used for approved NHS purposes. The Green Book says using them for non-approved purposes, particularly private health services, may be considered fraudulent. That includes travel vaccines and occupational health for your own staff.

If you also work in an NHS practice, keep private and NHS stock physically and financially separate. See restrictions on seeing private patients.

Storing vaccines

Vaccines are prescription-only medicines and are damaged by heat, freezing and light. The Green Book sets out the standard:

• Use a specialised pharmaceutical fridge. Domestic fridges must not be used.
• Store at +2°C to +8°C, aiming for +5°C, in the original packaging, away from the fridge walls and with space for air to circulate.
• The fridge must be lockable or in a locked room, used only for vaccines and medicines, and plugged into a switchless or clearly labelled socket.
• Arrange at least yearly servicing and calibration, and record temperatures, cleaning and maintenance.
• Nominate at least two people to be responsible for ordering, receiving and caring for vaccines.
• Hold no more than two to four weeks' supply, and use the shortest expiry dates first.

Have a written cold chain policy that says what to do if the fridge fails or a temperature goes out of range. Vaccines stored outside their licensed conditions should not be used without a risk assessment. See equipment for private GPs.

Can the patient bring the vaccine?

A common workaround is to give the patient a private prescription to collect the vaccine from a pharmacy and bring it to the appointment. The CQC accepts that a patient may bring in a medicine dispensed elsewhere for the practice to administer. But the Green Book says patients should not normally be asked to store or transport vaccines, and only exceptionally, with advice on storage. If you use this route, keep it for occasional cases, give clear cold chain instructions and check the vaccine before you give it.

Who can give the vaccine

• You, as the prescriber, after assessing the patient.
• Registered nurses, pharmacists and paramedics under a patient group direction (PGD). The CQC confirms private providers can develop their own PGDs or buy authorised ones, following NICE guidance. Each professional must be named and authorised.
• Healthcare assistants cannot work under a PGD. They need a patient specific direction (PSD), written and signed by a prescriber who has assessed each patient.

Anyone giving vaccines needs immunisation training and anaphylaxis training, and an anaphylaxis pack must be in the room. See the emergency drugs cabinet.

Matching stock to bookings

Because you hold little stock, link ordering to your booking system. A practical approach is to require a minimum notice period for vaccine appointments, check stock when an appointment is booked, and order anything missing in time for delivery. Take payment or a deposit at booking for vaccines you order in specially, and explain your cancellation terms. Record the batch number and expiry date of every dose in the patient's notes.

What you can offer

You can offer vaccines outside the NHS schedule, provided they are within your competence and your registration. Common private requests include:

• travel vaccines, such as hepatitis A and B, typhoid, rabies and Japanese encephalitis
• chickenpox vaccine for children and adults who have not had chickenpox
• vaccines for people outside the NHS eligible groups, such as shingles, HPV or meningococcal vaccines
• occupational vaccines, such as hepatitis B for students or employers.

Base your advice on the Green Book and each product's licence. If a patient asks for something outside UK recommendations, such as following another country's schedule, discuss the evidence, document the decision and use UKHSA's guidance on people with uncertain or incomplete immunisation status.

Some services carry extra rules:

• Travel health. In England, travel health delivered by a doctor or nurse is a regulated activity. The CQC expects a pre-travel risk assessment and trained practitioners. NHS practices provide some travel vaccines free, so explain to patients which ones they could get from their NHS GP.
• Yellow fever. Only a registered yellow fever vaccination centre can give it. NaTHNaC runs registration and training. Check the arrangements if you are in Scotland.

For more on scope, see what you can treat as a private GP.