Classification: Official
Publication reference: PRN02509

To:

• regional directors
• regional directors of commissioning
• integrated care board chief executives
• GP practices
• community pharmacies
• primary care networks
• NHS trust chief executives
• local government chief executives
• health and justice healthcare providers
• directors of public health
• school aged immunisation service providers

Dear colleagues

Flu Vaccination Programme 2026/27

Thank you for your commitment to the planning and delivery of the national seasonal vaccination programmes. You are playing a vital role in helping to protect communities, easing winter pressures, and reducing flu-related hospitalisations, and deaths.

This letter sets out our initial 3-year ambitions for the flu vaccination programme, as well as what we need to do to deliver this programme in a safe, timely and equitable way. It builds on the National flu and immunisation programme 2026 to 2027 letter sent to you in February. We want to work with Trusts and ICBs to finalise the national targets for all groups this year so that they are deliberately ambitious and stretching.

Last year we saw a big effort by NHS organisations to improve their contribution to the flu vaccination programme, particularly for frontline healthcare workers. Whilst the average improvement for providers was 7 percentage points, some providers made big leaps in performance. These organisations improved their position in frontline healthcare worker uptake by over 30 percentage points, with the best Trust achieving uptake rates of 66%.

However, there is still unacceptable variation between regions and providers with the 30 lowest performing achieved below 40% uptake levels amongst their frontline healthcare workers. In order to support organisations in areas where frontline healthcare worker uptake is particularly challenging, we will be holding two regional events, one for London and one for the Midlands and East of England for colleagues to learn from those who made the biggest improvements last year, and agree the precise target we should all aim for this year.

Beyond healthcare workers, we also know that higher levels of uptake among children early in the season has the greatest impact on reducing transmission to other population groups.

This year, there will be a focussed effort across NHS England, the Department of Health and Social Care and the Department for Education to help ensure school age children are protected. Regional vaccination forums will be established and run throughout planning and winter to jointly tackle challenges and improve uptake.

We must also meet or exceed the WHO target of 75% uptake among adults aged 65 and over. For ICBs, we will also hold a similar event to share best practice and agree the targets we want to collectively achieve and what actions are needed from different parts of the NHS. These three events will take place in the coming weeks, and we will capture all of the learning from these events and share it on the Best of the NHS website pages.

The table below sets out our initial ambitions for the next three years at a national level which we will update following the three events.

Once targets are set, for those achieving or exceeding them already, the expectation is to maintain and continue to improve uptake. Ambitions will be broken down to ICB and trust level and shared with regions.

Local planning activities

The flu vaccination programme this year should begin on 1 September 2026 for children, pregnant women, and some adults, or as soon as the vaccine is available. All other cohorts from 1 October 2026. The expectation is that providers deliver a 100% offer to eligible groups, with the vast majority of vaccinations completed by 30 November, although the programme will continue until 31 March 2027. Assurance, through regional winter plans before the programme and national performance management during the programme, will align with these dates.

Regional commissioners must ensure their delivery network includes outreach services that meet the needs of communities, particularly those in the most deprived areas, and there must be plans in place to identify and address health inequalities across all underserved groups.

Regions, working with ICBs and trusts, must develop plans setting out how the ambitions and annual trajectories will be achieved for 2026/27. Plans must include a named board-level lead for seasonal vaccinations for each trust and ICB. These plans must be signed off by regional directors by 31 July 2026, including the completion of regional assurance statements. If you plan to submit a flu vaccination plan with ambitions below those set out in the table, please ensure you let your regional director know ahead of submission.

RSV vaccination is now available all year round to adults over the age of 75 and pregnant women. A single dose of the vaccine is already helping to reduce RSV-related hospital attendances and admissions over winter, helping to protect older people and babies from serious illness.

Performance will be monitored on a weekly basis using NHS Federated Data Platform operational data and be reviewed following completion of the 2026/27 programme. The Federated Data Platform operational data is live data and is representative of a point in time. It will change as populations change.

Annex A sets out the actions that should be taken to support improvement in all cohorts over 2026/27.

Thank you for your continued commitment and for everything you are doing to help protect patients, staff and communities this winter.

Yours sincerely

Sir James Mackey, Chief Executive Officer, NHS England

Annex A: actions to support improvement in 2026/27

Action must be taken at every level of the system to help us achieve these ambitions.

All cohorts

At a national level, this means we will:

• take one approach to planning and performance oversight as part of system winter planning
• use data and reporting in the Federated Data Platform to share insights and opportunities for improvement
• ensure digital capabilities are in place to maximise uptake and improve accessibility including:
  • opening the National Booking Service (NBS) earlier than before, on 17 August 2026. It will remain open until 31 March 2027
  • sharing walk-in information with the public on the ‘find a flu vaccination service’ from 1 October 2026
  • enabling GP practices to offer flu vaccination appointments for their registered patients through the National Booking Service
  • mandating all NHS trusts to use the Record a Vaccination Service (RAVS) to record all vaccination activity, including for pregnant women, inpatients and frontline healthcare workers
• work in partnership with the national Urgent and Emergency Care (UEC) team to align priorities and in-season monitoring
• support action to reduce vaccine inequalities through continued Access and Inequalities (A&I) funding – and by sharing best practice
• deliver an effective, multi‑channel national marketing and communications campaign targeting all eligible groups throughout the season
• work with representative bodies, patient organisations, 3rd and voluntary sector organisations and others to support engagement and share messages
• share examples of best practice across regions and systems through Best of the NHS / Futures, forums and networks

At a regional level, commissioners will work with ICBs to:

• develop and test seasonal vaccination plans as part of wider winter planning that demonstrate how the ambitions will be achieved, including plans to maintain vaccination activity throughout November, when demand has historically reduced. Plans must include a named board-level lead for seasonal vaccinations for each trust and ICB. These plans must be signed off by regional directors by 31 July 2026, including the completion of regional assurance statements
• work with all providers to ensure they purchase sufficient vaccine and plan ample convenient appointments to meet demand. Vaccinating sites must have robust plans for organisational sign off of legal mechanisms and appropriate clinical oversight of vaccine storage and safety
• coordinate communications at regional and local levels, ensuring consistent messaging, proactive engagement, and timely amplification across all channels
• implement targeted interventions and outreach services in communities and groups with low uptake. Interventions should be proactive, planned and delivered from the beginning of the programme
• support GPs to sign up to deliver the adult and children’s seasonal vaccination enhanced services on CQRS within the timescales outlined in the service specifications
• ensure GP providers deliver proactive call/re-call for eligible patients as set out in the GP seasonal vaccination enhanced service specifications and encourage practices to offer appointments through the national booking service, increasing accessibility and supporting national operational visibility
• support community pharmacy providers to fully engage with the national profile manager service to maintain accurate and up‑to‑date walk‑in information
• ensure all NHS trusts are using the Record a Vaccination Service (RAVS) to record all vaccination activity, including in maternity, for inpatients and for frontline healthcare workers
• monitor uptake during the season and adjust plans to address any areas of lower performance

Children aged 2 and 3 years old

Increasing flu vaccination uptake among 2- and 3-year-olds is essential to help to protect young children from serious illness and reducing wider transmission.

Regional commissioners must support general practice to sign up to the childhood seasonal influenza vaccination programme enhanced service. Where GP practices have opted out, they must ensure plans are in place to provide a 100% offer. National invitations to families of 2- and 3-year-olds will supplement GP call/re-call and will include information about how to access vaccinations.

Commissioners should ensure GP practices plan clinics as soon as delivery and supply of vaccine allows, running through the entire flu season, with the majority of vaccinations completed by 30 November.

Community pharmacies will continue to offer vaccinations to 2- and 3-year-olds from 1 October. Commissioners should ensure community pharmacies offering 2- and 3-year-old flu vaccinations are clearly identifiable on the National Booking Service and the ‘find a flu service’ and also advertised to the public ‘in-store’.

In line with local needs, school aged immunisation service (SAIS) providers can be commissioned to vaccinate in nurseries that are attached to primary schools and to offer opportunistic catch-up clinics as a supplementary offer for siblings.

A wide range of communications materials for providers and partners to help promote the flu vaccine offer to parents and guardians will be available through the campaign resource centre. This includes accessible versions such as translated materials promoting the pharmacy 2- and 3-year-old offer.

School-aged children

Improving flu vaccination uptake among school-aged children helps to protect from severe illness and reduce community transmission. This year, the School Aged Immunisation Service (SAIS) Schedule 2A has been strengthened to reflect operational delivery requirements in line with the flu letter for 2026/27. The SAIS schedule will be shared with regions in June 2026. Regional vaccination support forums will be established in collaboration with the Department for Education (DfE) to improve engagement with schools and bring together commissioning and DfE leads.

The Manage Vaccinations in Schools (MAVIS) service is now available to all SAIS providers at no cost. It has been shown to increase the number of returned consent forms and improve data capture and flow. Providers not using MAVIS from September 2026 should transition from the NIVS bulk upload tool to the MAVIS National Reporting Tool. All commissioners need to ensure that SAIS providers adhere to the requirements of the SAIS service specification (for example, ensuring there is a memorandum of understanding with each school and that all information governance standards are complied with).

Community pharmacies will be able to offer vaccinations to children who miss their vaccines at school from 1 December 2026.

Regional commissioners should work with SAIS providers to develop an action plan by the end of Q1 to strengthen the school-aged offer. This should include:

• how SAIS providers will achieve or exceed the national ambitions for 2026/27
• assurance that all dates for school visits have been scheduled by the end of the summer term, with a first offer to all primary and secondary schools by 30 November. In schools where uptake is below 40%, second visits should be considered in December
• evidence that providers will be prioritising special educational needs and disabilities (SEND) and primary school visits before half term
• a commitment to run community catch-up clinics throughout the flu season, with a clear offer for those not in mainstream school (for example, home schooled children) or children who were not in school on the day of the planned session. These clinics should be well publicised to make access easier for parents
• a non-porcine vaccine offer in all school and community sessions run by SAIS

Effective contractual arrangements should be in place to monitor provider performance, including regular contract meetings and ongoing monitoring of data and performance against agreed trajectories. Any operational delivery barriers, such as issues with access to schools, should be escalated by the end of June.

Frontline healthcare workers

To help support readiness all trusts must use the Record a Vaccination Service (RAVS) to capture frontline healthcare workers’ vaccinations. This will enable detailed, real-time trust-level reporting in the Federated Data Platform. This year, performance is a scoring metric in the NHS Outcomes Framework.

NHS England will be in contact shortly to support plans to vaccinate staff this winter.

Plans will include vaccinations starting on 1 October and completion of most by 30 November. It should ensure the offer is accessible until the end of the flu season, with walk-in and bookable appointments. It should include a clear escalation path, with named board-level representative for seasonal vaccination at ICBs and trusts.

To support accurate reporting, trusts must ensure that the frontline healthcare worker flag is applied to all clinical and non-clinical staff who are in direct contact with patients. This should be done continuously but be as complete as possible by 1 October. Action to improve the Master Person Service (MPS) matching process by encouraging staff members to check that the personal details held by their GP practice match their Electronic Staff Record (ESR) details, should be completed no later than 31 August.

65 years and over

Uptake of the flu vaccine among people aged 65 and over and among care home residents remains strong. Maintaining current uptake is essential to reducing severe illness, hospitalisations, and winter pressures on the health and care system.

To supplement GP local call/re-call, national, digital-first invites to people aged 65 and over will be sent from late September and will be supported by a multi‑channel marketing and communications campaign.

Regional commissioners must ensure all residents in long-stay residential care homes have been offered vaccinations by 30 November and that NHS trusts have plans in place to offer vaccinations to all eligible long-stay inpatients (21 days and above) and to all patients being discharged from hospital into a care home.

Commissioners should also support primary care networks in meeting their new obligations to ensure that all eligible care home residents in aligned care homes are offered seasonal vaccinations, as set out in the 2026/27 Primary Care Network Directed Enhanced Service (PCN DES) contract.

Pregnant women

Vaccination helps to protect pregnant women and babies from serious illness.

Services should continue promoting vaccination confidently and consistently to ensure there is a 100% offer to pregnant women, with clear pathways in place from 1 September.

Health professionals involved in maternity care should understand these routes and actively promote them. Pregnant women should be offered their flu vaccination at every healthcare encounter where it would be appropriate to do so.

Regional commissioners must ensure all maternity providers have ordered sufficient vaccine to start vaccination of this cohort on 1 September and work with vaccine suppliers to ensure that all maternity providers have supply ahead of this date.

Maternity providers must use the Record a Vaccination Service (RAVS) to record all flu vaccinations.

Clinically at-risk

People in a clinical risk group, as defined in the Green Book, face a higher likelihood of severe illness and complications from flu.

Supplementary national invites for adults and children in this group will be sent from late September. To ensure they are given the best chance of protection as early as possible, commissioners should emphasise that at-risk children can come forward for vaccination before getting offers in their schools. Commissioners should use clinical networks to ensure clinicians, paediatricians and specialist teams in trusts are promoting vaccinations.

At-risk children aged 2 to under 18 years can be vaccinated in community pharmacies from 1 October.

COVID-19

In March, the government accepted advice from the Joint Committee on Vaccination and Immunisations (JCVI) about eligibility for the 2026 autumn vaccination programme. The cohorts and timing of the programme will be the same as autumn 2025, with providers encouraged to co-administer with flu where possible. Regions are expected to maintain or exceed the uptake in the autumn 2025/26 campaign.

When individuals present for flu or COVID vaccinations, providers should ensure they promote any other vaccines the individual is eligible for. Further details are available in the Green Book.