1. Introduction

1. The NHS Shingles Vaccination Programme is a general practice essential service. All practices are required to offer eligible registered patients shingles vaccinations in line with the UK Vaccination and Immunisation Schedule.

2. There have been a number of changes to the NHS Shingles Vaccination Programme in the recent years. In September 2021, Shingrix® was introduced for individuals for whom the live Zostavax® was contraindicated. From 1 September 2023, further programme changes were introduced to implement the full JCVI recommendations (with Shingrix® replacing Zostavax® for the whole programme), and GP contracts have been updated accordingly.

3. Most recently, from 1 September 2025, the non-live shingles vaccine Shingrix® vaccine should be offered to:

• all severely immunosuppressed individuals (eligibility as defined in the Green Book Shingles chapter) from 18 years of age with no upper age limit. Individuals only become eligible from their 18^th birthday
• immunocompetent individuals who will become eligible for Shingrix vaccine from 60 years of age in a phased implementation over a 10-year period starting with those turning 65 and 70 years of age

4. The full eligibility criteria for this programme are set out within the tables within the Statement of Financial Entitlements (SFE). Further information is available in the Shingles’ Green Book Chapter, and in the 22 July 2025 UK Health Security Agency and NHS England letter.

5. Further information is available in the Shingles the Green Book Chapter, and in the 22 July 2025 UK Health Security Agency and NHS England letter Eligible cohorts and timings between doses.

6. This guidance outlines the changes and technical requirements for the NHS Shingles Vaccination Programme from 1 September 2025. It provides practices with information on the eligible cohorts, clinical codes required to record shingles vaccination events and outlines how payments are supported through the General Practice Extraction Service (GPES).

2. Eligible cohorts

7. Eligible patients can be immunised at any point in the year as soon as they become eligible and shingles vaccination should be offered all year-round.

8. Practices are required to call and recall all cohorts as individuals become eligible and can also offer vaccination opportunistically, if clinically appropriate when an individual attends the practice for another reason.

Severely Immunocompromised cohort

9. From 1 September 2025, the shingles vaccine Shingrix® should be offered to:

10. all severely immunocompromised individuals (eligibility as defined in the Green Book Shingles chapter) from 18 years of age

11. Severely immunocompromised individuals aged 18 and over represent the highest priority for vaccination given their risk of severe disease. Although shingles can occur at any age, the risk and severity of shingles and its complications increases with age and is high in individuals who are severely immunosuppressed.

12. Individuals who are considered to have a mildly, rather than severely, weakened immune system will fall within the immunocompetent cohort at the appropriate age point for the purposes of this vaccination programme.

13. Severely immunocompromised individuals become eligible on or after their 18^th birthday and should be offered two doses of Shingrix^®, with the second dose offered eight weeks to six months after the first. Eligible patients who do not receive the second dose within six months however, can still receive the second vaccine later, there is no need to start the course again. There is no upper age limit for this cohort. Severely immunocompromised individuals aged 18 and over represent the highest priority for vaccination given their risk of severe disease.

14. If an individual has had Zostavax vaccination previously and then becomes severely immunosuppressed, they should be offered 2 doses of Shingrix when they reach the eligible age for the national programme. If an individual has had 2 doses of Shingrix and then becomes severely immunosuppressed, there is no need to repeat the course.

15. For further details see Annex A ‘Vaccination outside of the National Routine Vaccination Schedule (NHS programme)’ and Shingles immunisation programme: information for healthcare practitioners.

Immunocompetent cohort

16. The expansion of eligibility for the immunocompetent cohort is being implemented over a 10-year period from 1 September 2023 to 31 August 2033 in two stages:

• the first stage is from 1 September 2023 to 31 August 2028 and has been confirmed
• the second stage expansion is subject to confirmation but is proposed from 1 September 2028 to 31 August 2033

17. Eligible immunocompetent people have been divided into four cohorts to support implementation and payment through GP contracts:

a. From 1 September 2023 to 31 August 2028, GPs must offer vaccination to immunocompetent people who are:

1. turning 65 years old and these individuals will remain eligible until their 80^th birthday (if the second dose is due after their 80^th birthday, they will be eligible to receive this up until their 81^st birthday); and
2. turning 70 years old and these individuals will remain eligible until their 80^th birthday (if the second dose is due after their 80^th birthday, they will be eligible to receive this up until their 81^st birthday).

18. The immunocompetent cohort expansion was proposed for implementation over a 10-year period from 1 September 2023 to 31 August 2033 in two stages. The first stage is from 1 September 2023 to 31 August 2028 and has been confirmed. The second stage expansion is subject to confirmation but is proposed from 1 September 2028 to 31 August 2033. Subject to this confirmation of the second stage catch-up, it is proposed that after the 10-year catch-up shingles vaccination will be routinely offered to those turning 60 years of age.

19. Eligible immunocompetent individuals should be offered two doses of Shingrix®, with the second dose offered 6 to 12 months after the first dose (individuals can still receive the second dose later than 12 months, there is no need to start the course again).

20. Immunocompetent individuals aged 70 to 79 years on or before 31 August 2023, will continue to be eligible for a shingles vaccination until their 80^th Where one of these individuals is offered Shingrix® then the second dose can be given until their 81st birthday.

21. Immunocompetent individuals who have received Zostavax® previously as part of the NHS shingles vaccination programme do not need to be revaccinated with Shingrix^®. However, where an immunocompetent individual who received Zostavax® privately or before the programme was implemented then the individual should be offered two doses of Shingrix® once they reach the eligible age for the routine programme. This applies to both the severely immunocompromised and immunocompetent cohorts and further information, including the eligibility and timings required between doses, is available in Shingles immunisation programme: information for healthcare practitioners.

3. Vaccine supply

19. There is now only one shingles vaccine currently available for use within the national programme. Shingrix is a non-live recombinant sub-unit vaccine given as a 2-dose schedule. Shingrix® is available to order online via the ImmForm website.

20. Details of ordering are available on the ImmForm website. Order controls may be put in place to enable UKHSA to manage the supply and demand. It is recommended that practices should only hold two weeks of stock and should ensure that local stocks of vaccine are rotated in fridges to avoid wastage.

4. Technical implementation of the shingles programme to enable payments

21. To support the implementation of the shingles programme changes from 1 September 2025, the General Practice Extraction Service (GPES) and the Calculating Quality Reporting Service (CQRS) have been updated.

22. The 2025/26 shingles programme went live in CQRS at the end of July 2025. To account for the immunocompetent cohort expansion each year, CQRS will be updated accordingly each year around July. Commissioners must offer this service to practices and practices are required to accept and participate in this service (as it is an essential service).

23. Data is extracted monthly through GPES to support the automated payments for shingles vaccination events administered in the preceding month.

24. Where a shingles vaccination event is not correctly recorded or is not recorded within GP IT systems within the month it took place, these vaccination events may not be included in the monthly extract. In these circumstances, the practice will need to raise the missing vaccination events with their commissioner who will need to approve the claim and once approved the claim will either need to be through a:

• manual adjustment in CQRS before the payment is approved by the service provider and commissioner in CQRS
• payment variation managed outside of CQRS.

Timings between doses

25. It is important that practices offer the second dose of Shingrix^® within the specified timeframes as required by the programme to ensure individuals complete the course. The GPES extract will therefore look for second doses given within these timeframes and the timing between doses will be calculated in days as follows:

a. severely immunocompromised cohort – eight weeks (56 days) to six months (186 days), where:

i. 56 days is calculated as eight weeks x seven days, and

ii. 186 days is calculated as six months x 31 days; and

b. immunocompetent cohort – six months (187 days) to 12 months (372 days), where:

iii. 187 days is calculated as six months x 31 days, and

iv. 372 days is calculated as 12 months x 31 days.

Payment for second doses given outside of the defined timescales  

26. From a clinical perspective, it is important that an individual receives a second dose of Shingrix®, even if this is outside of the specified timings (noting that immunocompetent individuals are eligible until they turn 80 and require a second Shingrix® dose to complete the course before their 81st birthday whilst there is no upper age limit for those that are severely immunocompromised). While the requirement is for the second dose to be given within the specific timeframes, there may be circumstances where this is not possible. In recognition of this and to encourage giving the second dose, the GPES extract will include counts that do not include an upper timing between the doses. There is no upper age limit for those severely immunocompromised individuals, there will be three counts for each cohort:

a. one payment count for the first dose

b. one payment count for the second dose given within the timeframe between doses; and

c. one payment count for the second dose with only a lower timing and no upper timing (note: for the immunocompetent cohort there is an upper age limit for payment purposes of day before 81^st birthday).

GPES payment extracts

27. The GPES payment extracts will be divided into the following three groups:

a. Group 1: those aged 70 to 79 years old at the point of vaccination who are immunocompetent and who will receive two doses of Shingrix on or after 1 September 2023 (routine programme);

b. Group 2: those aged 65 years on or after 1 September 2023 at the point of vaccination who are immunocompetent and who will receive two doses of Shingrix (catch-up programme); and  

c. Group 3: those aged 18 years and over at the point of vaccination who fall within a severely immunocompromised cohort and who will receive two doses of Shingrix (routine programme for severely immunocompromised).

28. The shingles severely immunocompromised cohort will be automatically identified via the GPES payment extract. However, due to the restrictions in the way data can be extracted from GP clinical systems, it is not possible to extract exact data in accordance with the Green Book definitions for the shingles severely immunocompromised cohort. The shingles severely immunocompromised cohort has therefore been developed in the GPES extract to be largely over-inclusive for payment purposes and includes some patients who do not strictly meet the Green Book shingles definition for severe immunosuppression. This is to support clinical discretion and reduce the need for manual payment claims. However, there are also some areas of under-inclusion where technical and coding limitations mean it is not possible to fully identify all eligible patients in the GPES extract (for example identifying patients currently receiving, or who have received, a set of immunosuppressive medications/therapies or a combination of therapies). Practices wishing to use the GPES severely immunocompromised logic to identify eligible patients for call and recall should be mindful of the limitations of the count and must review their patient list to ensure that all eligible individuals are identified.

29. Patients are considered as severely ‘immunocompromised’ for the purposes of the GPES extract where:

a. the patient has a clinical code on their medical record indicating any of the following up to and including the end of the month in which the shingles vaccination was administered:

• Acquired immune deficiency syndrome (AIDS)
• Human immunodeficiency virus (HIV) diagnosis
• Graft versus host disease (GVHD)
• Haematological malignancy
• Lymphoproliferative disorder code

OR

b. the patient has a clinical code indicating any of the following in the period stated in brackets up to and including their first shingles vaccination of any kind OR up to and including the end of the month in which the shingles vaccination was administered:

• Unresolved persisting immunosuppression diagnosis (ever)
• Unresolved expiring immunosuppression diagnosis (last six months)
• Immunosuppressive procedure (last six months)
• Immunosuppressive drug (last six months)
• Allograft stem cell transplant code (last 24 months)
• Autograft stem cell transplant (last 24 months)
• Disease-modifying antirheumatic non-drug code (last six months).
• Radiotherapy treatment (last six months)

30. The SNOMED clinical codes included in the code clusters (also known as the reference sets) to support the criteria outlined in paragraph 34 are available for review on the Primary Care Domain Reference Set Portal. The content of the code clusters is subject to change as new SNOMED codes are introduced and/or the definitions within the code clusters are refined. The way in which a patient’s inclusion in the relevant payment counts is determined through application of the clinical codes, is set out within the business rules documents.

31. Additionally, to address the restrictions in the way in which clinical data can be extracted from GP clinical systems and to further support general practice, there is a clinical code available for ‘requires shingles vaccination’.

31. This code will enable clinicians to use clinical discretion when identifying an individual who should be offered Shingrix^® due to their severely immunocompromised status but who will not be picked up by the automated definitions in the GPES business rules as outlined above. As such, there will be additional payment counts for those clinically identified as severely immunocompromised from aged 18 years through usage of the ‘requires shingles vaccination’ code. This code will need to be added to the patient’s medical record either before or on the same day as the administration of the first Shingrix® vaccination event to ensure the patient is picked up in the ‘requires shingles vaccination’ counts. The GPES extract will look for the ‘requires shingles vaccination’ code up to 12 months before the first Shingrix® vaccination event and until the end of the month (reporting period) in which the vaccination event occurs. This code will only need to be added once and will not need to be re-coded for the second dose. Practices will not be required to use this code for every patient identified as severely immunocompromised for a shingles vaccination, but rather for those where the practice is unsure if they will be picked up under the automated GPES severely immunocompromised cohort or where clinical discretion has been applied to offer a shingles vaccination.

From 1 September 2025 the following cohorts will apply:

34. These counts will be effective until 31 August 2026 after which time the extract will be updated to extend the catch-up programme. From September 2025 the payments count will therefore run on a rolling 1 September to 31 August cycle in line with the programme. For example, from 1 September 2025 to 31 August 2026 the extract will include those who turned 65 during this period, as well as those who are 66 and 67 (having turned 65 during 1 September 2023 to 31 August 2025) and who have been vaccinated.

35. To support practices in understanding how the payment counts will be operationalised, several scenarios have been included in Annex B.

5. Clinical codes for recording shingles vaccinations

36. Practices will be required to use the clinical codes set out in Table 1 to record shingles vaccinations.

37. Practices will be required to ensure that updates are undertaken to any locally created templates, within their clinical systems, to accommodate the coding changes for this programme. The use of incorrect codes will result in the vaccination event not being captured by the GPES extract and practices will need to re-code the vaccination event accordingly in the patient’s medical record, claiming the relevant payment as outlined in section 4.

Table 1: Shingles clinical codes to enable payment extracts

38. The service will also look for the following code, but this code will not confer eligibility for payment on the basis it is in respect of shingles vaccination administered by another healthcare provider.

39. Previously, if a generic code was used it was presumed to be Zostavax vaccine and therefore practices were advised to stop using the codes below so as to avoid the risk of non-payment. However, as the Zostavax vaccine is now depleted and Shingrix vaccine is the only one available for use for this programme, these codes can be used to be eligible for payment from 2025. Anyone coded with a generic code on after the 1 October 2024 i.e. after depletion of Zostavax will be captured and practices will not be penalised for coding with a generic code.

6. Helpful resources

40. The following resources have been published:

• Shingles vaccination programme letter on changes from September 2025
• Shingles Patient Group Directions (PGD) template
• Shingles vaccinations guidance for healthcare practitioners
• Shingles vaccination guide
• Shingles the Green Book Chapter
• Shingles eligibility calculator – from September 2025

Annex A: Vaccination outside of the National Routine Vaccination Schedule (NHS programme)

1. Practices are commissioned to deliver vaccinations that fall under the National Routine Vaccination Schedule alongside some selective vaccination programmes for patients in clinical risk groups as per the Green Book recommendations. Under the GP contracts, Paragraphs 19(4) and 19(5) in Part 5 of the Statement of Financial Entitlements (SFE) set out the circumstances in which a practice is eligible for an Item of Service (IoS) payment for delivering a vaccination. These circumstances would have due regard to the requirements set out in tables 1-3 of the SFE, including where this may be for medical reasons (including post-transplant).

2. A practice would therefore be eligible for an IoS payment where it has administered additional doses of any of the vaccines set out in the SFE for medical reasons, but this would be where the individual being vaccinated would already have passed the age eligibility stipulated, in line with the routine number of doses as per the Green Book. The SFE does not allow for payment of an IoS fee outwith of the bounds of the National Routine Vaccination Schedule (NHS programme) for example where the individual may require re-vaccination for medical reasons prior to being eligible or in a scenario where they have never been eligible under the routine schedule and as set out in tables 1-4 in the SFE.

3. Where revaccination for medical reasons is required and this falls within the bounds of the National Routine Vaccination Schedule (and tables 1-3 in the SFE), the practice may use centrally supplied vaccines. Where additional doses are required and these are not in line with the National Routine Vaccination Schedule, the practice will be required to procure the vaccine and claim reimbursement. It will, under this circumstance, be a decision for the commissioner on whether the practice may receive an IoS payment.

4. Vaccination which falls outside of the routine programme will not be supported within the nationally developed Patient Group Direction and in some circumstances might constitute off label use of the vaccine. It is important to ensure the correct legal mechanisms are in place and that clinical teams work within their scope. This might require liaison between the individual’s practice, the specialist secondary care team and/or the local commissioning team. 

Annex B: Operationalisation of the GPES counts

This Annex provides several scenarios to explain how the GPES extract will operate to support the shingles vaccination programme. They are not exhaustive.

Scenario 1 – Shingrix^® for an immunocompetent individual turning 74 years on or after 1 September 2025

Patient A is immunocompetent and turned 74 years on 31 August 2025. The patient had previously received a first dose of Zostavax® on 1 August 2024 whilst the practice still had stock of Zostavax® and using clinical code 871898007, and the patient received a second shingles vaccination and a first dose of Shingrix® on 1 October 2025 using clinical code 1326111000000107.

Patient A was included in the practices August 2024 but not included for October 2025 GPES extracts for payment. See table for summary.

Scenario 2 – Shingrix^® for immunocompetent individuals turning 70 years on or after 1 September 2023

Patient C is immunocompetent and turned 70 years on 1 October 2023, so is eligible for a Shingrix® vaccination. The practice administers the first dose of Shingrix® on 31 October 2023 using clinical code 1326101000000105 and the second dose on the 15 June 2024 using clinical code 1326111000000107.

Patient C will therefore be included in the practice’s October 2023 and June 2024 GPES extracts for payment. See table for summary.

Scenario 3 – Severely immunocompromised

Patient D is severely immunocompromised and turned 55 years on 1 September 2023, so is eligible for shingles vaccination. The medical record for Patient E confirms severe immunosuppression through the clinical coding of a bone marrow transplant on 1 January 2022. The practice administers the first dose of Shingrix® on 10 November 2023 using clinical code 1326101000000105 and the second dose on 1 February 2024 using clinical code 1326111000000107.

Patient D will therefore be included in the practice’s November 2023 GPES extract for payment of the first dose of Shingrix® and in the February 2024 GPES extract for payment of the second dose of Shingrix®. See table for summary.

Scenario 4 – Severely immunocompromised

Patient E is severely immunocompromised and turned 18 years on 1 September 2025, so is eligible for shingles vaccination. The medical record for Patient F confirms severely immunocompromised through the clinical coding of a bone marrow transplant on 1 January 2022. The medical record for Patient F also confirms a first dose Shingrix® vaccination recorded on 1 August 2024 using clinical code 1326101000000105. The practice administers a second dose of Shingrix® on 1 February 2026 using clinical code 1326111000000107.

If a single dose of Shingrix® vaccine has been given to a severely immunocompromised individual over 18 years of age then a second dose of Shingrix® should be given with minimum interval o f8 weeks to complete the 2 dose course, regardless of the interval between doses. The course does not need to be restarted.

Patient E will therefore only be included in the practice’s February 2026 GPES extract for payment of the second dose of Shingrix®. The first dose of Shingrix® was given prior to 1 September 2025 when the NHS Shingles Vaccination Programme changed to lower the age of eligibility for severely immunocompromised individuals to 18 years and over. As such the practice was not eligible for payment of the first dose of Shingrix® as it was administered prior to the programme changes being implemented.

If an individual has received a single dose of the Shingrix® vaccine prior to becoming eligible for the national programme then they should wait until they reach the eligible age for the Shingrix® vaccine via the national programme and then be offered a second dose to complete the course for full protection. Where the course of immunisation is interrupted, there is no need to restart the course.

See table for summary.

Scenario 5 – Shingrix^® vaccination for individual clinically identified as requiring a shingles vaccination

Patient F was 55 years old on 1 September 2023. The practice has identified that Patient F falls within one of the severely immunocompromised cohorts as per the Green Book definitions and administers a first dose Shingrix® vaccination on 1 October 2023. It is recorded using clinical code 1326101000000105. The practice identifies that Patient F was not included in the October 2023 GPES extract due to not being picked up under the severely immunocompromised payment count and adds a ‘requires shingles vaccination’ code using 1730561000000103 to Patient F’s medical record on 20 November 2023. The practice then administers the second dose of Shingrix® on 1 February 2024 using clinical code 1326111000000107.

Patient F will be included in the February 2024 GPES extract in the ‘requires shingles vaccination’ count for the second dose. This is because the ‘requires shingles vaccination’ code was added to Patient F’s medical record before the second dose was administered. However, Patient F will not be included in the October 2023 GPES extract as the ‘requires shingles vaccination’ code was not included in Patient F’s medical record before the first dose was administered. The practice will need to manually claim for this first dose. See table for summary.

Scenario 6 – Shingrix^® vaccination for immunocompetent catch-up with second dose given on or after the minimum six months interval between doses

Patient G was 64 years age of 1 September 2023 and turned 65 years old on 1 October 2023. Patient I is immunocompetent and therefore becomes eligible for the NHS Shingles Vaccination Catch-up Programme from this date (i.e. their 65th birthday). The practice administers a first dose Shingrix® vaccination on 1 November 2023 using clinical code 1326101000000105 and a second dose of Shingrix® on 1 June 2024 using clinical code 1326111000000107.

Patient G will therefore be included in the practice’s November 2023 GPES extract for payment of the first dose of Shingrix® and in the June 2024 GPES extract for payment of the second dose of Shingrix® which was given more than six months after the first dose. See table for summary.

Scenario 7 – Shingrix® vaccination for immunocompetent catch-up with second dose given before the six months interval between doses

Patient H was 64 years age of 1 September 2023 and turned 65 years old on 1 October 2023. Patient H is immunocompetent and therefore becomes eligible for the NHS Shingles Vaccination Catch-up Programme from this date (i.e. their 65th birthday). The practice administers a first dose Shingrix® vaccination on 1 November 2023 using clinical code 1326101000000105 and a second dose of Shingrix® on 1 March 2024 using clinical code 1326111000000107.

Patient H will therefore be included in the practice’s November 2023 GPES extract for payment of the first dose of Shingrix®. Patient H will not be included in the March 2024 GPES extract for payment of the second dose of Shingrix®, this is because the second dose was given less than six months after the first dose which is outside the required minimum interval between doses. See table for summary.

Scenario 8 – Shingrix® vaccination for immunocompetent catch-up given to individual who did not turn 65 years during 1 September 2023 to 31 August 2024 (the reporting year)

Patient I was 65 years of age on before 31 August 2023 and turned 66 years on 1 December 2023 and is therefore not eligible for the NHS Shingles Vaccination Programme until they turn 70 years of age during 2027/28. Despite Patient I not being eligible, the practice administers a first dose Shingrix® vaccination on 1 November 2023 using clinical code 1326101000000105 and a second dose of Shingrix® on 1 June 2024 using clinical code 1326111000000107. 

Patient I will not be included in the in the practice’s November 2023 GPES extract for payment of the first dose of Shingrix® nor the June 2024 GPES extract for payment of the second dose of Shingrix®. This is because Patient I did not turn 65 years during the reporting year. See table for summary.

Scenario 9 – Shingrix® vaccination for immunocompetent catch-up given to individual who turned 65 years on 1 September 2023

Patient J turned 65 on 1 September 2023 and is therefore eligible for the NHS Shingles Vaccination Programme. The practice administers a first dose Shingrix® vaccination on 1 November 2023 using clinical code 1326101000000105 and a second dose of Shingrix® on 1 June 2024 using clinical code 1326111000000107.

Patient J will be included in the in both the practice’s November 2023 and June 2024 GPES extract for payment.

 Publication reference: 02294