Avian Flu Diary: UKHSA: Rule Changes Allowing Doctors & Pharmacists Greater Latitude In Prescribing Flu Medications

Credit UKHSA

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Now that it is September our attentions are once again focused on the upcoming Northern Hemisphere flu season, and while it is impossible to predict how severe it may be, there are a number of worrisome signs.

First, Australia has reported a pretty severe flu season (link), which Dr. Ian Mackay has chronicled in his Virology Down Under blog (see A Flunami in July).

Second, last week Denmark reported An Unusually Early Major Outbreak of Influenza A (H1N1), which displayed unspecified `unique changes'.

Third, the UK has seen an unusual surge in avian flu outbreaks in poultry this summer, which increases the risks of human exposure.
Fourth, the UK has seen a steady increase in flu severity over the past couple of seasons, with 2023 being more severe than 2022, and 2024 being more severe than 2024.

Yesterday (Sept 1st) the UK's Health Security Agency (UKHSA) released several documents outlining changes in this year's flu prevention and treatment policy.

First, eligibility for this year's flu vaccine has been expanded (see Your guide to who’s eligible for the autumn 2025 flu vaccine). Essentially:

The NHS recommends flu vaccination for several groups:

From 1 September 2025
pregnant women
all children aged 2 or 3 years on 31 August 2025
children with certain long-term health conditions (aged 6 months to less than 18 years)
primary school aged children (from reception to Year 6)
secondary school aged children (from Year 7 to Year 11)
all children in clinical risk groups aged from 6 months to under 18 years
From 1 October 2025
everyone aged 65 years and over
individuals aged 18 to under 65 with certain long-term health conditions
care home residents
carers in receipt of carer's allowance, or those who are the main carer of an elderly or disabled person
those living with people who are immunocompromised
frontline health and social care workers

In years past, influenza antivirals have only been made available during the `regular' flu season (October–March), and could only be released out-of-season if their CMO (Chief Medical Officer) issued an annual letter of confirmation.

While exceptions could be made, GPs and pharmacists had to go through bureaucratic appeals, which could delay treatment. A serious concern - because to be most effective - antivirals should be given in the first 48 hours on an illness.

While this doesn't give UK pharmacists carte blanche to prescribe antivirals, it does remove a number of (mostly seasonal) barriers. First the press release, after which I'll have a postscript.

Government to combat flu outbreaks by removing red tape

The government will remove red tape, allowing doctors and pharmacists to prescribe flu medicines year-round to reduce winter pressures and protect the NHS.

From:Department of Health and Social Care, UK Health Security Agency and Stephen Kinnock MP Published1 September 2025
Rule change will allow doctors and pharmacists to better respond to flu outbreaks
Patients will get access to vital treatment for flu whatever time of the year
Government reducing restrictions and slashing bureaucracy to help save lives and protect the NHS
Patients will get the flu medicines they need more quickly and at any time of the year, thanks to government changes to prescribing regulations.

As part of its commitment to reduce winter pressures and protect the NHS, the government is removing the restriction that means certain flu medications cannot begin to be prescribed outside the usual ‘flu season’ until an annual letter of confirmation from the Chief Medical Officer is received, which can lead to delays in treatment.

These rules are being removed so action can be taken to tackle flu all year round. This will allow patients to receive treatment sooner and ease winter pressures by allowing outbreaks to be contained.

The move is part of the government’s ongoing drive to slash unnecessary bureaucracy in the health service through the red tape challenge and put power back in the hands of clinicians on the frontline.

It coincides with the NHS launching this year’s improved flu vaccine programme today (1 September 2025). The autumn rollout kicks off with flu vaccines for millions of children and pregnant women. And it follows the recent introduction of the chickenpox vaccine for thousands of children and the RSV vaccine for pregnant women and older adults across the country, as the government continues building the NHS’s defences ahead of winter.

Health Minister, Stephen Kinnock, said

Flu can strike all year round, so it doesn’t make sense to restrict doctors and pharmacists from taking action to protect the most vulnerable in their communities.

That’s why, as well as starting the flu vaccination programme today, we are also removing the need for clinicians to have to ask for permission to prescribe what their patients need.

It is exactly the type of change we wanted to see when we launched the red tape challenge to bulldoze bureaucracy and prioritise patients over paperwork.

While the number of flu outbreaks outside of the ‘flu season’ in October to March is relatively low, the potential outcomes are no less severe. Removing these barriers now will enable the NHS to respond more quickly to health challenges year-round, strengthening its preparation for winter.

Until now GPs and pharmacies had to be commissioned via a patient-specific direction to prescribe certain medicines, which led to delays. It also meant clinicians could prescribe some medicines and not others.

The reasons for the restrictions no longer apply, and removing them means clinicians can provide the right treatment at the right time to patients. Specifically this change will allow oseltamivir (Tamiflu®) and zanamivir (Relenza®) to be prescribed and dispensed outside the flu season.

These antivirals are recommended for treatment of those at highest risk of severe disease outside of the flu season, following a confirmatory test for flu. They are also recommended to prevent disease in specific settings such as care homes where confirmed cases of flu have occurred.

Dr Jamie Lopez Bernal, consultant epidemiologist for immunisation at the UK Health Security Agency, said:

While the majority of influenza cases and outbreaks occur during the flu season, we do continue to see outbreaks outside the peak period.

These changes will allow primary care providers and health protection teams to respond more rapidly with effective treatment to reduce the risk of severe disease and the spread of infection at any time of year.

As the flu vaccination programme gets underway, vaccine teams are working across the country to make it as easy as possible for those eligible to get their jabs - with some school providers now offering vaccines in nursery settings for 2 to 3 year olds for the first time ever.

Expectant mums and all children aged 2 to 16 are eligible for the flu vaccine, expanding to 6 months to 18 years old for those in clinical risk groups.

The NHS national booking system also opens today for all eligible individuals to book their winter flu and COVID-19 vaccinations, with appointments starting from 1 October

These steps are all being promoted as part of a national strategy to reduce impact of the winter respiratory season's on the NHS. In recent years, hospitals have been in crisis mode for months at a time, with long waits in A&E, lengthy ambulance handover delays, and increased reliance on `corridor care'.

Over the summer the NHS released a new `10 year health plan' to deal with this perennial crisis, which is summarized in:

Urgent and emergency care plan 2025/26

A lot will depend upon what kind of flu/COVID/respiratory season emerges. HPAI H5N1 is a wild card, as are any new COVID variants. Seasonal flu can sometimes show us new tricks (see When Seasonal Influenza Goes Rogue), and Norovirus (aka `winter vomiting bug') often exacerbates the problem.