As the importance of vaccinations continues to grow, especially in the wake of increasing awareness around respiratory viruses, questions often arise about who is legally and practically able to administer vaccines. One VERY common question at the moment is whether healthcare assistants (HCAs, also know as Healthcare Support Workers or HCSWs) can administer the RSV (Respiratory Syncytial Virus) vaccine, which is crucial for protecting vulnerable populations. It’s a big question, and not a straightforward one to answer. It involves looking to many pieces of national, local and legal guidance surrounding medication administration. It also involves a bit of scrutiny of the needs and context of the surgery that’s asking the question.
Understanding the Role of Healthcare Assistants
Let’s first look at what this role is designed for. Healthcare Assistants (HCAs) are integral members of the healthcare team, providing essential support to registrants like nurses and doctors. HCA’s do so much helpful stuff! Their duties typically include assisting with patient care, supporting care plans like measuring blood pressures and taking blood, and helping to provide the information needed to help registrants to monitor and assess patient conditions. HCAs often work closely with registered nurses and doctors to ensure that patients receive the care they need. I personally see them as ‘the backbone of the office’, keeping things running well and being a conscientious second pair of eyes on things that may easily get missed when times are busy. They are BRILLIANT. And yes, they often are already immunising people with a small selection of vaccines.
Scope of Practice
However, while HCAs play a vital role in healthcare, their scope of practice is limited compared to that of registered healthcare professionals. HCAs are generally not authorised to perform clinical tasks that require advanced medical training or decision-making. This limitation often includes administering certain medications or vaccines unless specific legal and institutional guidelines permit it. This is why they are not already vaccinating everyone with everything.
RSV Vaccines – what’s the big deal?
Respiratory Syncytial Virus (RSV) is a common respiratory virus that can cause severe illness, particularly in infants, the elderly, and individuals with compromised immune systems. It is one of the leading causes of respiratory infections worldwide, often leading to hospitalisations in vulnerable populations. The impact of RSV on public health is significant, making vaccination a critical tool in preventing severe cases and reducing the burden on healthcare systems.
RSV vaccines have been developed to protect those most at risk from the virus. These vaccines are particularly targeted at infants (via the maternal programme as there are no vaccines for this age group) and older adults. As the vaccines are now available since the introduction of the RSV programmes in September 2024, ensuring they are administered correctly and safely is paramount. And there is a whole lot of new guidance to digest around this particular programme. It’s a LOT of reading to do.
Of course, there is going to be the inevitable question of ‘who can administer them?’. HCA’s seem like a logical answer. After all, they often already have the skill set to deliver injections from the other programmes. But first, let’s look at the literature more closely.
Legal Frameworks for Vaccine Administration
In healthcare settings, the administration of medications, including vaccines which are prescription only medicines (POM), is governed by strict laws and regulations. These regulations are designed to ensure patient safety and maintain high standards of care. In the UK, for example, the Medicines Act 1968 outlines who can legally prescribe and administer medications, and the CQC, NMC, GMC, and GPC, as well as the UKHSA immunisation training guidelines fall in line with this.
Prescribing authority is typically reserved for registered healthcare professionals such as doctors, nurse practitioners, and pharmacists. These professionals can prescribe medications, including vaccines, and in some cases, they can delegate the administration of these medications to other healthcare workers, including HCAs – under stringent supervision. This delegation must adhere to strict guidelines. In the UK, the Nursing and Midwifery Council (NMC) provides clear guidelines on delegation, emphasising that the responsibility for ensuring safe and effective care remains with the registered professional who delegates the task.
Legal mechanisms must also be followed and adhered to. Registered members of staff can work under Patient Group Directions (PGDs) which include a degree of clinical assessment against the criteria. HCA’s are excluded from the legislation to work under PGD so are required to to have the drug prescribed for the specific patient (Patient Specific Directions (PSD)). This is often a physical barrier to HCA’s being able to give certain vaccines as it is simply not practical to keep getting an individual prescription each time. It is often felt that the registrant might as well do it themselves. So, with regard to administration itself, legally the mechanism a HCA would have to work under to administer RSV would be via a PSD.
But this is only the beginning of answering the question.
The question now changes from ‘can they?’ to ‘should they?’
Current Immunisation Guidelines and Regulations
We have seen that HCAs technically may be involved in the administration of RSV vaccines under strict supervision and within prescribing guidelines. However, the question of whether HCAs can administer RSV vaccines also depends on the individual competence of the HCA and the relationship they have with their prescribers, and the local requirement to actually get HCA’s vaccinating. In many healthcare settings, HCAs are not authorised to administer every type of vaccine due to the complex nature of vaccine administration, the specific questions a patient might ask, and the potential risks involved. There are boundaries to their role. However, in some cases, HCAs are allowed to administer certain vaccines under the direct supervision of a registered nurse or doctor, provided they have received the appropriate training and the patient has been individually assessed by a prescriber. The prescriber of the vaccine ultimately has the final say here as they will be the one delegating the responsibility and writing the patient specific direction. They have to be assured that the HCA they are delegating to is appropriately knowledgeable and competent.
There are government guidelines and training standards which outline the characteristics and training required of a HCA before administering any vaccine. Typically, these guidelines emphasise the need for appropriate training and supervision, and in these documents the vaccines that are given on the routine childhood programme and in travel health settings are omitted for HCA’s. These vaccines usually involve a much larger degree of clinical assessment and consideration which is beyond the scope of the HCA role.
Are any specific vaccines mentioned in the guidance around what HCA’s can give?
The RCN have written a guidance document which specifies which vaccines HCA’s are supported to administer. Namely Shingles, Influenza and Pneumococcal vaccines. These vaccines are given in large numbers to the eligible groups and are fairly straightforward in their application. Flu is seasonal, therefore large volumes of patients need to be vaccinated within specific time frames. It’s helpful to expand the workforce here, and necessary. More recently, mass COVID vaccination campaigns have necessitated an urgent widening of the workforce, whereby HCA’s have also become involved there too. This RCN document does not mention RSV at all, but that could always change down the line. As it stands though, RSV is NOT one of the vaccines that the RCN specifically supports HCA’s to administer.
RSV is not a seasonal vaccine requiring periodic expansions of the workforce, nor one that requires annual boosters or repeated doses. Nor is it an urgent pandemic-related vaccine. We have been urged to try to get ahead of the RSV season with the roll out being in September (the disease is seasonal, but the vaccine not so) so at the moment there is a bit of panic to get people in for it. But this will settle eventually and become less of a mad rush when we have settled into the programme. Is the demand for it then going to be manageable without HCA’s having to get trained up and involved?
Training and Knowledge Requirements
For an HCA to be considered for vaccine administration, they must undergo specific training on that disease. They are not mindlessly administering a medication, they will be checking the patient has been assessed, noticing anything a prescriber may have missed since the PSD was written, answering patient questions and allaying concerns. They can only do this if they have a sound degree of knowledge about all those things. Vaccine training in general includes understanding vaccine storage, handling, administration techniques, and recognising and responding to adverse reactions. Each vaccine has its own unique profile with regards to all that. One example of this is that RSV is particularly tricky as it has a vial adapter for reconstitution rather than the same way one might prepare a shingles vaccine with needles. Specific training and supervision would therefore be needed if a HCA was administering the RSV vaccine.
Supervision and Support
This is the first time an RSV programme has been implemented in the UK and is not a disease that is common knowledge to most people. The general public will also have a lot of questions which requires an in-depth knowledge of RSV and the vaccine development and epidemiology that led to this programme being implemented. This therefore requires a LOT of reading around the topic and extra training which can take hours.
Even with proper training, HCAs administering vaccines must always do so under the supervision of a registered healthcare professional. This supervision ensures that any complications or questions that arise during the vaccine administration process can be promptly addressed by someone with the necessary clinical expertise. This is a brand-new programme. And with all brand-new things, there are bound to be initial teething issues (think what happened with Shingles this year with the extensive changes to the existing programme). Clear protocols and procedures must be in place to guide HCAs in these situations. At the moment many registered members of staff are learning themselves about this new vaccine and may not feel in the position to supervise and train someone else just yet.
The Practice in question may simply not have provision for all this training and supervision, especially as we simultaneously embark into the depths of flu vaccine season and grabble with the latest on the autumn COVID booster programme too. On top of preparing for potential measles outbreaks as schools return after summer, getting used to new pertussis vaccines, and evaluating the first year of the Shingles programme expansion. Lots is going on at the minute. HCA’s administering RSV could be either really helpful OR more time-consuming. It could go either way. It all depends on the needs of the practice and the skills and experience of the HCA themselves.
So, this is quite a nuanced decision right?
While HCAs play a crucial role in supporting healthcare teams, their ability to administer RSV vaccines, and the need for them to, is going to vary from person to person and team to team. This HAS to be a local decision ultimately. Can they do it? Yes, potentially under PSD. But SHOULD they do it? Only with caveats about all of the above if the law and guidelines and the best interests of patients and staff are going to be upheld.
As the healthcare landscape continues to evolve, the roles of various healthcare professionals may change. It is essential for healthcare providers to stay informed about current regulations and guidelines to ensure that all staff operate within their scope of practice, particularly when it comes to the administration of vaccines. Widening the roles of who can vaccinate is something that is being discussed in the literature a lot, for example the National Vaccination Strategy was published in December 2023 and is an interesting read about future plans, welcoming the expansion of roles in vaccination.
Healthcare professionals, including HCAs, should be encouraged to pursue relevant training and certifications to maintain and expand their competencies. And alongside this, healthcare institutions should regularly review and update their policies to align with current laws and best practices, whilst always ensuring the highest standards of patient care. They also must consider the extent to which they are developing people’s roles and the fair pay that should come with it. But this question surrounding RSV vaccination and HCA’s HAS to be a local decision and is certainly not the easiest of answers.
So, to help and summarise, here is a possible series of counter-questions to help answer the question of can or should MY HCA give RSV vaccines?
- Have you and they got time to allow training? Properly.
- Is there adequate supervision in place?
- Are the prescribers happy to delegate this task to the HCA?
- Are the prescribers happy to delegate the task in the absence of RCN support? I.e. Are they happy for a HCA to give a vaccine that is not listed in the RCN guidance?
- Is your practice willing to recognise this as an expansion to the HCA role with the appropriate considerations for this extra duty?
- Has the HCA done foundation immunisation training? Are they experienced enough? Will they get the hang of it pretty quick or are they only just starting out?
- Does your practice insurance cover HCA’s administering certain medications?
- Will this programme roll out be made HARDER or EASIER locally if your HCA starts administering RSV vaccines?
- Are there better ways to use a HCA? Can the HCA help in ways other than giving the vaccine? Such as ordering promotional material from NHS stock? loading up the waiting room with posters and leaflets, or helping to run search lists and find possible candidates ready to be assessed for eligibility?
Need a comprehensive training course for anyone on your team who is giving RSV vaccines?
Look no further! Why not try this?
And finally, good luck with your implementation of the programme! We hope it’s going well for you so far.
