What changed for 2026/27?
Five things. COVID-19 vaccination became a community pharmacy advanced service on 1 April 2026, under one specification with adult flu. The flu fee rose to £10.06. The COVID-19 fee now depends on the date. The £10 housebound supplement went. And two new groups were added to the pharmacy flu offer in June 2026: children, and people experiencing homelessness.
NHS England published the joint specification with a letter dated 15 December 2025. The letter lists the structural changes. The two specifications were combined into one document. Contractors can still provide flu only. COVID-19 is commissioned as an advanced service from April 2026. And NHS England has "retired the current COVID-19 vaccination provisions around surge, pausing of services and designation of sites". Community Pharmacy England (CPE) records that from 1 April 2026 the new service replaced the COVID-19 national enhanced service and the adult flu advanced service.
| Change | 2025/26 | 2026/27 |
|---|---|---|
| COVID-19 commissioning | National enhanced service | Advanced service from 1 April 2026, joint specification with adult flu. |
| Flu fee | £9.58 | £10.06 per dose. |
| COVID-19 fee | Fee plus £10 housebound supplement | £8.70 from 1 September 2026 to 31 January 2027, £10.06 outside that window; no housebound supplement. |
| Children's flu in pharmacy | Not commissioned nationally | Two and three year olds and at-risk children from 1 October 2026; school-aged catch-up from 1 December 2026. |
| Homeless people | Not a national cohort | Aged 16 and over, eligible from 1 October 2026. |
| Vaccines for 65 and over | IIVc not treated as equivalent | IIVc now equivalent to aIIV, IIV-HD and IIVr. |
The rest of the machinery carries over from 2025/26, including the National Booking Service (NBS), point of care recording and the co-administration duty. Fees for the MenB service, which also runs through the pharmacy fridge this year, are covered separately in how the MenB vaccination service works.
When does the 2026 season start?
On 1 September 2026 for pregnant women and on 1 October 2026 for the other adult cohorts. CPE's service page says that from 1 September 2026 "pharmacies will be able to vaccinate pregnant women". From 1 October 2026, it adds, "vaccination of the other adult cohorts can commence". The flu letter of 26 February 2026 sets 1 October for adults aged 65 and over, for clinical risk groups and for health and social care workers.
The programme runs to 31 March 2027, but the letter says most vaccinations should be completed by the end of November. That matters for staffing. The bulk of the year's doses, and therefore the bulk of the fee income, fall in eight weeks from the start of October. The spring 2026 COVID-19 campaign, for comparison, ran from 13 April to 30 June 2026 and prioritised care homes for older adults and eligible housebound patients.
The specification itself does not fix campaign dates. It says commencement and end dates "will be announced and authorised by the Commissioner", and CPE confirms that campaign timings "will be confirmed via system letters". Watch for those letters; the flu letter dates are the working assumption until they arrive.
Who is eligible for a free flu jab?
The same groups as in 2025/26, with one addition. The flu letter of 26 February 2026 states that there are "no changes to eligible cohorts for the 2026 to 2027 programme". The amendment letter of 9 June 2026 then added people experiencing homelessness, as defined in the Green Book, aged 16 and over. They "should be included in the national flu programme from 1 October 2026".
| Cohort | From | Note |
|---|---|---|
| Pregnant women | 1 September 2026 | Vaccinated with IIVc or IIVr. |
| Adults aged 65 and over | 1 October 2026 | Four vaccine options treated as equivalent. |
| Adults aged 18 to 64 in clinical risk groups | 1 October 2026 | As defined in the Green Book. |
| Residents of long-stay residential care homes | 1 October 2026 | Pharmacy vaccinates in care homes only at the commissioner's request. |
| Carers and close contacts of immunocompromised people | 1 October 2026 | Carers in receipt of carer's allowance or main carers. |
| Frontline health and social care workers | 1 October 2026 | Social care workers without an employer occupational health scheme. |
| People experiencing homelessness aged 16 and over | 1 October 2026 | New for 2026/27 under the 9 June 2026 amendment. |
| Children aged two and three, and at-risk children aged two to 18 | 1 October 2026 | New in community pharmacy; general practice starts on 1 September. |
| School-aged children who missed the school session | 1 December 2026 | Catch-up offer in pharmacy. |
The children's offer is the biggest structural change for pharmacy. The amendment letter opens community pharmacy vaccination of two and three year olds from 1 October 2026. Pharmacy is "supplementing the offer in general practice which will start vaccinating from the 1 September 2026". Children aged two to 18 in clinical risk groups can attend from the same date. Children from six months to under two are excluded. School-aged children who missed their school session can attend a pharmacy from 1 December 2026. The amendment letter also says pharmacies must use centrally supplied LAIV and cannot offer an egg-based inactivated vaccine to children.
Under the joint specification you may only vaccinate someone who is in "a JCVI Cohort which has been announced and authorised by the Commissioner". Eligibility "is likely to be communicated using the Flu Letter and relevant national communication". A dose given outside an authorised cohort is unpaid.
Who gets a COVID-19 vaccine in autumn 2026?
Adults aged 75 and over, residents of care homes for older adults, and immunosuppressed people aged six months and over. That is the JCVI advice of 16 July 2025. It considers it "appropriate to offer vaccination to the same groups in autumn 2026 and spring 2027" as in autumn 2025 and spring 2026. JCVI added that more data is needed before it can say whether groups under 75 with particular conditions face similar risk.
The COVID-19 cohort is small compared with flu, and it is old. Most of it is also eligible for flu, which is why the specification makes co-administration a duty rather than an option. Pharmacies registered for both services "must offer co-administration of both vaccines, where clinically appropriate, to each Patient", in line with the Green Book.
One forward signal arrived just before this article's date. On 16 July 2026 JCVI published its advice for autumn 2027, which lists "adults aged 80 years and over", care home residents and immunosuppressed people aged six months and over. The 2026/27 season is not affected, but anyone planning COVID-19 capacity for 2027 should read it.
Which vaccines are used?
Whatever the flu letter specifies for each age group, and a centrally supplied COVID-19 vaccine. The specification pays for flu only where the contractor "has only used the specified vaccines listed in the Flu Letter and/or Commissioner guidance". Alternatives are allowed "on an exceptional basis" when the recommended vaccine is unavailable. For COVID-19 it requires "a COVID-19 vaccine supplied and recommended in accordance with the latest advice".
| Group | Flu vaccines recommended for 2026/27 |
|---|---|
| Aged 65 and over | Adjuvanted (aIIV), cell-based (IIVc), high-dose (IIV-HD) or recombinant (IIVr), treated as equivalent. |
| Aged 50 to 64 in clinical risk groups | The same four options; IIV-HD can be used off-label at ages 50 to 59. |
| Aged 18 to 49 in clinical risk groups, including pregnant women | IIVc or IIVr. |
| Children aged two to 17 | LAIV; IIVc where LAIV is contraindicated or unsuitable, then IIVe. |
| Children from six months to under two in risk groups | IIVc, then IIVe; not a pharmacy cohort. |
The letter flags two JCVI changes. For people aged 65 and over, IIVc "should be considered equivalent" to aIIV, IIV-HD and IIVr. For people aged 50 to 59 in clinical risk groups, "IIV-HD can be used off-label". Both widen your ordering options for the over-65 clinic, which is where most pharmacy volume sits.
Supply routes differ. You order flu vaccine yourself, "following guidance in the Flu Letter on recommended vaccines", and the specification reimburses "the cost of the influenza vaccine administered" plus a VAT allowance. COVID-19 vaccine "will be provided centrally by the Commissioner", ordered through the Federated Data Platform and delivered to the registered premises. Children's LAIV is also supplied centrally.
What does the NHS pay per dose?
£10.06 for an adult flu vaccination, and £8.70 or £10.06 for a COVID-19 vaccination depending on the date. NHS England's letter of 15 December 2025 sets the figures below, and the Drug Tariff determination carries them.
| Item of service | Fee | Condition |
|---|---|---|
| Adult flu vaccination | £10.06 | Up from £9.58; vaccine cost reimbursed plus VAT allowance. |
| COVID-19 vaccination, 1 September 2026 to 31 January 2027 | £8.70 | "While the flu vaccination campaign is underway". |
| COVID-19 vaccination outside that window | £10.06 | Spring campaigns and late autumn doses after 31 January. |
| Housebound COVID-19 supplement | Removed | "There will no longer be an additional £10 payment". |
The logic is that a COVID-19 dose given alongside a flu dose costs less to deliver, so the fee drops while the flu campaign runs. A pharmacy giving 1,500 flu vaccinations at £10.06 earns £15,090 in fees, before the reimbursed vaccine. Add 400 co-administered COVID-19 doses at £8.70 and the total is £18,570. For how that compares with consultation-based services, see which NHS pharmacy services actually pay in 2026.
Payment has a recording condition. Every dose must go into an NHS-assured point of care system on the same day, unless exceptional circumstances apply. Where the record "is not created within 15 days of the vaccination being administered, the pharmacy contractor shall not be eligible for payment". One point of care system must be used for all new vaccines administered in a calendar month. Records are kept for three years.
What are the delivery rules?
The legal mechanism is the PGD, delivery is at the pharmacy by default, and bookings must be open on the NBS. Four rules deserve attention.
Authorisation. Vaccinators must have "the necessary experience, skills, competence and training" and be "authorised to work under the valid legal mechanism". The evidence is a Declaration of Competence for registered pharmacy professionals, or the UKHSA competency assessment tool. For COVID-19 the mechanism has narrowed. The GOV.UK COVID-19 vaccination programme collection notes that the national protocol for the COVID-19 vaccine was removed on 1 April 2026 "as it is no longer covered by legislation". Pharmacies now rely on the PGDs published by NHS England. Where PGDs apply, only registered healthcare professionals can administer; for the general position on who may vaccinate, see when pharmacists need a PGD or an independent prescriber.
Location. The default is the registered premises, with a consultation room that meets the Pharmacy Regulations and is used whenever the patient prefers it. Distance selling pharmacies "are not permitted to provide vaccinations to Patients at the pharmacy premises". Off-site clinics need the commissioner's consent and must be in the same NHS England region. A pharmacist or pharmacy technician must be on site, with indemnity that covers off-site work. And the majority of doses must still be given at the pharmacy.
Housebound and care home patients. You "must not administer vaccines to Patients who are Housebound, in a Care Home, under 18 years of age" unless the commissioner asks. The letter says you "do not need to agree" to such requests but are "strongly encouraged to accept". With the £10 supplement gone, a housebound COVID-19 visit in the flu window pays £8.70. Plan those visits around flu co-administration or agree local terms.
Booking. Contractors "must offer COVID-19 vaccinations through the NBS" and are "strongly encouraged" to use it for flu and co-administered appointments. Registration is through Manage Your Service: by 31 July 2026 for autumn COVID-19 vaccine, and by 30 November 2026 as the final deadline for either service. Miss the November date and "they will not be able to deliver either service in 2026/27".
How should you plan the campaign?
Register, order, book, then staff for October. The sequence matters because the deadlines and the supply routes are different for the two vaccines.
Your flu volume in 2026/27 is the same cohorts as last year, so last year's numbers are a fair forecast for adults. The new money is in children from 1 October 2026, co-administered COVID-19 doses for the over-75s, and the 65-and-over clinic where you now have four equivalent vaccine choices. Register for autumn COVID-19 before 31 July 2026, decide now whether you will take the children's service, and open NBS slots for co-administration from the first week of October.
- Register on MYS for autumn COVID-19 by 31 July 2026 and confirm flu registration well before the 30 November 2026 final deadline.
- Check your flu order against the letter's vaccine list for each age band, including the new IIVc option for over-65s.
- Decide whether to offer the children's service from 1 October 2026 and train staff on LAIV and parental consent.
- Update PGD authorisations and Declarations of Competence for every vaccinator, including the COVID-19 PGD now that the national protocol has gone.
- Open NBS appointments for co-administration and set up reminders for the over-75 and immunosuppressed lists; see how to add online booking to a pharmacy website.
- Test the point of care system before September so no dose misses the 15-day payment window.
Finally, keep an eye on the system letters. The specification leaves campaign dates and the authorised cohorts to NHS England's in-season communications, and the children's service is new enough that its operational detail may change before October.
Key takeaways
- COVID-19 vaccination has been an advanced service since 1 April 2026, under a joint specification with adult flu published with a letter of 15 December 2025.
- Flu pays £10.06 per dose, up from £9.58; COVID-19 pays £8.70 from 1 September 2026 to 31 January 2027 and £10.06 outside it; the £10 housebound supplement has gone.
- Pregnant women can be vaccinated from 1 September 2026, other adults from 1 October 2026, and the programme runs to 31 March 2027 with most doses due by the end of November.
- Flu cohorts are unchanged, plus people experiencing homelessness aged 16 and over from 1 October 2026.
- The autumn COVID-19 cohort is adults aged 75 and over, care home residents and immunosuppressed people aged six months and over, per JCVI's advice of 16 July 2025.
- Community pharmacy can vaccinate two and three year olds and at-risk children from 1 October 2026 and school-aged catch-ups from 1 December 2026, using centrally supplied LAIV.
- For over-65s, IIVc now counts as equivalent to aIIV, IIV-HD and IIVr; adults under 65 in risk groups get IIVc or IIVr.
- Register for autumn COVID-19 by 31 July 2026, record every dose in a point of care system within 15 days, and offer co-administration to every eligible patient.
Sources and further reading
- COVID-19 and adult influenza vaccination advanced service specification 2026/27 (NHS England)
- Letter: 2026/27 COVID-19 and adult influenza vaccination service specification now published (NHS England, 15 December 2025)
- National flu immunisation programme plan 2026 to 2027 and amendment letter (GOV.UK)
- COVID-19 vaccination in autumn 2026 and spring 2027: JCVI advice, 16 July 2025 (GOV.UK)
- Seasonal vaccination services, COVID-19 and adult flu (Community Pharmacy England)
- Community pharmacy (NHS England)
FAQs
Fill the clinic before October arrives.
Vaccination pays on volume, and volume comes from bookings, reminders and a record that is complete on the day. Dataforge PMR runs the appointment book, texts the eligible cohorts and files each dose to the point of care record inside the 15-day window.
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