GPC England has sought advice from NHS England and clarified the action needed if there is no adjuvanted trivalent inactivated influenza vaccine (aTIV) available as part of the vaccination programme delivery, and no further is expected. The appropriate steps for practices to follow are: 
1.    Where a practice has no aTIV, discuss this with the CCG flu lead.
2.    If the CCG confirms that no aTIV is available, offer patients Quadrivalent Influenza Vaccine (QIV).
3.    If a patient declines QIV, the practice can exception report and then should record the reason.