Patients became aggressive towards pharmacy staff after changes to COVID-19 vaccine eligibility and failures in the national booking system allowed ineligible people to make appointments, according to a survey by the National Pharmacy Association (NPA). 

The problems arose after the government narrowed eligibility for the autumn 2025 COVID-19 booster programme. However, the online booking system continued to accept appointments from people who no longer qualified, leading to wasted visits and confrontations in community pharmacies.

A survey of NPA members found that 88% of pharmacies reported intimidation from frustrated patients, with some staff describing being spat at or pushed. On average, around half of vaccine appointment bookings towards the end of last year had been made through what the NPA described as “a fundamentally flawed national NHS system” that still accepted ineligible patients.

Pharmacies also reported poor communication from NHS England, with little explanation given to individual sites about the system failures or the rationale for the change in eligibility.

Pharmacies Seek Compensation for Wasted Costs

The NPA called on the NHS to compensate its 6000 independent community pharmacy members for wasted staff time and resources. It estimated the cost could amount to at least £2 million a day. 

A Department of Health and Social Care (DHSC) spokesperson said that, in line with independent advice from the Joint Committee on Vaccination and Immunisation (JCVI), the autumn 2025 COVID programme was focused on the oldest adults and immunosuppressed people, who are at highest risk for serious complications from respiratory infections.

“Abuse of staff in any setting is unacceptable and should not be tolerated,” the spokesperson said in a statement emailed to Medscape News UK. “Pharmacy providers have policies in place to protect individuals and should ensure any inappropriate incidents are reported where necessary.”

Under the updated rules, boosters were offered to adults aged 75 years or over, residents of care homes for older adults, and immunosuppressed people aged 6 months or over.

Eligibility Narrowed After JCVI Advice

This marked a change from the autumn 2024 programme, which also included adults aged 65-74 years and all those aged 6 months or over in a clinical risk group. Frontline health and social care workers and staff in care homes for older adults also became ineligible for routine vaccination in autumn 2025.

The JCVI advised that vaccinating these groups would likely have “only a very limited impact on reducing staff sickness absence.”

Accepting that advice last June, the DHSC said that “in the current era of high population immunity,” additional doses would “provide very limited, if any, protection against infection and any subsequent onward transmission of infection.”

Despite this, the national booking system allowed ineligible patients to make appointments anyway, the NPA said. Some patients also reported receiving text messages from the NHS or their GP inviting them for vaccination despite no longer qualifying.

NPA chief executive Henry Gregg said: “This was a problem of the NHS’s own making that should have been avoided. It is disgusting to learn of pharmacists being spat at by disgruntled individuals, and any physical intimidation or abuse is utterly unacceptable.”

He added: “The NHS must learn the lessons from this issue for future years. This includes doing the right thing and compensating pharmacies for losses made during this process.”

Although some costs, such as staff time and supplies, could not be quantified, he said “other consequences such as the loss of reputation and the impact of abuse cannot be.”

Cost-Effectiveness Now Part of Vaccine Decisions

The JCVI has described COVID-19 as “a relatively mild disease for most people,” noting that it is now becoming endemic, with widespread immunity from previous infection or vaccination.

Because pre-2023 vaccine procurement arrangements no longer apply, the committee now uses standard cost-effectiveness measures to assess whether the “substantial investments” in vaccination programmes represent good value for public money, and whether resources could be better spent on other healthcare interventions. 

It said this had led to “a more refined approach,” with the autumn 2025 campaign targeted at people at highest risk for hospitalisation and death.

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.