NAAVoices
Survivor-led · Evidence-informed
Professional Resources
Wales Primary Care · HCA Immunisation Training
HCSW Immunisation
Training Resource Pack
A comprehensive, evidence-informed reference for Healthcare Assistants (Level 4) and their supervisors delivering vaccination programmes in Wales primary care.
Document version control
June 2026
1.0
June 2027
NAAVoices.com
Authoritative sources underpinning this resource
- UKHSA National Minimum Standards and Core Curriculum for Vaccination Training 2025
- All Wales HCSW Immunisation Training and Assessment of Competence Guidance — Nov 2025 v1
- PHW Advisory Document to support UKHSA NMS in NHS Wales — May 2026 v2
- PHW Flu Immunisation Training Recommendations for Wales — Aug 2025 v1
- PHW VPDP RSV Training Guidance — Nov 2025 v2
- NMC Code: Professional Standards of Practice and Behaviour 2018 (Section 11 — delegation)
- NMC Delegation and Accountability: Supplementary Information to the NMC Code
- RCN Accountability and Delegation Guide
- HEIW All Wales Guidelines for Delegation 2020
- Code of Conduct for Healthcare Support Workers in Wales — Welsh Assembly Government
- Resuscitation Council UK — Emergency Treatment of Anaphylaxis Guidelines 2021
- WMAS (Welsh Medicines Advice Service) — Supply and Administration of Vaccines in Wales
- VGD (Vaccine Group Direction) — UK Medicines Legislation April 2026
NMC Code obligations for the delegating nurse (Section 11, NMC Code 2018): The supervising Registered Health Professional (if a nurse or midwife) is bound by the NMC Code when delegating to this HCA. The Code requires: only delegating tasks within the HCA’s scope of competence; ensuring she fully understands the instructions; ensuring adequate supervision and support; and confirming outcomes meet the required standard. The NMC Code is explicit that accountability for the decision to delegate remains with the registered nurse — if an incident occurs the NMC will consider whether the delegating nurse has a case to answer. Competency records, supervised practice logs, and sign-off documentation in this pack constitute valid evidence for the supervising nurse’s NMC revalidation (practice-related CPD).
Note — HCA vs Nursing Associate: This resource is for Healthcare Assistants (HCSWs), who are not NMC registered. A Nursing Associate (NA) is an NMC registrant with their own scope of practice and Code obligations — they are not the same as an HCA. If a Nursing Associate is involved, different standards apply.
Note — HCA vs Nursing Associate: This resource is for Healthcare Assistants (HCSWs), who are not NMC registered. A Nursing Associate (NA) is an NMC registrant with their own scope of practice and Code obligations — they are not the same as an HCA. If a Nursing Associate is involved, different standards apply.
Important — April 2026 legal update: National Protocols for COVID-19 and Flu expired 31 March 2026. A new Vaccine Group Direction (VGD) mechanism was introduced into UK medicines legislation in April 2026. Under a VGD, operational tasks (vaccine preparation, administration, record-keeping) can be delegated to trained non-registered staff — but clinical assessment and obtaining informed consent remain RHCP responsibilities and cannot be delegated. In General Practice, PSD remains the primary legal mechanism for HCSW vaccine administration.
About this resource pack
This pack has been developed for Level 4 HCAs (Healthcare Assistants) and their supervising Registered Health Professionals in Wales primary care settings. It is produced in line with the UKHSA National Minimum Standards 2025 and the All Wales HCSW Immunisation Training Guidance (November 2025).
- Interactive task database — what HCA can and cannot do
- Wales learning pathway with progress tracker
- PSD / PGD / VGD legal framework guide
- Complete vaccine and training module reference
- Daily pre-vaccination checklist
- Emergency reference (anaphylaxis, needlestick, cold chain)
Wales-specific requirements
This resource reflects the specific requirements of NHS Wales, which differ in important ways from England.
- Minimum 2 years patient-facing experience required before training (Wales)
- Minimum 10 supervised administrations per vaccine (Wales)
- Mandatory pre-training: ANTT, IPC Level 2, BLS, anaphylaxis, safeguarding, information governance, record keeping
- Training via Y Ty Dysgu / Learning@Wales (Units 1–6)
- Agored Level 3 face-to-face session required (e-learning alone insufficient)
- Record in WIS (Welsh Immunisation System) and CYPrIS
—
Can do
—
With conditions
—
RHCP only
—
Not permitted
Overall progress — 0 of 23 items complete
1
Mandatory prerequisites
All must be complete before immunisation training begins
2 years patient-facing clinical experience confirmed by RHP
Wales All Wales HCSW Guidance requirement — must include direct clinical interaction with patients and healthcare staff.
Information Governance (ESR / Learning@Wales)
Record Keeping (ESR / Learning@Wales)
Basic Life Support — adult annual (+ paediatric if role involves children)
Anaphylaxis training (annual)
Safeguarding adults and/or children (appropriate to role)
Infection Prevention and Control Level 2
ANTT — Aseptic Non-Touch Technique (Wales mandatory)
Required before starting immunisation training. Via ESR or Learning@Wales.
Named RHP supervisor identified and confirmed
Must be experienced in immunisation and up to date with their own annual update training.
Training Information Checklist (Appendix 1) completed and submitted to Health Board
Required before booking the Agored Level 3 immunisation training course.
2
Mandatory core units (Units 1 and 2)
Complete before any vaccine-specific unit
Unit 1: The role of the immuniser (Y Ty Dysgu / Learning@Wales)
Covers delegation, PSD/VGD, scope of practice, accountability, limitations of HCSW role.
Unit 2: Immunisations and how they work (Y Ty Dysgu / Learning@Wales)
Immunology, how vaccines work, types of vaccine, immune response, herd immunity.
UKHSA e-learning foundation modules (e-LfH) — already started
Agored Level 3 face-to-face training session (Administering Immunisations and Injection Giving)
E-learning alone is not sufficient. Book via Health Board immunisation team.
3
Vaccine-specific training units
One per vaccine — each needs its own unit and sign-off
Unit 4: Immunising adults against influenza (or Unit 3 if children in role)
FluOne (PHW eLearning): Flu vaccine information for health and social care staff in Wales
FluTwo (PHW eLearning): Flu clinical update for Wales (annual — before flu season)
Unit 5: Immunising against Pneumococcal Pneumonia
Unit 6: Immunising against Herpes Zoster (Shingles)
COVID-19 modules (ESR / Learning@Wales) — before each campaign
RSV training (if RSV delegated to you) — PHW slide sets and webinar
B12 IM injection training (if delegated — separate from vaccination framework)
Listed in All Wales HCSW Training Checklist Appendix 1. Governed by employer policy and PSD — not immunisation framework. Arrange with practice manager and supervising GP.
4
Supervised practice and competency sign-off
Wales: minimum 10 supervised per vaccine · Signed off by RHP
Supervised practice — flu injection (minimum 10 administrations)
Wales requirement: minimum 10, or more until both learner and assessor feel confident and competent.
Supervised practice — pneumococcal (minimum 10)
Supervised practice — shingles (minimum 10)
UKHSA Appendix A competency assessment tool — completed and signed by RHP supervisor
All three sections (Knowledge, Core clinical skills, Clinical procedure). Retain signed original in training portfolio. Locally held record must also be kept.
Knowledge assessment passed and recorded (MCQ, scenario, or oral)
5
Ongoing — once active as immuniser
Annual requirements and continuous updating
Annual vaccination update training (minimum half day)
Annual BLS and anaphylaxis refresh
FluTwo (PHW) — annual flu clinical update for Wales
FluOne (PHW) — flu vaccine information for Wales (every 3 years)
Subscribe to PHW VPDP updates, UKHSA Vaccine Update, and Welsh health circulars (GOV.WALES)
HCSWs cannot work under PGDs — absolute rule. This applies regardless of qualification level, experience, or employer instruction. PGDs legally require a registered professional (NMC, GMC, GPhC, HCPC).
Legal mechanisms — Wales primary care
PSD
Patient Specific Direction
Patient Specific Direction
Primary mechanism in GP/primary care. Prescribing RHCP reviews the individual patient, confirms suitability, and issues a written (manual or electronic) direction for the vaccine to be given to that named patient. Informed consent must also be obtained by the prescriber. HCA then administers. The clinical decision is already made.
A PSD is required for every patient, every time. A group-level PSD does not exist.
A PSD is required for every patient, every time. A group-level PSD does not exist.
PGD
Patient Group Direction
Patient Group Direction
Not permitted for HCSWs — absolute. PGDs require registration with NMC, GMC, GPhC, or HCPC. HCSWs are not on a professional register and cannot use PGDs under any circumstances, regardless of qualification level.
VGD NEW Apr 2026
Vaccine Group Direction
Vaccine Group Direction
Replaced National Protocols (expired 31 March 2026). Introduced April 2026. Provides a structured framework for vaccine delivery. Under a VGD, operational tasks (preparation, administration, record-keeping) can be delegated to trained non-registered staff including HCSWs.
Critical: Clinical assessment and obtaining informed consent cannot be delegated under a VGD and must be carried out by the RHCP authorised under the VGD.
Critical: Clinical assessment and obtaining informed consent cannot be delegated under a VGD and must be carried out by the RHCP authorised under the VGD.
National Protocol
Expired
Expired
Expired 31 March 2026. Any practice previously operating under a National Protocol must now use VGD or PSD.
Four criteria for safe delegation (All Wales HCSW Guidance, Nov 2025)
1. Training complete
HCSW has completed required training and competency assessment for each vaccine to be administered. Locally held record exists.
2. Legal authority
Fully completed PSD for every patient for every immunisation, OR valid VGD covering the programme. Cannot work from a PGD.
3. RHP on site
A Registered Health Professional must be within the clinical environment and available to provide advice, guidance, and emergency assessment.
4. Record keeping
HCSW has access to record-keeping facilities and local Record Keeping policy. In Wales: must be aware of WIS (Welsh Immunisation System) and CYPrIS.
Units 1 and 2 are mandatory for all HCSWs before any vaccine-specific unit. Wales requires a minimum of 10 supervised administrations per vaccine before competency sign-off.
Wales vaccination training modules — Y Ty Dysgu / Learning@Wales
| Unit / module | Content | Frequency | Platform |
|---|---|---|---|
| Unit 1 (Mandatory) | The role of the immuniser | Once | Y Ty Dysgu / Learning@Wales |
| Unit 2 (Mandatory) | Immunisations and how they work | Once | Y Ty Dysgu / Learning@Wales |
| Unit 3 | Immunising adults and children against influenza | Once | Y Ty Dysgu |
| Unit 4 | Immunising adults against influenza | Once (choose 3 or 4) | Y Ty Dysgu |
| FluOne (PHW) | Flu vaccine information for health and social care staff in Wales | Every 3 years | Y Ty Dysgu / Learning@Wales |
| FluTwo (PHW) | Flu clinical update for Wales | Annual (pre-season) | Y Ty Dysgu / Learning@Wales |
| Unit 5 | Immunising against Pneumococcal Pneumonia | Once | Y Ty Dysgu |
| Unit 6 | Immunising against Herpes Zoster (Shingles) | Once | Y Ty Dysgu |
| COVID-19 modules | Campaign-specific — product dependent | Before each campaign | ESR / Learning@Wales |
| RSV training | Older adult and/or maternal programme slide sets and webinar | Once (+ updates) | PHW SharePoint |
Which vaccines can an HCSW administer in Wales?
| Vaccine | Status | Key conditions / notes |
|---|---|---|
| Influenza (IM, adults) | Permitted | Unit 4 + FluOne + FluTwo + min. 10 supervised + sign-off. PSD or VGD. |
| Pneumococcal (adults) | Permitted | Unit 5 + min. 10 supervised + separate sign-off from flu. |
| Shingles (Zostavax SC / Shingrix IM) | Permitted | Unit 6 + min. 10 supervised + sign-off. Note product-specific technique. |
| COVID-19 | Permitted | Campaign module for current product. PSD or VGD. |
| RSV (older adult / maternal) | Conditional | Complex new programme. RHCP must assess each patient. PHW notes delegation may not result in operational efficiency. |
| Intranasal flu (LAIV) | Conditional | Unit 3. Only where local policy permits and RHP present (typically school teams). |
| B12 (hydroxocobalamin) | Conditional | Listed in All Wales Appendix 1. Employer policy + PSD per patient + separate IM training. Not vaccination framework. |
| Yellow Fever | Not permitted | RHCP only. Absolute. No exceptions. |
| Travel vaccines | Not permitted | Full RHCP risk assessment required first. |
| BCG | Not permitted | Specialist intradermal technique. RHCP only. SCID screening implications in Wales. |
| Any vaccine — infants/under 5s | Not permitted | Clinical complexity requires RHCP. Always. |
