A GP practice is expected to follow Green Book chapter 3 for its vaccine fridges, and CQC will ask to see that it does. What makes a practice different is that it is usually closed at weekends, it takes vaccines out to clinics and home visits, and it is the provider that decides what happens after a breach. The full cold chain teaching, with a worked excursion, is on Vaccine fridges.
Why it matters
The practice owns the decision and the consequences
When a vaccine fridge fails, UKHSA's incident guidance says the provider where the breach happened decides, case by case, after advice from the screening and immunisation team, the health protection team and the manufacturer. If the vaccines are used, the prescriber or provider takes responsibility, so the reasoning must be well documented.
Closed periods are where practices are most exposed. The Green Book asks for readings each working day and says nothing about weekends, so a reading on Monday morning has to cover the whole weekend through the max/min memory. A fridge that failed on Friday evening may not be noticed until Monday, and the max/min reading cannot say when it started. SPS's excursion guidance says to assume the worst case from the last reset, which over a weekend can mean treating stock as out of range for about 72 hours.
What the rules say
Green Book, CQC and your contract
The national reference is Green Book chapter 3. For practices it adds one specific duty: at least two named people, one from the nursing team and one from administration or management, responsible for ordering, receiving and caring for vaccines, including cold chain recording, stock rotation and disposal.
CQC's GP mythbuster 17 is CQC's reading of that guidance and shows what an inspector will ask for: the fridge temperature log, maintenance checks and a policy on what to do after a breach. CQC says the cold chain policy should cover handling from delivery to administration, transport of vaccines outside the practice, actions after a breach and how learning from incidents is shared.
Contracts can add their own wording. The NHS England GP COVID-19 vaccination enhanced service specification (2024–26, now expired) required max/min thermometers in every fridge storing vaccine and readings "on all working days". That version ran to March 2026, so check the one in force. In Northern Ireland, the PHA guidance for GP practices asks for a data logger as back-up and same-day reporting of significant breaches to HSC Trust Medicines Information and the PHA duty room.
What good looks like
A routine built around opening hours
The NHS England South West ICARS cold chain toolkit, regional guidance built on the Green Book, is the clearest description of a practice routine. It recommends fridge checks in the closing routine before weekends and bank holidays, and downloading data loggers weekly, ideally on first entering the premises after the weekend and before the first vaccines of the week are given. It also names unclear roles and missed checks during staff absence among avoidable breaches, so deputies and cross-cover are part of the expectation.
CQC is clear that a logger does not replace the daily manual check. Even with one fitted, you still read and record the minimum, maximum and current temperatures and reset each working day, and CQC warns that reviewing a logger only weekly or monthly risks missing breaches.
- Trained staffEvery working day
- Read current, max and min
- Record and sign
- Reset the thermometer
- React to anything outside +2 °C to +8 °C
- Trained staff, with coverAround closuresWeekends and bank holidays
- Fridge check in the closing routine
- Logger download on first entry, before the first vaccine
- Named vaccine leadsWeekly to quarterly
- Weekly stock rotation and expiry check
- Order every two to four weeks
- Quarterly vaccine management review
- Named vaccine leadsEvery year
- Fridge service
- Thermometer calibration
- Maintenance log kept with the fridge
Drawn from Green Book chapter 3, CQC GP mythbuster 17 and the NHS England SW ICARS toolkit.
Worked example
A flu clinic at a care home
This is an illustrative example. A nurse takes vaccines to a care home for a morning clinic. Following the Green Book and the SW ICARS toolkit, she uses a validated medical-grade cool box with a validated max/min thermometer, takes only enough vaccine for the session, keeps the vaccines in their original packaging and wrapped so they do not touch the cool packs, and records the cool box temperature at the start and end of the session.
Back at the practice, the end-of-session record shows the box stayed within +2 °C to +8 °C, so the unused vaccines can go back in the fridge, marked with the return date and time and used first. If the thermometer had not been read, there would be no evidence the cold chain held, and the stock would be risk assessed as for a fridge excursion.
Where it is unclear
Paper, loggers and weekends
Whether an alarmed, continuously monitored system could replace the daily paper record is not answered by CQC: see logger versus daily reading. Check with your ICB or inspector before dropping paper records. Reading frequency also varies by nation, from once each working day in England to twice daily recommended in Scotland: see once or twice a day. For weekends, no source sets a rule, so assess how long a failure could go unnoticed and how much stock you hold, and record your reasoning in your cold chain policy. Our recommendation below gives a default to start from.
In summary
The short version
- Name at least two vaccine leads, one nursing and one administrative, and set up deputies for absence.
- Read, record, reset and react every working day, even with a data logger fitted.
- Add a fridge check to the closing routine before weekends and bank holidays.
- Check the weekend before the first vaccine on Monday, using logger data where you have it.
- Use validated cool boxes with a max/min thermometer for clinics, recorded at the start and end of each session.
- After a breach, quarantine, report to the screening and immunisation team, and record who advised and who decided.