"Take 2" - Navigating the 2025 UK Immunisation Schedule Changes

I had the amazing opportunity to record a short education session for Dovetail Medical Events covering the changes to the UK Schedule Immunisation Programme and they have agreed that I can use the audio from this as a more in detail break down of how we navigate the changes to the Childhood Immunisation Schedule - check out the video with slides HERE.

UK healthcare professionals face significant changes to the immunisation schedule, with new timings for MenB, PCV, and introduction of an 18-month appointment designed to provide better protection against disease.

• MenB now offered at 8 and 12 weeks instead of 8 and 16 weeks, with PCV moving to 16 weeks
• Change implemented from 1st July 2025 due to earlier presentation of meningitis B cases (now peaking at 1-3 months)
• Primary immunisations schedule change applies to all babies regardless of birth date
• One-year immunisations depend on birth date - those born on/after 1st July 2024 follow new schedule without Menitrix
• Children born before 1st July 2024 continue old schedule with Menitrix (or 6-in-1 if stocks depleted)
• New 18-month appointment starting January 2026 includes additional 6-in-1 and brings forward second MMR
• Specific protocols for babies born to hepatitis B positive mothers
• Healthcare professionals should check previous immunisations carefully at each appointment
• Incomplete immunisation algorithm requires reading the entire age column before making decisions
• Resources including calculators and visual guides available to support implementation

Access the UK HSA resources for detailed information and practical tools to help implement these changes confidently.

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Chapters

• 0:18 Introduction to UK Schedule Changes
• 1:22 Primary Immunisations: One-Year Changes
• 4:42 Rationale Behind Schedule Updates
• 8:12 Step-by-Step Primary Schedule Implementation
• 11:14 Navigating One-Year Immunisations
• 15:48 18-Month and Pre-School Changes
• 22:56 Hepatitis B Positive Mothers Protocol
• 27:33 Incomplete Algorithm Explained
• 35:22 Key Resources and Closing Thoughts

Transcript

Ashleigh: 0:13

Hello and welcome to this Dovetail Medical Events snippet on the changes to the UK immunisation schedule. My name is Ashley and I'm a practice nurse myself. In this session we'll talk through the changes to the UK immunisation schedule and aim to make it simpler to understand, because there is a lot to consolidate. If you're particularly concerned or overwhelmed at the minute, I would focus primarily on the changes to the primary and one year immunisations. First, the primary and one-year immunisations first. As we know, these changes were implemented from the 1st of July 2025, while the further changes we do have until the 1st of January 2026 to get our heads around. But hopefully after this session it will be a little bit clearer. They will go through the changes for each sort of section of the immunisation schedule and will also touch on the incomplete algorithm as well. So what we need to know from the 1st of July 2025, menb will be offered at 8 and 12 weeks to all who present for those appointments and PCV will be at 16 weeks, and this is due to an earlier presentation of meningitis B cases in babies. Menitrix manufacturing is ceasing and stocks are expected to be exhausted by mid-25. Meningitis C vaccination in early childhood is not considered necessary due to the success of the teenage meningitis ACWI campaign. But vaccination against Hib must continue in the second year of life. So therefore, an additional dose of 6-in 1 will be given at 18 months of age to meet that Hib requirement. This new 18 month of age appointment will allow for the second dose of MMR to be brought forward from three years four months and that will allow for a address in the rise in measles cases. From the 1st of July 2025, miniterics will no longer be offered at 12-month immunisation appointments for selected demographics depending on their date of birth, which we'll go through, and then, from the 1st of January 26, an additional six in one will be offered at the new 18-month immunisation appointment. So this is a lot of changes and I think it's really important that we understand why these changes have been implemented.

Ashleigh: 3:00

And firstly, meningitis B cases in babies previously peaked between five and six months of age. Between five and six months of age, meningitis B cases in babies now peaks between one and three months. So previously most babies would have at least been offered their vaccination before the peak instance of the disease. However, now the disease peak is much younger and so early protection is vital and so getting the most babies we can onto the new schedule as soon as we can is essential, hence why date of birth doesn't matter for this change. We then need to think about HIB, and we need to continue offering HIB over one year of age due to the number of instances.

Ashleigh: 3:47

Now, obviously, the UK HSA presentation went into a lot of detail about the rationale for the changes and all of that, so I'm not going to repeat too much, as the purpose of this session is to make it easy read, if you like. We're then thinking about bringing the second dose of MMR forward to combat the rising number of measles cases. So that's the rationale for the changes that have come about. So how will this look in our practice? And we're going to break down these changes into a step-by-step process, beginning with those changes that come into effect from the 1st of July. We'll look through the primary immunisations changes. Then we'll move on to the one-year immunisations and the need for date of birth consideration at those appointments. Then we'll look at the plan changes from the 1st of January 2026, and then we will look at babies born to hepatitis B positive mothers and how these changes will impact their immunisations. Ok, so primary immunisations Again, if we're feeling overwhelmed. I would focus on the changes to the primary immunisations and the one year immunisations first, as these have been implemented from the 1st of July 2025. Obviously, we've got a little bit longer. For the other changes We've got until the 1st of January 2026 when the further changes come into effect.

Ashleigh: 5:17

The primary principle of the changes to the primary immunisations are that date of birth should not be used to establish any changes. This is to ensure that most babies are moved onto the new schedule as soon as possible. As previously stated, this is due to the shift in age of presentation of meningitis B instances. So let's go through each appointment. So eight week immunisations no change there. Absolutely nothing different at all. That's nice and easy. I would reiterate that the Green Book guidelines we do not need to wait for a GP check or child health notification, anything like that. If a baby is eight weeks of age, we can commence them on the UK schedule for immunizations. There's actually nothing within the GP check that would contraindicate or impact on immunizations as long as the baby is well. But as competentizers we're going to be assessing whether they are well enough for immunization anyway. But nothing that the GP would check would impact on our decision to immunize. It would be our own assessment. So, eight-week immunizations, no changes.

Ashleigh: 6:28

Twelve-week immunizations, and obviously we're recording today after the 1st of july, uh 25. So that makes it a little simpler that any baby presenting um now will um have the new schedule if they're presenting for their second immunizations. But just popping back, thinking, 12-week immunisations, thinking is the date the baby attends for their second primary immunisations after the 1st of July 2025. If the date we are giving them their second lot of immunisations, their 12-week M's, so it doesn't matter if they've come late. I actually I kind of wish we referred to them as first, second and third primaries instead of 8, 12 and 16 weeks, because I do think sometimes we get focused on the age and, and you know, um get a little bit uh distracted by that. So it's their second set of immunizations. If it's after the 1st of July 2025, yes, then we're going to be using the new schedule.

Ashleigh: 7:31

We're not going to be using the date of birth for this. So, while there is a brilliant calculator on health publications that has been used, there is a disclaimer on it that says it shouldn't replace clinical judgment and, unfortunately, because the calculator is used with an Excel spreadsheet, it has to embed formulas and for it to work, that has to include date of birth. It will assume that babies are not attending late. So it will assume that if they turn 12 weeks, you know, on the 30th of June, it'll assume they're attending then. So it can't factor in the fact that babies may be attending at different times to the actual date they tick over to that age. So don't use date of birth for the changes to the primary immunisations. All we have to think about is the date we're giving these vaccines. After the 1st of July, obviously it will be now.

Ashleigh: 8:31

So we're going to be using the new schedule and we're going to be getting as many babies as possible offered their second MenB at 12 weeks, 16 week immunisations. So this is the appointment that I do think we really need to be careful about, as I think this is the one that has the potential for errors I'm sure we all do but just taking the time to check every time what the baby's received previously. Because if they have had the 12-week immunisations as per the old schedule, so if they attended for their 12 weekends before the 1st of July, then we have to continue the old schedule, remembering that the primary course of immunisations given over the three appointments should include three doses of 6-in-1, two doses of Membi, two doses of Rota and one dose of PCV. So we need to be checking what they've had previously. So we need to be checking what they've had previously. If they've either come before the 1st of July or, in error, they followed the old schedule, we'd need to give what's outstanding. So and this is where we'd look at this chart so obviously it's after the 1st of July. Now we're going to be checking what they've had at their 12 weekends. If their 12 weekends were given as per the old schedule, meaning they had six in one rota and pcv, if their 12-week IMS were given as per the old schedule, meaning they had 6-in-1 rota and PCV at their 12-week IMS, they still need their second dose of an MB. So we're then going to have to follow the old schedule and give a 6-in-1 and an MB. If they had their 12-week IMS as per the new schedule, that means that at their 12 weekends they received six in one rota and then B. We therefore need to be offering PCV because they won't have had that yet.

Ashleigh: 10:20

Okay, so that's the changes for the primary immunizations. Remembering date of birth is irrelevant here we're essentially swapping the MenB dose with the PCV dose if it's after the 1st of July, really being mindful of our 16 week appointments and checking what they've already had, because we don't want to miss a PCV dose by giving a third MenB at 16 weeks because we've just moved everybody onto the new schedule. We need to be looking at what they've had, because there will be babies who are attending perhaps on the same day in the same IMS clinic and that their previous appointment might have been a day or two. Either side of the 1st of July change date and so they may be having different immunisations based on what they previously had. So, really taking the time to check what they've previously been given, okay, one-year immunisations. So this is where it becomes a little bit more intricate and this does depend on a child's date of birth and we have to remember some babies are coming late. We have to be mindful of the late attenders. So, again, checking their date of birth before giving anything, as I'm sure we do, checking their date of birth, checking what they've previously had and then checking how they would fit into the new schedule.

Ashleigh: 11:50

So, for children born on or after the 1st of July 2024, for these children, we move straight on to the new schedule. These children should not be offered minotaurics. At one year immunisations we're giving MMR, menb and PCV. These children will be offered an 18-month immunisation appointment. So children whose date of birth is on or after the 1st of July 2024. Now I think this is the simpler part of the one-year immunisations change. Obviously, as we should anyway, we'll be checking that they've had their primaries, that they've not missed any, any of those. But for children born on or after the 1st of July 2024, we're onto the new schedule. Now, the way I think of it is, the 1st of July 2025 is the date that we changed the schedule. So those children it'll have either been their birthday on that day or after that day, so they won't have been one when the changes took effect. So those ones move on to the new schedule.

Ashleigh: 13:02

Now for children born on or before the 30th of June 2024, these children will remain on the old schedule. Therefore, at the one-year immunisations we're going to be administering MMR, menb, pcv and Minitrix, as we always have. These children should still be offered a Hib containing vaccine. These children will not be offered an 18-month vaccination appointment routinely. They will routinely be offered their next immunisations at three years, four months. If stocks of minotaurics are extinguished before these children present, then we're to give an additional dose of 6-in-1 in place of the minotaurics. Therefore, we'd be administering MMR, memb, pcv and 6-in-1.

Ashleigh: 13:51

So this is a little bit more complicated and we will go over the incomplete algorithm shortly, but it's for those children whose date of birth is on or before the 30th of June 2024. So, essentially, they are going to have. They may not have been invited for their IMS yet, they may not have presented for the rims, but on the day that the schedule changed, which was the 1st of July 2025, on that date, those children will have already been one. So that that's a way that I've thought of of looking at it. Because of their date of birth, they will have already been one, and I do believe Wales have been advised slightly differently. So if anybody is practicing in wales, then obviously follow your local guidance. I believe you had a hard swap from miniaturics to six in one but, um, obviously following your local guidance and for everywhere else this would apply, um, so, yeah, if, if children were already one when the changes took effect, so if their date of birth was on or before the 30th of june 2024, then this is how we would proceed.

Ashleigh: 15:04

So that's it for the changes to one year immunizations. We're going to be remembering to check date of birth. Also, not to panic if a child should have been offered Minitrix and you can't order it anymore, we're giving six in one instead. If you miss Minitrix, or six in one to somebody who should have received it in error, then not to worry, we can call them back in to administer. They will not be routinely called for their 18 month appointment because of their date of birth. So we need to be making sure that we are giving that Hib containing vaccine over the age of one. So that's why we would do that, so we wouldn't be sort of waiting until 18 months or anything like that, be sort of waiting until 18 months or anything like that. If we do realise that an error has occurred, then we would call them back in as soon as we're aware of that.

Ashleigh: 16:01

So changes from the 1st of January 2026. So again, if what we've all been through just is a little bit much, then we've got six months to embed our knowledge and come back to this. Obviously, nursing is a constantly growing and changing profession and learning is continuous, so there's no harm in revisiting this later, but changes from the 1st of January 2026. So, thinking about this new 18-month immunisation appointment, it will be offered to those children who essentially who followed the new one-year schedule. This will bring the fourth dose of 6-in-1 and it will pull forward the second MMR. However, at the minute it's not for all children. It's only for those who were born after the 1st of July 2024 and who followed the new schedule for one year immunisations. So this will mean those children will no longer be offered a second MMR at three years. Four months For all of the ones who followed the new one year schedule and who've had an 18 month appointment, um, thinking about their date of birth, though, uh, the changes to the preschool boosters won't actually come into effect, um, until sort of november 2027, because it only applies to those born after the 1st of July 2024.

Ashleigh: 17:35

So they won't reach preschool booster age until November 2027. So really don't worry about the changes to the the preschool boosters at the minute. Just be aware of it and be conscious of that. So, 18 month immunizations really be mindful of late attenders. Check they've had their one-year and they they've um had what they should have had at that appointment? Um, I'm sure we do. But just getting into the habit of every appointment checking their previous ends to ensure nothing's been missed, uh, just embedding that as part of one of your checks that you you go through before um, before administering um, personally, I like to talk it aloud to myself in my room. I'll say their age, date of birth, I'll read through what they've had before um and then have the most up-to-date schedule um there on my second screen and read through that. That's my way of second checking and I guess it's sort of replacing the second checker that you'd have in secondary care. And I personally like to get things ready with no distractions. But we've obviously all got ways of working and things that work for us. But it is worth having some sort of extra layer of checks.

Ashleigh: 18:48

While all these changes are afoot, and thinking about times, you could be seeing babies for the same type of appointment. For example, a couple of weeks ago in clinic I had two one-year-olds back to back. Their dates of birth were a few days apart, but it meant I was giving them different IMS, or well, it meant one of them was having menitrix, one of them wasn't one of them. I was saying their next immunisations would be three years, four months. One of them, I was saying their next would be 18 months. So be mindful of that.

Ashleigh: 19:23

I also think come January and we start inviting some babies for 18-month appointments, parents are going to get wind of that and so they may proactively book in um their baby for an 18 month immunization appointment, but because of that baby's a day to birth, they wouldn't actually be eligible. So, thinking about the one-year-olds that I immunized a couple of weeks ago, they, they could, you know, they could well go to the same um sort of nursery and things. Parents, parents, chat, the mum of the one born in June could book them in for an 18 month appointment, thinking that, you know, oh, we've just not been invited yet, but actually because of that child's date of birth, they wouldn't be eligible. And so it's being careful of that and being able to confidently address those conversations with parents if they have questions. You know, because they may well ask well, why is you know, so-and-so, two doors down had immunisations at 18 months and my child hasn't? And it's explaining that actually that's because your child will have had a Hib containing vaccine in their one-year IMS, whereas you know, child two doors down, who's having an 18 month appointment wouldn't have been offered that. So yeah, just being familiar with and confident with navigating those conversations, so three-year four-month immunisations, changes to the three-year four-month immunisations, as we've said, realistically aren't going to happen until interested three-year four-month immunizations, as we've said, realistically aren't going to happen until, in practice, until the 1st of November 27 when those children with the relevant dates of birth reach that age.

Ashleigh: 21:01

All children who were born, as we said, on or after the 1st of July 2024. They will have been offered the new immunization schedule at one year of age they will have been offered an 18 month immunisation appointment. They won't turn three years four months until November 27. But for those children they will only need four in one at three years four months. For all of the children whose birthday is 30th of June 24 or before, they'll continue on their schedule that they are currently on. So they will continue to be offered the second MMR at three years four months.

Ashleigh: 21:41

Obviously some areas bring that forward to 18 months already now anyway. So if that applies to your local area, then obviously you keep doing what your local area does and I'm thinking, for example, some of the London boroughs routinely have MMR given at 18 months. It's areas where we've got higher instances. So if your area has already got its own guidance etc. Then you carry on as that. This is just broadly speaking and again we're checking every time we see them what they've had before, what they're eligible for as well. So that's it for the changes from the 1st of January 2026.

Ashleigh: 22:23

There is also the highly likely addition of varicella, the chickenpox vaccine in the form of an MRV vaccine. So it would be measles, mumps, rubella and varicella. At present we do have some possible schedules, but nothing official. So since we don't have anything official, we'll park that for now. It is likely it has been mentioned in the sort of 25, 26 GP contract. So it is highly likely that it will be introduced and they have outlined a potential catch-up campaign, but there hasn't been anything definitive yet. But just be mindful, that's potentially gonna happen, highly likely.

Ashleigh: 23:11

So babies born to hepatitis B positive mothers really specific demographic and so the following only applies to those babies. So children born on or after the 1st of July 24 and their mums have hepatitis B. So they will no longer be offered monovalent hep B at 12 months of age. They'll receive hep B containing vaccine at 18 months of age in the form of their six in one. The dry blood spot testing can be undertaken at any time between one year and 18 months of age. We've we've always done it with the 12 month immunisation, so I would personally see no reason to change that practice. Um, obviously, whoever's carrying out that that test in your area will carry on. So if that's um, if that's you in general practice, or if you have another service health visitor etc. That are helping with that in your area, that should continue as it as it is. Uh, but the guidance says it can be done at any time between one year and 18 months of age. This does not affect the doses of monovalent hep B that should be administered at birth and four weeks of age. And again, whoever is currently giving those in your area will continue to do so. So Children born on or before the 30th of June 24 and whose mums have hepatitis B, so they will continue to be offered monovalent hep B at one year vaccinations. If they are immunised as per the old schedule and stock of minotaurics remains, then we're to administer MMR, menb, pcv, hib and MenC and monovalent HepB If we have no stock of miniterix before this child presents. So if we've run out, then we would replace that miniterix with a six in one, exactly the same as we would for babies whose mothers do not have hepatitis B. So that would therefore mean, though, that the 6-in-1 we are giving in place of miniterix, if we ran out, would meet the hepatitis B requirement. So, if we're using 6-in-1 instead, 6 in 1, instead of Miniterix, we'd give MMR, menb, pcv and 6 in 1. And again, this does not affect the doses of monovalent Hep B that should be administered at birth and four weeks of age for these babies whose mothers have Hepatitis B, and whoever is currently given that monovalent Hep B should continue to do so. That's it for the upcoming changes.

Ashleigh: 25:54

I do think chunking it into different steps or stages is quite helpful. It makes it manageable, as it can be a little bit unnerving when there's lots of changes happening all at once, and so hopefully, this has made it a little bit simpler to understand. When I had, you know, clinic, with babies back to back being given slightly different, I did have to take a minute and think right, okay, let me work through this, um, with no distractions, and let me get my head around what we're doing, even though you know I I felt I was quite happy with the changes. In practice, when you've got that in front of you in a busy clinic, it is just taking a moment. It will take time to get used to it and, honestly, mistakes are probably going to happen and so we just need to address and action those as we normally would. Um it's you know, um, we've got lots of other things that we're doing in clinic, so it is difficult to get everything right 100% of the time. But, remembering it's highly unlikely that this would cause harm, we'd just move them back onto whatever schedule we should have followed as soon as possible. You know, for example, if we inadvertently give a miniaturix to somebody who's born on the 1st of july, it's not going to do harm because if they'd have been born the day before they'd have, they'd have got that. It's just addressing it as we would normally, um contacting the relevant teams, speaking with the parents as as we would normally. Uh, but I think uk hsa have acknowledged that that there may be some errors, um, and it's just being transparent and addressing it as we would normally.

Ashleigh: 27:40

So the incomplete algorithm. We're going to find the correct column for age. We're going to read the whole column in its entirety before making any decisions, including the subsequent doses. Sometimes it's helpful to cross off what's already been administered, but in some instances that can actually be a little bit confusing. So we'll go through that. General principles of immunisation we would never restart a course and again, we cannot over-immunise.

Ashleigh: 28:10

Now, I used to love the old algorithm. I'm not saying I dislike the new one, but I have to be honest there was a little bit that I wasn't quite sure on, and so I did reach out to UK HSA for some further clarification, which they thankfully provided. So we'll talk through a few bits on it. Now the best, I think the best advice I could give is to really take time with this one and read the whole column down before you make any decision, because sometimes there's things further down the column that in certain situations sort of contradicts what's higher up. Now the general principles section here is helpful. It highlights that we should aim to offer the most protection in the least visits. So we'll work through it.

Ashleigh: 29:03

The first column eight weeks up to first birthday. Remember, if baby comes on their first birthday they're gonna be following the next column along, anyway. So first column eight weeks up to first birthday. So let's say they present for the first IMS over the age of 16 weeks. If we look down here, we can give PCV at that first appointment if they present for their first immunisations over 16 weeks. I'm getting close to trying to see it on my screen because it's quite small.

Ashleigh: 29:43

Remember, we're going to be checking the age for rota, and if your area screens for S-SID which not all do, then we should normally have made every reasonable sort of effort to obtain that result, including asking the parents if they've had a latter. However, if the parents were to decline the heel prick testing, we would still offer rota. If they've moved from an area that doesn't test for estherd as part of the heel prick, then we'd still offer rota. And if you work in an area that doesn't include estherd in the heel prick, then we would still offer that immunisation. And then we can just continue down to the subsequent uh vaccinations boxes. So it's yeah, so that one slightly simpler.

Ashleigh: 30:28

Just remembering if they're 16 weeks of age when they attend for their first immunizations, we can give the pcv at the same time, which is actually going back to fairly similar to what we did, sort of um, quite a few years ago, but we could do that because they're already at the age they should have been offered that we're going to get the protection in general principles get as much protection as we can in the fewest visits, remembering the rota age guidance there. So from first up to the second birthday this is the one that threw me a bit, so I'll try and simplify it. If they have had primaries before they turn one and then come late for one year IMS but before their second birthday we look at their date of birth. However, if they didn't have any primaries before they turned one or they had at least one primary dose over the age of one, then they've met the requirement for Hib over one and so they don't need a meniteric. They don't need the additional meniterics or six in one. If they've had at least one dose over one year of age, you're still going to obviously be doing your three doses, but it's just it's. It's just this bit here where it says about the um, the date of birth and what they've had, because we're remembering over one. It's. It's the Hib, not the Men's C that we're giving for now. So if they've had at least one dose of Hib over the age of one, we don't need to give an additional Hib or we don't need to give an additional Minotrix or 6 in 1. So if they're coming for their immunisations and they've not had any before, then we work it down. We're going to look at the date of birth, follow that through. If they've had one dose of Hib containing vaccine over one year of age, then they've met that Hib over one requirement.

Ashleigh: 32:40

All children need MenB over one year of age. However, if they didn't have two doses in their first year of life, then they would need two doses in their second year of life. So this is where I know. I've just said sometimes it's helpful to cross off what they've had. However, let's say if they'd had their first lot of primary immunisation, so they'd had that as normal and then they didn't come back again, we might be tempted to think they've had six in one. They've had menb because they had their eight week ims. However, if they've had oh, if they've had less than two doses of MenB before they were one, they'll need two doses of MenB before they turn two. So that's where crossing out the MenB because they've already had it might be a little bit unhelpful. So, yeah, it's just reading it all the way through, so and there it'll talk you through that and then continue reading down about your subsequent doses.

Ashleigh: 33:45

So read down the whole column. And I would say, read down the whole column before you make any decision about any immunisation, before you give anything, read the whole column. So then, second to tenth birthday, it gets a little bit simpler here. But I would highlight that they may have had all their primaries but no one year IMS and pre-score booster. So we may be tempted to initially think right, I'm going to cross off. They had their eight week, they had their 12 week, they had their 16 week, oh, we just need MMR. However, if we read all the way down, oh, we just need MMR. However, if we read all the way down, they will still need a dose of Hib over the age of one. If they've had, for example, their primaries and their one-year rims, then they'll have met that Hib requirement. So it very much depends on what they had previously.

Ashleigh: 34:38

So just reading down the whole column, looking at what they've had and then making that decision, and then reading subsequent vaccinations and boosters, as the intervals required may need to be adjusted, and then obviously it gets a little bit simpler for over 10 years and onwards. But, yeah, reading it through, also thinking about hepatitis B. So if anybody is born before if any, sorry, if anybody is born from the 1st of August 2017 and they haven't had a hepatitis B containing vaccine, then we can offer monovalent as well. So it's just just reading all through and taking time to check. I'm sure we'll do, but, yeah, it it's a little bit more intricate.

Ashleigh: 35:33

The the new schedule. Yeah, I would say if, if somebody presented in a busy clinic, I don't think there's anything wrong with saying I'm really sorry. I need to make sure that we're going to be actually following the algorithm. Let me work this through, and sometimes you might have to say you know we'll need to call you, call you back again and etc. We want to be making sure that we're getting it right. But really important reading through the whole column, because sometimes things further down here impact decisions up here.

Ashleigh: 36:09

Here's the resources, and so, as I say, the UK HSA slides go into a lot more, a lot more depth. I hope this has been a little bit, you know, simplified, if you like to make it a little bit easier to work through. Um, have a look at the, the resources and things. I do think they are really helpful. The calculator is great, but not for primaries. Uh, you know we've got visual guides and aid memoirs etc. So use the resources that are there. Um, I do hope that it has been helpful in summarising all of the changes you know, helpful to sort of work it through step by step. I hope it's been useful, thank you.