In the UK, a national HPV immunisation programme will be introduced for all girls aged 12-13 years (school year 8) starting in Autumn 2008. The national immunisation programme will use the bivalent HPV vaccine (CervarixTM, GlaxoSmithKline) and will protect girls against infection with HPV 16 and 18 (associated with 70% of cervical cancers). There will be a catch-up campaign for girls aged up to 18 years: in England this will be a two-year campaign starting in Autumn 2009. The Joint Committee on Vaccination and Immunisation (JCVI) has advised that the programme would be most efficiently delivered through schools. Primary Care Trusts in England will plan local delivery of the HPV vaccination programme. The JCVI advised that a catch-up programme for all women aged 18-25 years was unlikely to be cost effective but could benefit some individual women: the Department of Health is considering this further.
The NHS Choices website has more info here.
HPV vaccination frequently asked questions.
Q1. My patient is within the national campaign age range but wants the Gardasil brand instead of the Cervarix brand. Can I prescribe?
It is recommended that all prescribing is evidence based and with proven cost effectiveness. Every patient presenting should be clinically assessed for treatment based on each individual circumstance and where a GP clinically assesses that Gardasil is most appropriate, this should be prescribed using an FP10 (both vaccines are available on the NHS, it is just that Cervarix has been selected for the national programme)
Q2. My patient falls outside the national campaign age range but wants to receive the vaccination. Can I prescribe on the NHS?
It is recognised that it may be good medical practice to prescribe for patients who fall outside the national campaign. In this case the GP should clinically assess such patients considering the risks and benefits and make a decision whether the vaccination is clinically indicated. If clinically indicated, then the vaccine must be provided on an FP10.
Q3. Can I prescribe Gardasil or Cervarix privately for patients who request it?
Following clinical assessment, if it is clinically indicated then you can proceed to prescribe on the NHS via an FP10. To prescribe privately and charge patients contravenes GMS and PMS regulations as you either clinically determine that the patient needs it or doesn't. For those patients who are clinically assessed as not needing the vaccine but who insist on receiving it, you should suggest that they seek treatment at either a Private Hospital or Private clinic.
Q4. Can I set up a reciprocal arrangement with a nearby practice for patients requesting the HPV vaccination but who fall outside of the national programme so that we can charge privately ?
No. If HPV vaccination is indicated for health reasons then directing patients to another GP as part of a reciprocal arrangement for private treatment is not permissible. .
Q5. I have stock of Gardasil in the practice. Can I use this as part of the national campaign?
No. The national campaign is for Cervarix only and the route of supply is through central supplies. Cervarix will be supplied based on three times the number of identified girls for 100% uptake of the programme.
Q6. I gave the vaccine to a patient who does not fall within the national programme and charged for this on the information I received at the time. The patient requires a second and third dose so can I continue to charge for these?
No. You must provide these on the NHS. The second and third doses should be provided using an FP10 You will need to explain to the patient that the information provided at that time was incorrect, which is why a charge was made. You should refund the charge originally made to the patient for the first dose.
Q7. My patient has started a course of Gardasil elsewhere. Can I prescribe the rest of the course on the NHS?
Yes if you clinically assess the patients as requiring the vaccine.
Q8. A consultant Gynaecologist has recommended me to prescribe Gardasil for a patient he has seen privately. Can I prescribe?
If you clinically assess the patient as requiring Gardasil vaccine, then you should provide via an FP10 on the NHS.
Q9. Can I claim a personal administration fee for those patients vaccinated under the national HPV campaign?
No the full fee for administration is as set out in the local enhanced service.
Q10. Will my prescribing budget be affected by taking part in the LES for administration of Cervarix as part of the national campaign?
No all supply is centrally sourced and no FP10 practice prescribing is included so your prescribing budget will not be affected.
Q11. Can I give Cervarix to a different age cohort if there are parental requests to vaccinate siblings who will be eligible in the catch-up programme?
If you clinically assess that the patient would benefit from the vaccine, then you can either prescribe via an FP10 or suggest to the parent that the sibling waits for call up as per the national three year programme timetable.
SW November 2008
| 
