Guidance

Funding and Charging for Vaccines

  • There was a change to the funding arrangements for vaccination and immunisations in the contract changes 20/21.
  • Vaccinations and immunisation became an essential service rather than an additional service
  • All practices are expected to offer all routine, pre and post-exposure vaccinations and NHS travel vaccinations currently covered by the previous additional service to their registered eligible population.
  • The element of global sum related to the additional service for immunisations and vaccinations that practices receive will be retained in full. It will continue to cover NHS travel vaccinations and pre/post prophylaxis vaccinations.

The section below is taken from the BMA’s Focus on Travel Vaccinations.

The following travel immunisations highlighted in green must be given as part of NHS provision through GMS & PMS Regulations.

The immunisations above in the blue section are not prescribable as part of NHS services.

The contractor may therefore charge a patient registered for GMS/PMS/APMS services for the immunisation if requested for travel.

  • the patient may either be given a private prescription to obtain the vaccines, or
  • they may be charged for stock purchased and held by the practice
  • the process of administration of the immunisation is also chargeable
  • practices should provide the patient with written information on the immunisation schedule proposed and the charges involved at the outset of the process.
  • an FP10 (or equivalent NHS prescription) must not be used to provide these vaccines.

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Travel Immunisations that can be Given as Either NHS or as a Private Service

This category is the one that causes most confusion. The ambiguity in this section stems from the regulations regarding the charging of patients that are registered with the practice. Schedule 5 of the NHS regulations 4 states that:

“The contractor may demand or accept a fee or other remuneration…. for treatment consisting of an immunisation for which no remuneration is payable by the Primary Care Trust and which is requested in connection with travel abroad”

This wording leaves the decision as to whether the practice levies a charge or not to the discretion of the practice. The regulations do not impose any circumstances or conditions as to when these immunisations should be given on the NHS or as a private service nor do they allow any outside organisation to decide which option should be chosen.

Practices therefore need to be clear about their policy to avoid falling foul of regulations that prohibit charging NHS registered patients. The service must be provided either entirely as an NHS process or entirely as a private service, and the following paragraphs illustrate that difference.

If a confirmatory certificate is requested by the patient, then the practice may charge for this, but cannot charge just for recording immunisation details for the patient’s personal record.

Alternatively, the practice may decide that providing this is as a private service and charge a patient registered for GMS services for the immunisation. In this situation this can either be provided on a private prescription or the patient charged for the supply from practice stock. In this situation a charge may be made for the administration of the vaccine.

It is important to avoid mixing these two scenarios. If these immunisations are provided as an NHS service, then no charge can be made to the patient other than for certification if requested by patient (which is not compulsory).

Practices also must ensure that their policy is non-discriminatory and that this is not done contrary to the Equality Act 2010 (formerly the Disability Discrimination Act).

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GP Practices Obligations to Provide a Travel Health Service

One of the common questions that we are asked around travel, is whether or not an NHS GP surgery are obliged to provide a travel service?

In short – Yes, as you will be aware, there was a change to the funding arrangements for vaccination and immunisations in the contract changes 20/21, where vaccinations and immunisation became an essential service rather than an additional service, meaning all practices are expected to offer all routine vaccinations and NHS travel vaccinations currently covered by the previous additional service to their registered eligible population.

This expectation has not changed and all NHS GP practices in England must contractually continue to provide the NHS travel health service.

 

Another common question that we are asked is whether it is acceptable to provide just the required travel vaccinations without providing a full pre- assessment and travel consultation?

This is unfortunately a common misconception.

In addition to the contractual obligation above, the SFE (pg57) also states

Vaccines and immunisations required for the purposes of foreign travel

(5) Vaccines and immunisations in respect of the diseases listed in column 1 of Table 2 must only be offered in the case of a person who intends to travel abroad, and if the offer is accepted, given in the circumstances set out in column 2 of the Table.

(6) Contractors who offer and provide the vaccines and immunisations referred to in Table 2 must have regard to

(a) the guidance and information on vaccines and immunisations procedures set out in “Immunisation against infectious diseases – The Green Book”; and

(b) the information on travel medicine and travel health issues provided and published by the National Travel Health Network and Centre(a).

To practice safely and within the legal mechanisms, (SFE and usually a PGD), then a pre travel risk assessment is required to administer NHS travel vaccines. Anyone using a PGD will need to have undertaken the relevant assessment to comply with the section within the PGD – 4. Clinical condition or situation to which this PGD applies.

Furthermore, CQC also have a GP mythbuster 107  Pre-travel health services, that states:-

We expect to see processes to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients. Examples include:

  • Using a recognised online tool to identify country-specific risks to help make recommendations. Country-specific risks include vaccine-preventable and mosquito-borne diseases. See the  travelhealthpro website
  • A comprehensive travel health risk assessment completed for each person using the service.
  • Clear documentation of the risk assessment for:
    • all vaccines given
    • medicine prescribed or advised
    • vaccines declined.

We are very aware that practices all have demand, capacity and possibly workforce issues. So, what can you do?

  • We would suggest that the practice website is updated to explain how travel health appointments are dealt with in your surgery, to manage patient expectation.
  • We understand many practices have a pre-travel assessment on their website that they ask patients to complete and send in xx weeks prior to their travel appointment with the practice nurse to enable the nurse to consider and be ready for the appointment. It may be in some instances that patients need to seek advice and vaccines from a private travel clinic if they have not booked within a reasonable time frame.
  • Practices may also wish to point out that some vaccinations have a time frame in which they must be given prior to travel, so patients need to be mindful of this.
  • We would further suggest that patients are made aware that these travel appointment slots are very popular and get booked up very quickly, so patients should book up and allow a minimum of 6 – 8 weeks weeks before travel.

More information on why an NHS GP Practice is obligated to provide a travel health service, that should include a pre-travel risk assessment, travel consultation with post exposure advice, in addition to providing the required travel vaccinations, can be found on Jane Chiodini’s webpage Providing an NHS Travel Service – Jane Chiodini.

With special thanks to Jane Chiodini for giving us permission to share these resources

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NHS Covid Pass

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Competencies: Travel Health Nursing: Career and Competence Development

 

Recently updated May 2023 the RCN guidance on “Competencies: Travel health nursing: career and competence development”, confirms that Registered Nurse Associates are now able to provide a travel health service.

 

Who can deliver travel health care?

Travel health care can be delivered by registered health care practitioners who are appropriately trained and demonstrate competence in this field of practice. Nursing associates became registrants under the NMC in January 2019 (NMC, 2018b), so since the last review of this publication, they became a new group of nurses who could deliver travel health services. Currently, there are certain prescribing obstacles for the administration of travel vaccines for this particular group that need to be taken into consideration as explained under the ‘Prescribing, supplying and administering travel vaccines’ section on pages 16-17.

(Taken from page 12 of the RCN document.)

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What Else is New?

  • Recommendations for timings of appointments
  • New ways of delivering a travel health service
  • Greater attention to certain topics, including types of travellers and purpose of travel.
  • New definition of a ‘Nurse Consultant’

And much more…………………

More information and a summary of the key changes to the document can be found via Jane Chiodini’s blog dated 26th May 2023 – Jane Chiodini’s Blog: 4th Edition of RCN Competency document, where you will find a link to this very useful poster outlining all the changes.

With special thanks to Jane Chiodini for giving us permission to share these resources.

 

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