Vaccines and Immunisations – Guidance for Practices
NHSE advise that 2023 has seen a steady rise in measles cases. The UK Health Security Agency (UKHSA) has published updated national measles guidelines and resources, with a new slide set for healthcare professionals and support staff in primary care. These guidelines advise how to manage cases of suspected measles, what patient details to take, who to notify and assessing risk of disease spreading in close contacts.
On 31 October 2023, NHS England National Medical Director and UKHSA Chief Medical Advisor wrote to healthcare system leaders to alert them to the risk of a measles resurgence in England, due to sub-optimal uptake of the Measles Mumps and Rubella (MMR) vaccine and cases linked to overseas travel.
Vaccinations and Immunisation Programme
The national arrangements for providing vaccines and immunisations are set out in the Statement of Financial Entitlements (SFE).
The IOS Fee remains at £10.06
There are a number of changes to this year’s programmes.
- move from a two-dose schedule to a one dose schedule for the routine adolescent programme up to the age of 25 years
- This change will not apply to those who are immunocompromised and those known to be HIV positive for whom the three-dose schedule will remain.
- There will be a change from a two-dose to a one-dose HPV programme for those aged 14 to 25 years from 1 September 2023 to align with the school’s programme.
- General practice delivery remains opportunistic or on request. Eligibility remains up to 25 years of age for girls born after 1 September 1991 and boys born after 1 September 2006. This difference is due to the programme for boys being introduced at a later date (2019).
From 1 September 2023, Zostavax will be replaced with the 2-dose Shingrix vaccine as Zostavax goes out of production.
Shingles is also an indicator in QoF – VI004
|VI004. The percentage of patients who reached 80 years old in the preceding 12 months, who have received a shingles vaccine between the ages of 70 and 79 years
There are a number of changes to this programme around cohorts and frequency. With thanks to our colleagues at SE Screening and Imms team who have produced this very handy chart to help with the changes for 2023-24. Click here to download a copy.
NHSE say the expansion of the immunocompetent cohort will be implemented over two five-year stages as follows:
- first five-year stage (1 September 2023 to 31 August 2028): Shingrix will be offered to those turning 70 and those turning 65 years of age in each of the five years as they become eligible.
- second five-year stage (1 September 2028 to 31 August 2033): Shingrix will be offered to those turning 65 and those turning 60 years of age in each of the five years as they become eligible.
- Additionally, practice call/recall for the immunocompromised and immunocompetent cohorts as they become eligible for the programme will be implemented from 1 September 2023, as well as catch-up call/recall for the newly eligible immunocompromised 50-69-year-old cohort.
- Shingles can be delivered at any time during the year thus enabling practices to manage timing for when the individual is invited and can also be opportunistically delivered if clinically appropriate when an individual attends the practice for another reason.
- The Shingles GPES extraction will be updated to accommodate these changes.
- Further information on the programme changes and management of the immunocompetent cohort expansion will be provided in due course.
Shingles Eligibility Calculator – from September 2023
To support practices with the changes to the dose schedule in the shingles vaccination programme, health professionals can use the eligibility calculator to enter a patient date of birth to work out if the patient is eligible for vaccination and if so which vaccine they are eligible for. Please download this Excel calculator to use offline. It is available for download here: https://www.healthpublications.gov.uk/ViewArticle.html?sp=Sshingleseliligibiltycalculatorfromseptember2023
If you have any queries about this tool, please email firstname.lastname@example.org.
Discrepancy between GPES business rules and Green Book definition of severely immunocompromised cohort eligible for a shingles vaccine
We understand that there was an issue relating to the discrepancy between GPES business rules and the Green Book definition of severely immunocompromised patients within Ardens search tool.
Ardens based their search tool on the coding clusters included in the GPES extract. However, the GPES business rules are built for payment purposes and should not be used for the purpose of identifying eligibility for a shingles vaccine.
The advice for practices using the Ardens tool as a basis to create the cohort search criteria was that they would need to exclude patients who do not fall under the Green Book definition of ‘severely immunosuppressed’ from their routine call and recall, and consider if any patients may be missed out who would otherwise be eligible due to specific drug dosages. Practices should apply searches that match the Green Book eligibility criteria which would also be in line with the PGD inclusion criteria as well. Practices can of course apply clinical discretion on the basis of clinical need when appropriate.
However, Ardens have now confirmed that they have updated their searches for the shingles immunosuppressed cohort and this information is reflected on their website. They have separated out all the ‘immunocompromised’ patients and have invited practices to review these and added the ‘requires vaccination against shingles’ code to the electronic record if patients are deemed ‘severely immunocompromised’ as per the Green Book definition.
Shingles SNOMED codes
The Clinical SNOMED codes shown in the table below should be used by GP practices for the recording of shingles vaccination events for payment purposes.
|Administration of vaccine product containing only live attenuated Human alphaherpesvirus 3 antigen (procedure)
|Administration of vaccine product containing only live attenuated Human alphaherpesvirus 3 antigen via subcutaneous route (procedure)
|Shingrix first dose
|Administration of first dose of vaccine product containing only Human alphaherpesvirus 3 antigen for shingles (procedure)
|Shingrix second dose
|Administration of second dose of vaccine product containing only Human alphaherpesvirus 3 antigen for shingles (procedure)
|Requires shingles vaccination
|Requires vaccination against herpes zoster (finding)
UKHSA (previously PHE) Shingles training slides: https://www.gov.uk/government/collections/shingles-vaccination-programme
There will be a number of changes to the childhood V&I programme. These include:
- Removal of the V and I repayment mechanism if a practice achieves under 80% coverage
- Changes to the childhood V & I QOF thresholds, so that lower thresholds are reduced to 81% – 89% (dependent on indicator) and the upper thresholds raised to 96%. QoF Guidance can be seen from Pg 94.
- Clarification of the wording in the SFE that an Item of Service fee will be payable for vaccinations for medical reasons and incomplete or unknown vaccination status (‘evergreen offer’).
- A new Personalised Care Adjustment will also be introduced for patients who registered at the practice too late (either too late in age, or too late in the financial year) to be vaccinated in accordance with the UK national schedule (or, where they differ, the requirements of the relevant QOF indicator).
- UKHSA have produced a number of publications and resources to help with uptake of MMR
Confirmation of national vaccination and immunisation catch-up campaign for 2023/24
You will be aware that practices are required to participate in a national vaccination and immunisation national catch-up campaign each year, as a requirement of the GP contracts.
NHS England published a letter on 1 November confirming the 2023/24 national vaccinations and immunisations catch-up campaign will focus on measles, mumps, and rubella (MMR).
The campaign will run from November 2023 to March 2024 in two stages:
November 2023 to March 2024 – practices to undertake local call and recall for eligible individuals aged 12 months up to and including 5 years.
January 2024 to March 2024 – practices to support requests for vaccination from eligible individuals aged 6 years up to and including 25 years.
This cohort will be identified through phased national call and recall, and where individuals or parents/carers contact their practice following receipt of the invitation, practices are required to check the individual’s vaccination status for valid vaccinations (e.g., given at the
correct age and at the correct intervals) and book an appointment for vaccination if clinically appropriate. Further information will follow, via the Primary Care Bulletin and Regional cascade, to provide advanced notice of the phased national call and recall, including the schedule of call and recall communications. This catch-up will be supported by the School Age Immunisation Service (SAIS) for the relevant age cohorts, alongside general practice activity.
Funding and vaccine ordering
Funding for participation in the national catch-up campaign is included in global sum payments. Practices are also eligible for an item of service payment of £10.06, in line with requirements set out in GP contracts, for each MMR vaccination administered because of this catch-up activity.
The MMR vaccine continues to be available for practices to order through IMMFORM.
Details of practice activities to support the campaign are outlined in the letter with a summary of requirements included in Annex A.
- UKHSA have produced a number of publications and resources to help with uptake of MMR
The following programmes will continue unchanged for 2023/24:
- 6-in-1 (DTaP/IPV/Hib/HepB)
- Rotavirus – N.B Rotavirus vaccine and (SCID) newborn screening. We have produced a summary of guidance for practices to check on actions they need to take based on the PHE issued information for GPs and practice nurses.
- PCV (infant pneumococcal)
- MMR provision to remain unchanged for both the 0-5-year-olds programme and 6 years and over programme
- 4-in-1 pre-school booster (DtaP/IPV)
- 3-in-1 booster (td/IPV)
- Men ACWY (provision for those aged up to 25 years who miss the schools programme)
- PPV (65-year-olds and 2-64-year olds in defined clinical risk groups)
- HepB (Babies)
- Pertussis (pregnant women).
GP Collections Timetable
NHS Digital publish the GP collections timetable on a monthly basis and can be seen at: – https://digital.nhs.uk/services/general-practice-extraction-service/gp-collections-schedule
Public Health Contacts for Imms and Screening
NHS England Thames Valley, Hampshire and IoW Public Health Commissioning
NHS England South West Public Health Commissioning – covering BSW and Dorset
- England.email@example.com for all Section 7A screening and immunisation programmes
- England.firstname.lastname@example.org for the Immunisations Clinical Advice Service (ICARS)
- England.email@example.com for CQRS queries
- England.firstname.lastname@example.org for Covid-19 programme operational queries
Child Health Information Service’s
- BaNES and Swindon – South Central and West CSU
- BaNES email@example.com tel: 0300 561 1853
- Swindon firstname.lastname@example.org tel: 0300 561 1853
- Wiltshire – Virgin email@example.com tel: 0333 321 2194
- Dorset – Provide firstname.lastname@example.org tel: 0300 303 9995
- HIOW – Southern Health Foundation Trust email@example.com tel: 02382 310251
SCID, BCG and Rotavirus
UKHSA 1st September 2021 – Changing the timing of the neonatal BCG immunisation programme to a 28-day immunisation programme. Although the BCG is not routinely given in practices, it is helpful to be aware of the process and the SCID screening.
UKHSA have also published a patient pathway flowchart for BCG and SCID which maybe useful.
However, SCID screening does need to be checked before babies have the Rotovirus vaccine. UKHSA have also published a handy guide and a flowchart for practices on how to manage Rotovirus immunisations with regard to SCID.
Further information on these changes can be found in the UKHSA Vaccine update: issue 327, May 2022, SCID, TB and BCG special edition.
Patient Group Directions
PGDs in Dorset, Hampshire and the Isle of Wight (Wessex)
- All PGDs can be found at: https://www.england.nhs.uk/south-east/info-professionals/pgd/patient-group-directions-for-nhs-primary-care-services-in-the-south-east-of-england/
PGDs in Bath, Dorset, Swindon and Wiltshire
For more advice and guidance on PGDs and PSDs go to: https://www.wessexlmcs.com/patientspecificdirectionspsdsandpatientgroupdirect
HPV Vaccination Guidance for Healthcare Practitioners
This guidance provides information for healthcare practitioners about the human papillomavirus (HPV) universal programme for adolescents and the HPV for men who have sex with men (MSM) programme. It includes information on eligibility, scheduling and vaccine administration.
Responding to Private HPV Self-sample Tests
The purchase of Human Papillomavirus (HPV) self-sampling home testing kits is increasing. Results of these private tests will not be acted on by the NHS Cervical Screening Programme (NHS CSP) and cannot be recorded in an individual’s NHS screening record.
If a private test result is positive, the person should be advised that having HPV does not mean they have or will get cervical cancer.
HPV is common; over 80% of the population will get it at some point during their lives.
Individuals eligible for the NHS CSP remain so, even if they have had a private test. Most HPV infections clear themselves without causing problems. If someone has persistent HPV infection, it will be identified when they accept their next NHS CSP invitation.
Cervical cancer usually develops slowly over 10 years in three stages:
1.Infection with HPV
2.Development of abnormal cells if the immune system does not rid the HPV infection
3.Development of cancer if abnormal cells are not treated.
Childhood Immunisation Resources
The RCN have produced a really useful document on best guidelines in Managing Childhood Immunisation Clinics.
- Core areas around immunisations
- Common vaccination errors
- The 8Rs to consider prior to giving a vaccine
- Vaccine storage and ordering and
- Top tips
Nursing Standard – Childhood immunisation: best-practice guide for nurses published
Information for Immunisation Professionals
For further information/links to the national immunisation schedule, incomplete immunisation algorithm and e-learning resources, go to:
MMR For Practice Staff
The Green Book Chapter 12 details infromation for the Immunisation of healthcare and laboratory staff.
Gov.uk also has a webpage entitled MMR for all: general leaflet. This leaflet explains the measles mumps rubella (MMR) vaccine for all ages.
We would advise that for any staff member over the age of 16 who has not received 2 doses of MMR they are eligible to receive the vaccine which can be given by the patient’s own GP who is able to claim the fee for this. It should be noted that people born before 1970 are likely to have immunity from exposure or single vaccine but this doesn’t preclude them from having an MMR if in doubt.
On the following weblink you can download an algorithm that provides information on what to do if the vaccination status of an individual is uncertain or incomplete. https://www.gov.uk/government/publications/vaccination-of-individuals-with-uncertain-or-incomplete-immunisation-status Please also refer to the relevant pages in the Green Book.
Adults born in the UK before 1970 are likely to have had measles, mumps and rubella as a child or to have had single measles or rubella vaccines which were used before MMR was introduced in 1988.
If you are unsure whether or not you have had these infections or the vaccines to protect against them, you can ask your GP to vaccinate you. You will need two doses, one month apart. Even if you have had the vaccines before, you will not come to any harm from having extra doses as your immune system will recognize and quickly destroy the vaccine viruses.
For other vaccinations which are not part of a national programme then please see below a really useful link to one of the CQC myth busters relating to the immunisation of healthcare staff:
Practices have a responsibility to ensure they have logged for each employee (clinical and non-clinical) their immunisation history or a risk assessment as to why this is not required. The list of vaccinations this applies to can be found via the attached web link.
When new members of staff join the practice you may ask for a health questionnaire to be completed. At this stage you can ask for the immunisation history and a clinician should then assess if any immunisations may be required, these can either be given by the practice (which is what happens in most practices) or by an occupational health service. If there was anything else identified on the questionnaire which you feel requires an occupational health assessment you may wish to identify a service and refer them at this point.
Practices can’t register staff as Temporary Residents as they are not actually resident in your area for more than 24 hours nor should you use supplied stock.
There is no longer an occupational health service for practice staff (only for GPs) other than for needle stick injuries and so you would need to find a service to commission or staff can request their own GP to provide the vaccination.
The Green Book
The Green Book has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK. To download a version click here: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
BMA ‘Focus On’ Guidance
Focus on travel immunisation
This guidance explains which travel immunisations are available on the NHS and which can be charged for privately.
Focus on hepatitis B immunisations
The Focus on hepatitis B immunisations aims to clarify the circumstances where charges can be made and where active attempts to encourage immunisation ought to be made.
Maintaining the Cold Chain
CQC’s definition of Cold Chain is: “This term describes the cold temperature conditions in which certain products need to be kept” and they say:-
“All providers should have a policy which includes how to handle vaccines to maintain the cold chain from the point of delivery to administration. It should include transport of vaccines outside the practice, actions to take in the event of a breach in the cold chain and details of how the practice will ensure learning from cold chain incidents”
Further details and up dates can be found on the CQC Guidance page GP Mythbuster 17: Vaccine storage and fridges in GP practices.
- The NHS Specialist Pharmacy Service (SPS) has a policy specific for Primary care that also covers transporting vaccines.
- SPS have produced a useful tool for advice on whether refrigerated medicines can or cannot be used after exposure to out-of-range temperatures which can be found at Refrigerated medicines stability tool – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice
Wessex LMCs also has information on our page Cold Chain
Vaccinating people with a learning disability and autistic people – Podcast
NHS England and NHS Improvement, Learning Disability and Autism, National Clinical Director is in conversation with Fazilla Amide, whose 17 year old son has complex health needs, learning disability and autism. Please click HERE to access the conversation.