Vaccines and Immunisations - Guidance for Practices
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/our-work/info-professionals/pgd/wessex/downloads/
PGDs in Bath, Dorset, Swindon and Wiltshire
For more advice and guidance on PGDs and PSDs go to: https://www.wessexlmcs.com/patientspecificdirectionspsdsandpatientgroupdirect
Vaccinations and Immunisation Programs
The national arrangements for providing vaccines and immunisations are set out in the Statement of Financial Entitlements (SFE).
Those vaccines and immunisations that are provided as enhanced services will have their arrangements outlined in service specifications
Contract changes from 1st April 2021 will see the provision of vaccination and immunisation services become an essential service for all routine NHS-funded vaccinations with two exceptions:
- childhood and adult seasonal influenza, which will continue as enhanced services, and
- COVID-19 vaccination
There will be five core contractual standards will be introduced to underpin the delivery of immunisation services. These are described in more detail in Annex A of the NHSE letter.
- A named lead for vaccination services
- Provision of appointments
- Call/recall and opportunistic offer standards
- Participation in national agreed catch-up campaigns
- Standards for record keeping and reporting
A single item of service fee (IOS) will be fully implemented for all doses delivered in vaccination programmes funded through the GMS contract - More detail in Annex B (of above letter).
Practice Index have also published a table within their guidance on the new IOS reimbursements arrangements. The LMC also assisted with the table and think you may find it helpful. Full details can be seen here.
The Childhood Immunisation Target DES will be retired on 31 March 2021 and a new vaccination and immunisation domain in the Quality and Outcomes Framework (QOF) introduced for 2021/22. The vaccination and immunisation indicators in this domain were referenced in the letter of 21 January 2021.
The 2020/21 Programmes
From 1 April 2020, the item of service (IoS) fee for the following vaccinations was £10.06 per dose.
- Hepatitis B at-risk (new-born babies)
- HPV completing dose
- Meningococcal B (infant)
- Meningococcal completing dose
- Meningococcal Freshers
- All MMR doses
- Shingles routine
- Shingles (catch up)
- Seasonal influenza and pneumococcal polysaccharide
The payment for pneumococcal PCV and Hib/MenC will remain at £15.02 for administering the final completing course (all four of the vaccines in the set must be completed)
The following programmes continue unchanged:
- Men ACWY freshers
- Shingles (catch up)
- The requirements for the following vaccination programmes are available in the service specifications which are available to download:
The detail of these programmes are available in the GMS Contract 2019/20 guidance and audit requirements We await the 2020 update.
It is recommended that you read all the specifications to confirm the eligible cohort and ensure that you are able to deliver the requirements in full, including all the data requirements.
Sign up to CQRS is required and will indicate your full participation in the programme. Payments will be made via CQRS and sign up. Failure to do so may result in delayed payments as the offer will close and you will be unable to claim on CQRS for any programme that you are not signed up to.
If you have any patients presenting with incomplete or uncertain immunisation status, Public Health England have published a guide to assist with decision making.
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-gp-collections/gp-collections-schedule
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
For advice on travel vaccinations, go to: https://www.wessexlmcs.com/travelvaccinations
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.
Cold Chain - CQC
CQC's definition of Cold Chain is: "This term describes the cold temperature conditions in which certain products need to be kept"
Further details and up dates can be found on the CQC Guidance page GP Mythbuster 17: Vaccine storage and fridges in GP practices
Wessex LMCs also has information on our page Cold Chain
Vaccine Incident Guidance Responding to errors in vaccine storage, handling and administration
Guy's and St Thomas' NHS Foundation Trust - Overcoming your needle phobia (fear of needles)
Reviewed in October 2020, please click HERE to access their leaflet about needle phobia.
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.