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, Swindon and Wiltshire
- All PGDs can be found at: https://www.england.nhs.uk/south/info-professional/pgd/bgsw/
- South West - https://www.england.nhs.uk/south/info-professional/pgd/south-west/
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 additional services section of the Statement of Financial Entitlements (SFE).
Those vaccines and immunisations that are provided as enhanced services will have their arrangements outlined in service specifications
The 2018/19 Programmes
From 1 April 2018, the item of service (IoS) fee for the following vaccinations was increased from £9.80 to £10.06 per dose in line with the consumer price inflation (CPI) index:
- Hepatitis B at-risk (new-born babies)
- HPV completing dose
- Meningococcal B
- Meningococcal ACWY freshers
- Meningococcal completing dose
- Singles routine
- Shingles catch-up
The Item of Service fee for the following programmes is unchanged at £9.80 per dose:
- Childhood seasonal influenza
- Seasonal influenza and pneumococcal polysaccharide
The payment for pneumococcal PCV will remain at £15.02.
A number of changes have been agreed to the vaccination and immunisation programmes.
- Hepatitis B (newborn babies) – programme name changed to hepatitis B at-risk (newborn babies). Vaccine changes and number of recommended doses set at three, therefore the payment of the second dose has now been uncoupled from the third dose. This was an in-year change effective 30 October 2017, included for completeness.
- MenACWY 18 years on 31 August – programme removed.
- Meningococcal completing dose – cohort extended to include eligible school leavers previously covered by the 18 years programme. The eligibility is now 1 April 2012.
- Meningococcal B – programme moved in to the SFE, but is not included in the targeted programme. There are no changes to eligibility of payment requirements.
- Pneumococcal PCV three-month dose – removed from the targeted childhood programme, however the funding for the remaining dose remains at £15.02 and was not subject to the IoS increase.
The following programmes continue unchanged:
- childhood seasonal influenza
- hepatitis B at-risk (babies)
- human papilloma virus (HPV) completing dose (adolescent girls)
- measles mumps and rubella (aged 16 and over)
- MenACWY freshers
- pneumococcal polysaccharide (PPV)
- seasonal influenza
- shingles (routine)
- 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 will be available in the vaccination and immunisation programmes 2018/19 guidance and audit requirements document which will be published in due course.
The technical requirements for 2018/19 GMS contract changes document will be published in due course.
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 is required no later than 30 June 2018. 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 2018/19
To download HSCIC’s GP collections timetable for 2018/19, click here: https://digital.nhs.uk/services/general-practice-gp-collections
Managing Childhood Immunisation Clinics
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
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
Please see the attached information in relation to staff accessing MMR vaccinations which is part of a national programme.
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.
Where a patient asks their own practice for the vaccination, if a GP decides that a patient would benefit from vaccination but they do not fall into the national programme, then they have to take a decision on whether to give it or not balancing the risks and benefits (same as any other therapy). If the GP is prepared to give it they can claim a personally administered fee via an FP34D but not the fee for the vaccine itself nor can they use centrally procured stock.
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/patientspecificdirectionspsdsandpatientgroupdirect
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.
Above link includes details on: Hep B, MenC, MMR, Pertussis, Rotavirus, Seasonal Flu, Pneumococcal, Shingles.