Travel immunisations/vaccines
The LMC often receives queries from practices in relation to immunisations, specifically travel vaccinations and what is core and non-core for practices to deliver, so we hope this guidance provides some clarity to practices.
The contract changes 20/21 saw a change to the funding arrangement for vaccination and immunisations in the GP contract, in which vaccinations and immunisation became an essential service rather than an additional service.
Pre-travel advice
GP practices are not contracted to provide pre-travel advice to patients e.g. souring what vaccinations are required for the different countries. However if practices decide to provide this service, then they should ensure they have appropriate indemnity and training.
Practice may wish to provide the attached template letter to patients, if the practice does not offer this service.
Funding & charging for vaccines
The following travel immunisations below must be given as part of NHS provision through GMS & PMS Regulations.
A practice cannot charge patients for the following NHS vaccinations:
- Hepatitis A (infectious Hepatitis) - first and second/booster doses
- Combined Hepatitis A & B - two doses with a third for over 16s
- Typhoid ¬ first and second/booster doses
- Combined Hepatitis A and Typhoid - first and second/booster doses
- Tetanus, Diptheria & Polio - as given in the combined Td/PV vaccine
- Cholera
The immunisations below relating to travel, these cannot be given as an NHS service and are not remunerated by the NHS as part of GMS/PMS services, so the practice may therefore charge a patient registered for GMS/PMS/APMS services:
- Yellow Fever
- Japanese B encephalitis
- Tick borne encephalitis
- Rabies
If the practice wish to administer the above vaccines to patient population, then the following may apply:
- 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.
Travel immunisations that can be given as either NHS or as a private service
• Hepatitis B (single agent) any dose
• Meningitis ACWY (quadrivalent meningococcal meningitis vaccine; A, C, Y and W135)
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.
To provide this as an NHS service, the practice would:
- either prescribe the immunisation on an FP10 (or national equivalent) or
- (in England and Wales) provide the vaccine from purchased stock and claim reimbursement through the normal channels
- the practice must not charge the patient for the administration of the vaccine
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).
SUMMARY
- Travel advice is not a contractural requirement for practices to provide
- All practices are contracted and expected to provide the NHS travel vaccines (indicated above) and cannot charge the patient.
- If you provide a full travel service (pre-travel advice, vaccine and administration) you can only charge for the administration and vaccine of the private vaccines.
- 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.
USEFUL LINKS
- BMA’s Focus on Travel Vaccinations.
- GP mythbuster 107: Pre-travel health services - Care Quality Commission (cqc.org.uk)
We recognise that NHSE guidance linked through the CQC mythbuster 107, is incorrect and we have written to GPC to ask this is amended.