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Travel immunisations/vaccines

Funding & charging for vaccines

In light of the changes to vaccine guidance, we have updated our guidance and would like to acknowledge Wessex LMC for sharing their guidance.

  • The 2020/21 contract changes saw a change to the funding arrangements for vaccination and immunisations in the GP 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 below must be given as part of NHS provision through GMS & PMS Regulations.

As a practice you cannot charge for the following 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

Travel immunisations that cannot be given as an NHS service and are not remunerated by the NHS as part of GMS/PMS services:

  • Yellow Fever
  • Japanese B encephalitis
  • Tick borne encephalitis
  • Rabies

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.

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).

Pre-travel advice

NHS GP practices can provide travel health care to eligible patients who are registered with them. They do not have a contractual obligation to do so, however if practices decide to provide this service, then they should ensure they have appropriate indemnity and training.

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.

 

Updated on Thursday, 2 March 2023, 2879 views

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