PLEASE READ THIS GUIDANCE PAGE IN FULL AND CONTACT US IF YOU HAVE ANY QUESTIONS
The LMC often receives queries from practices in relation to vaccinations, specifically for travel and what is core and non-core for practices to deliver, so we hope this guidance provides some clarity.
The 20/21 GP Contract saw a change to the funding arrangement for vaccinations, in which many became an essential service paid for via the Global Sum rather than an additional service.
Pre-travel advice
GP practices are not contracted to provide pre-travel advice to patients. However, if practices decide to provide this service, then they should ensure they have appropriate indemnity and training.
It must be noted that pre-travel advice should encompass a wide range of recommendations to protect a patient’s health whilst travelling. This would include a personalised risk assessment, with advice which could include:
- Vaccinations (NHS and non-NHS)
- Medication, including any limitations about the legal status of certain drugs in the destination(s), and antimalarials.
- About appropriate travel health insurance.
- Emergency contact numbers.
- Disease prevention (e.g. mosquito nets, insect repellents, foodborne and waterborne illnesses).
- Sun protection.
- Accident protection/high risk activities.
Practices may wish to provide the attached template letter to patients, if the practice does not offer this service. This also acts as a declaration from the patient to recognise that the practice is not responsible for any external travel advice given to the patient.
Funding & charging for vaccines and travel
Practices must provide the travel vaccinations listed below as part of their NHS contract. A practice cannot charge patients for these vaccinations which are funded as part of the Global Sum (so are also not eligible for an Item of Service payment):
- 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, Diphtheria & Polio – as given in the combined Td/PV vaccine
- Cholera
Details are included in Table 2 in the Statement of Financial Entitlements.
The vaccinations below when relating to travel cannot be given as an NHS service and are not remunerated by the NHS as part of GMS/PMS contract, so the practice may charge a patient:
- Yellow Fever
- Japanese B encephalitis
- Tick borne encephalitis
- Rabies
If the practice wishes to administer the above vaccines to the 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 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.
The practice can also charge;
- “For prescribing or providing drugs or medicines for malaria chemoprophylaxis.”
- “For prescribing or providing drugs, medicines or appliances (including a collection of such drugs, medicines or appliances in the form of a travel kit) which a patient requires to have in their possession solely in anticipation of the onset of an ailment or occurrence of an injury while that patient is outside of the United Kingdom but for which that patient is not requiring treatment when the drug, medicine or appliance is prescribed”
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. Regulation 25 of the NHS (GMS Contracts) Regulations 2015 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 Board, 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
- 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 to provide this as a private service and charge a patient registered for GMS services for the vaccination. In this situation this can either be provided on a private prescription or the patient charged for the supply from practice stock, and a charge may be made for the administration of the vaccine.
It is important to avoid mixing these two scenarios. If these vaccinations 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 contractual requirement for practices to provide
- All practices are contracted and expected to provide the NHS travel vaccines (listed 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 vaccination of the private vaccines and prescription
- malaria chemoprophylaxis
- prescribing or providing a travel kit
- 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 is 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)
Last Updated on 08 April 2025