The new contract deal for 2020/21 to 2023/24 includes some big changes to how vaccinations and immunisations will be contracted and paid for. Pulse Intelligence outlines what we know so far.
New GP contract details agreed for 2020/21 to 2023/24 include a major overhaul of the system by which GPs are contracted and paid to deliver vaccinations and immunisations on the NHS.
The changes are in large part a response to the recent review of vaccination and immunisation payment mechanisms by NHS England and NHS Improvement, with input from the BMA GP Committee, the RCGP, Public Health England (PHE) and the Royal College of Nursing as well as the Pharmaceutical Services Negotiating Committee.
The review concluded that the current payment system was unnecessarily complicated, with wide variations in payment rates, and made it difficult for GP practices to understand their current performance against targets. The payment mechanism was also found to be outdated in terms of incentives to meet desired coverage.
Here’s a summary of the new arrangements that have been announced.
Vaccinations and immunisations will now become part of essential services, rather than additional services, so all practices will be expected to offer routine, pre- and post-exposure vaccinations and NHS travel vaccinations (as most already do).
The Item of Service (IoS) fee will be standardised so practices are paid the same for the delivery of each dose of all routine and annual vaccines. From 2021 this will also apply to routine vaccines given outside the routine schedule where routinely indicated. The IoS fee will be set at £10.06 for the three remaining years of the current contract.
The standard IoS payment will apply to all MMR vaccines in 2020/21, with roll-out the following year to the routine infant vaccines: 6-in-1 vaccine (Diptheria, tetanus, poliomyelitis, pertussis, haemophilus influenza type B and hepatitis B); Rotavirus; Pneumococcal conjugate vaccine (PCV); Men B infant; Haemophilus influenza type B and Men C (HiB/MenC).
Currently practices only receive payment for routine childhood immunisations if they reach at least 70% coverage, so the introduction of the IoS fee for all doses administered will recognise the benefit of vaccinating children even where uptake is lower than this.
However, to prevent unfair redistribution of payments at the expense of higher performing practices, a portion of the IoS fee earnings will be clawed back from practices with less than 79% coverage (worth half their potential total earnings).
NHS England says this means practices will earn the full IoS fee for every patient vaccinated beyond 50% coverage, and insists all but the very lowest performing practices will be better off under the new arrangement.
The initial change in the IoS fee for MMR in 2020/21 is expected to give a boost in funding for practices to build on and reinvest in improving coverage, before the rest of the payment arrangements come in from April 2021.
To assist with cashflow, practices will in future be paid a monthly aspiration payment and a final balancing payment at year end, in a similar way to existing QOF arrangements. From 2021/22 all vaccine payments should be made via CQRS using automated data extraction.
From 2021 there will be a new QOF domain worth at least £40m to incentivise vaccinations and immunisations. Payments will be linked to achieving target coverage for certain vaccines where herd immunity is beneficial, eg, MMR.
Practices will be paid for achieving incremental improvements – rather than for reaching dual thresholds as with the current Childhood Immunisations DES targeted payments.
Details of the new domain are to be worked out, but it is anticipated that thresholds for MMR and the 6-in-1 vaccine will be set at 90% and higher.
The Childhood Immunisation DES will be retired rom April 2021.
There will also be incentives at Primary Care Network level for improving flu vaccination coverage, paid via the Investment and Impact Fund (IIF) – with an indicator worth £8m for flu vaccination uptake in over-65s starting from April 2020.
Existing QOF indicators incentivising flu vaccinations in at-risk groups will be reviewed during 2020/21 to come up with a new set of indicators for 2021/22. The Contract states that the QOF points released will be redistributed into other domains so ‘practice level investment will be protected’.
A new set of core contractual standards are being introduced to standardise practices’ approaches to organising and delivering the services (see below).
These comprise five core components:
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