Maximise your childhood immunisation payment

This payment applies to the vaccinations delivered under the routine immunisation schedule.

Payment is according to a formula and is based on 70% or 90% coverage for two and five year olds. A practice of 5,000 patients with 90% achievement can generate around £10,000 of income a year from this service.

There is no requirement for GP practices to have a call and recall system in place. Child health systems run by public health create a call and recall system that GPs are not responsible for.

Note: Practices were advised as part of the new contract deal for 2020/21 that the current target based payment system will be replaced from April 2021. Instead of only being paid once 70% coverage is reached, practices will be paid an Item of Service (IoS) fee for each of the individual vaccines administered – but some of that payment may be clawed back if they fail to reach 80% uptake.

However, for this year, the 70% and 90% targets remain in place, with the IoS fee applying only to MMR vaccinations.

Key points

• This is an important part of our national disease prevention programme
• Failing to present for routine vaccinations should raise alarm that a child may be at risk
• This is a complex service and clinics need to be run with care to avoid errors
• The premium for attaining the higher 90% payment is substantial, so the higher achievement is worth striving for.

How payment is calculated

All practices are expected to undertake childhood immunisations; these are now classed as essential services so practices can no longer opt out.

The arrangements for payment are set out in the GMS SFE Directions¹; payment is triggered at 70% and 90% of target cohort coverage. The average practice of 5,000 patients is assumed to have 63 two year olds and 58 five year olds and this is the denominator used to calculate the payment.

For two year olds, where A is the number of children immunised:

• 70% payment is A/63 x 722.61
• 90% payment is A/63 x 2,167.82

And for five year olds (defined as not yet reached their 6th birthday):

• 70% payment is A/58 x 223.82
• 90% payment is A/58 x 671.48

These apply to three vaccination schedules for infants: the multi-dose vaccine containing Diptheria, tetanus, pertussis, polio, Haemophilus influenza type b (Hib) and hepatitis B; the measles, mumps and rubella (MMR) vaccine; and the Meningococcal C vaccine².

This year practices will also receive the £10.06 IoS fee per MMR vaccine dose delivered.

The targets do not cover the Meningococcal B, pneumococcal or rotavirus vaccinations that also form part of the routine infant immunisation schedule, each of which comes under a separate payment mechanism.

Payments are made quarterly and are based on the number of children meeting the age criteria on the first day of the quarter, and the service achievement on the last day of the quarter.

How to claim and ensure payment

This is paid quarterly via the Open Exeter system, six months in arrears. It requires practice staff to carefully enter data in the clinic templates provided by IT systems to ensure the codes to trigger payments are entered.

Practice managers should be checking the statement to ensure the figures add up. The formula is difficult to understand and it is easy for mistakes to be made. Non-payment due to admin error should be reported to CCGs who can authorise retrospective payments.

How to maximise coverage

• These infants are possibly one of the easiest groups to find. We are notified of their births and we have health visitors with an interest in child protection and development who will help to target this group.
• Remind pregnant women of the vaccines their children will need. Lots of leaflets are available.
• Remind mothers when they attend for their own post-natal checks or appointments.
• Consider sending congratulations cards to new parents with information about your baby clinic and possibly with an appointment date and time to fit their age.
• Advertise the service on the web site and via waiting room noticeboards.

References

1. NHS General Medical Services Statement of Financial Entitlements Directions 2013. Section 11 Childhood Immunisations.
2. NHS General Medical Services Statement of Financial Entitlements (Amendment) Directions 2018. Amendment of Annex I.

Dr John Allingham is medical secretary for Kent LMC