GP Contract Enhanced Services

Boost income from pneumococcal vaccinations in vulnerable children and adults

This enhanced service requires GPs to vaccinate vulnerable groups of patients and over-65s.

At our practice of 5,000 patients, with a relatively young population, achieving 100% coverage of all target patients would provide a total income of approximately £7,000. This is non-recurrent funding as most people only need a single vaccine.

Key points

  • Target groups overlap with the seasonal influenza vaccination programme
  • Give the pneumococcal vaccine at the same time as flu vaccine where possible, to save time on recalling the patients later and saving them a second trip
  • Order vaccines directly from the pharmaceutical company
  • People with no spleen or splenic dysfunction need a booster every 5 years; for all other cohorts it’s a single administration of vaccine
  • While the vaccination can be given at the same time as the influenza vaccination, it can also be given any other time in the year.

This programme aims to protect vulnerable groups against pneumococcal infection due to Streptococcus pneumoniae, a common cause of pneumonia that can also lead to meningitis and septicaemia.

It comes under a directed enhanced service (DES) – which also covers seasonal flu vaccinations – and requires GPs to vaccinate those aged 65 years and over, and patients aged 2 years up to 65 years who are considered ‘at risk’, with pneumococcal polysaccharide vaccine (PPV23).1

Patients with no spleen or splenic dysfunction need to be vaccinated every 5 years, while everyone else only needs the vaccine administered once.

Target groups for PPV23 are listed in full in Annex A of the DES1 and include:

  • Elderly patients aged 65 years or over
  • Patients aged 2 or over with chronic respiratory disease (COPD or asthma requiring inhaled or oral steroids), chronic heart disease, chronic liver disease, chronic neurological illness
  • Patients aged 2 or over with diabetes
  • Patients aged 2 or over with Sickle cell anaemia (who need vaccination every 5 years)
  • Patients aged 2 or over with no spleen or splenic dysfunction and chronic kidney disease (need vaccination every 5 years)

What is it worth to practices?

The fee for administering the pneumococcal vaccine is £10.06. It needs to be pre-ordered directly from the pharmaceutical company – this means practices can cut their costs if they negotiate decent discounts. Bulk buying can bring discounts, through buyer groups such as those run by LMCs. This should be done throughout the year, not just in flu season, due to ongoing vaccine shortages.

The vaccine reimbursement is claimed back from NHS prescription services (NHS Business Services Authority). With careful negotiation and swift claiming it is possible to get the reimbursement before paying the original invoice.

How to claim and ensure payment

Practices must be signed up as delivering the service or ‘accepting a quality service’ on CQRS (Calculating Quality Reporting System) in order for payments to be made. Data for first doses are extracted automatically via GPES (General Practice Extraction Service) run by NHS Digital.

Updated business rules for 2020/21 including SNOMED codes are published on the NHS Digital website.

Relevant codes include the following:

  • SNOMED ID: 310578008
    • Code description: Pneumococcal vaccination given
  • SNOMED ID: 571631000119106
    • Code description: Administration of pneumococcal polysaccharide 23 valent vaccine
  • SNOMED ID: 401086001
    • Code description: Pneumococcal vaccination declined

Payments are made monthly. Check the Open Exeter statement every month to ensure all the claims made correspond with monies received and make sure that any errors are chased up swiftly. Any problems should be addressed initially with the commissioner. CQRS and GPES errors can also be pursued via NHS Digital.

For patients requiring a PPV vaccination every five years, your practice should make arrangements for payment with the commissioner – payment is only automatic for the first dose. See ‘Claiming for a 5-yearly dose’ in NHS Digital’s guidance on this programme.

How to boost uptake

  • The vaccine can be given throughout the year as well as during flu season along with the influenza vaccine
  • Book patients directly to clinics by phoning the target groups
  • Leave messages on the right-hand side of prescriptions (many of these patients are on repeat prescriptions)
  • Take the vaccine on home visits to known target patients (phone ahead)
  • Don’t forget the less obvious groups such as Sickle cell sufferers. Remember you can give them a vaccine every 5 years
  • Give the vaccine when doing QOF reviews, such as a diabetes or COPD annual review
  • For the cohorts that are not routinely reviewed by the practice such as those with spleen dysfunction or sickle cell anaemia, ask your admin team to flag any letters from the hospital clinic and make an appointment for the patient to have the pneumococcal vaccine
  • Remember to code refusers to help with QOF targets, further boosting practice income.

Dr Farzana Hussain is a GP Principal in East London


1. NHS England. Directed Enhanced Service Specification Seasonal influenza and pneumococcal polysaccharide vaccination programme 2020/21

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