GP Contract: Vaccination payments set for major overhaul

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 The payment mechanism was also found to be outdated in terms of incentives to meet desired coverage.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 to become part of core contract

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).

Introduction of standard Item of Service fee

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).

New ‘repayment’ scheme to address low childhood immunisation uptake

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.

Introduction of monthly aspiration payments

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.

New incentive payments through QOF

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.

Network level incentives for flu vaccinations

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’.

New contractual core standards – to be brought in from April 2020

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:

1. All practices will be required to have a named lead for vaccination services, who will ensure core standards and contractual requirements are met, and coverage maximised. The vaccination lead will liaise with other staff and bodies including the PHE screening and immunisation leads and Child Health Information Systems (CHIS)
2. Practices are expected to ensure they have sufficient trained staff and appointments to cover 100% of eligible patients. Appointments should be available at a range of times, including during extended hours in the evenings and weekends; they should also be bookable online and over time integrated with other digital developments such as the eRed Book and the NHS App.
3. Practices should ensure their call/recall and opportunistic offers are made in line with national standards.
4. Call/recall and opportunistic offers will have to be made in line with national standards for each vaccination programme and available technology. For example, all practices will be expected to adopt text-based reminders once infrastructure is in place.
5. Practices should participate in national catch-up campaigns. In 2020/21 this will be a continuation of the MMR catch-up in 10- and 11-year-olds introduced last year, but without the payment for call/recall activity – instead practices will be eligible only for an Item of Service (IoS) fee for each vaccine delivered.
6. Practices will be expected to follow standard methods for record-keeping and reporting of coverage data, for contract monitoring and payments, and for population coverage monitoring.

Other changes

• There is also a pledge to update the list of pre/post-exposure vaccines that come under the contract – to provide greater clarity of what is expected of practices and so remove the administrative burden involved in deciding who is responsible for providing these vaccines, and delays in patient care.
• Similarly, further guidance is promised on the division of responsibilities for delivering pre/post-exposure prophylaxis (separate from outbreak management).