How to improve HPV booster uptake

This is a service that supports the school nursing service in completing immunisations. It is an additional service. It is impossible to estimate the income possible from this activity because it is dependent on patients who have missed another scheme and will vary widely from area to area.

The scheme will expand to include 12 and 13 year-old boys in the autumn of 2019 and it is expected that the specification will be amended to allow GPs to provide catch-up vaccinations to boys from April 2020.

Key points

• Practices must be signed up as delivering or accepting a quality service on CQRS (Calculating Quality Reporting System).
• Tag the notes of girls who are aged 14 to 16.  Note the service is delivered by the school nursing service to 12- and 13-year-olds, so the GP target cohort is those a little older who have missed it at school.
• Look out for girls who are outside the normal school system, who are often missed.

The national programme for HPV (human papilloma virus) vaccination was introduced in 2008. Currently it consists of two doses of vaccine offered at school in year eight and completed six months later in year nine. 

The vaccine protects against cervical cancer and also against other oral and anogenital cancers. Males are protected through the herd immunity effect of females being immunised (the vaccination will be extended to 12 and 13 year-old boys in autumn 2019*). However, there is evidence that men who have sex with men (MSM) do not receive the same protection.

There is a programme that offers immunisation against HPV for MSM but it is only available through genito-urinary medicine services and GPs cannot currently provide this service on the NHS.

GPs can provide services that are not available on the NHS and this could include HPV vaccination to the over-20s of both sexes. Care should be exercised if offering this service, to ensure NHS vaccine supplies are not used for non-NHS purposes.

* NHS England has stated that the HPV vaccination for boys programme will begin from September 2019 and that the catch-up element for boys will not need to be delivered through GP practices in 2019/20. Any boys who miss the initial doses from September 2019 to March 31, 2020 will be offered another appointment via the school based programme. It is anticipated that boys will be added to the HPV catch-up scheme in general practice from April 2020.

What it is worth to practices

From April 2018 the item of service fee has been £10.06 per dose administered. The vaccine can be ordered through the ImmForm system for free via the Department of Health portal. The portal link only works in Internet Explorer.  The brand supplied is Gardasil.

How to claim and ensure payment

This service is covered under the additional services section of the GMS contract. Practices must be signed up as delivering or accepting a quality service on CQRS (Calculating Quality Reporting System) and the data are extracted via GPES (the General Practice Extraction Service) run by NHS Digital.

Any girl who does not commence the course before her 15^th birthday (boys from autumn 2019) will need three, not two, doses of vaccine. The second is given one month after the first and the third at six months. Payment is per dose.

Payment requires the correct clinical code and the SNOMED codes are:

1st HPV dose 428741008

2nd HPV Dose 429396009

3rd HPV Dose 428931000

Check the Open Exeter statements monthly to ensure claims made correspond with monies received and errors are chased up swiftly. Initially, contact the commissioner: the CCG if delegated co-commissioning, or NHS England. CQRS and GPES errors can be pursued by NHS Digital.

Maximising coverage

• Ensure all notifications from the school nursing service are recorded and coded.
• Tag the notes of all girls in years nine, 10 and 11 (aged 14, 15 and 16) and ask them if they had their HPV vaccine and ensure it is coded. Check boys aged 12 and 13 from autumn 2019 to ensure they have not missed vaccination at school.
• Target girls (12 and 13 year-old boys from autumn 2019) who are known to be outside the normal school system, for example learning disabled or not in mainstream school.
• Girls and boys who are looked after by social services often slip through the net and are worth targeting.
• School refusers are often known to practices through contact with mental health services and are worth targeting.
• Advertise the service on the practice website and via waiting room notices.
• Include information in any contraception templates and conversations. The programme is aimed at reaching children before they become sexually active.