How to run the new MMR catch-up service for 2019/20

This is a new service in the 2019/20 contract which pays practices to vaccinate 10- and 11-year-olds who have missed MMR jabs. It is described in the additional services section of the Statement of Financial Entitlements (SFE) and requires proactive call and recall.

The potential target cohort will depend on age and demographics for your practice and uptake of infant MMR vaccinations in your area. At our 5,000-patient practice, with around 140 children aged 10 and 11, in a local authority with 70% uptake of both MMR doses at the fifth birthday, complete coverage of those missing doses could potentially be worth about £200.

Key points

• Practices must be signed up as delivering or ‘accepting a quality service’ on CQRS (Calculating Quality Reporting System).
• The potential cohort are those children that are aged 10 or 11 after 1 September 2018 but are not aged 12 yet
• Payment can be claimed for sending out invites, if patients fail to attend or decline the offer of vaccine

This new service pays £5 per patient for carrying out a catch-up campaign in patients aged 10 and 11 who have not completed the MMR vaccination schedule. Practices can claim the fee on vaccination, and also where they have met criteria for having tried but been unable to vaccinate a child. 

Practices should continue to support the opportunistic vaccination of 5-24 year olds whose records show no, or an incomplete course of MMR vaccination. For patients aged 16 and over this continues to attract an Item of Service fee of £10.06 (see separate guide on this catch-up service here).

Specification

The service is detailed in point 14 of the 2019 GMS SFE (Amendment) Directions.¹

This states that practices can be paid for delivering the MMR catch-up campaign to patients aged 10 or 11 on or after 1 September 2018 who have not completed the course of MMR vaccination.  

To be eligible for payment, practices need to check patients’ health records to identify those who have missed one or both doses, and invite them by letter, email, phone call, text or digital ‘red book’, where available, to receive the appropriate dosage. They should prioritise those children who have missed both doses.

Practices will need to send out three invites – unless an earlier invite results in vaccination, or the patient’s carer or parent declines the offer.

If a third invitation fails to result in vaccination or a decline of offer, the practice must also notify school nursing services as a condition of payment.

How much practices are paid

For this catch-up campaign the item of service fee will be £5 per patient, where the complete number of doses have been administered, or where three invitations have been sent, or the offer declined. The vaccine can be ordered through the ImmForm system for free. Note the link to the Department of Health portal for this only works in Chrome and Internet Explorer browsers.   

How to claim and ensure payment

Practices must be signed up as delivering or ‘accepting a quality service’ on CQRS (Calculating Quality Reporting System) and the data are entered manually each month.

Payment count codes are included in the full technical requirements on the NHS England website here.

Key clinical codes include:

• SNOMED Concept ID: 927211000000105
  • Code description: Measles mumps and rubella booster vaccination invitation third letter (procedure)
• SNOMED Concept ID: 505031000000103
  • Code description: Measles mumps rubella catch-up vaccination declined (situation)
• SNOMED Concept ID: 505001000000109
  • Code description: Measles mumps rubella catch-up vaccination

Some important points on payment:

• Payment can be claimed within six months of the second dose of MMR vaccine
• If three invitations have been sent without resulting in vaccination, the date of the third invitation must be recorded
• You must record the date when a parent or carer declines the vaccination
• Make sure you record where the school nurse has been notified and inform the commissioner, to assure payment

Check the Open Exeter statements monthly to ensure claims made correspond with monies received and errors are chased up swiftly. Check with the commissioner initially, which is the CCG if it is operating delegated co-commissioning or NHS England otherwise. Any errors can be pursued by NHS Digital.

How to maximise coverage

Some tips to help boost uptake:

• Ensure a pop-up appears for every 10- and 11-year-old (on 1.09.18) who does not have a vaccine status recorded, or has only had one dose of MMR, to remind clinicians
• Look opportunistically through medical records of 10- and 11-year-olds attending for minor illnesses and vaccinate them in the consultation if no fever
• Run a search on the 10- and 11-year-olds to see how many are eligible and invite them for MMR vaccine
• Remember that any patient whose records show they are have not had two doses of MMR needs two doses, at least a month apart
• Advertise the service on the website and in the waiting room.
• Remember you get paid even without administering the jab, provided three invitations have been sent out or the offer is declined, so ensure the practice has a robust call and recall service
• Appoint an administrator to take charge of sending the invitations, monitoring and recording outcomes of each invite, ensuring the correct codes and data are entered onto CQRS

Reference

UK Government. NHS The General Medical Services Statement of Financial Entitlements (Amendment) Directions 2019. Section 14F: MMR Vaccine catch up programme for persons aged 10 and 11

Dr Farzana Hussain is a GP principal in East London