This is an enhanced service described in the additional services section of the Statement of Financial Entitlements (SFE). It does not require a call and recall system.
The potential target cohort for this is quite large and could represent as much as 20% of some practice lists. Securing vaccine supply would be a challenge but if a 5,000-patient practice were able to track down such a cohort, it would be worth at least £10,000.
The MMR (Measles, Mumps and Rubella) vaccination was introduced in 1988. Before this there were separate vaccines for measles and rubella available via the national programme.
There was a drop in vaccination rates during the early 2000s, following unfounded claims of a link with autism. Cases of measles are currently increasing across Europe, with rising numbers in the UK, especially in London.
The catch-up service is outlined in the 2014 GMS SFE (Amendment) Directions.1 This states that practices can be paid for administering up to two doses of the MMR to ‘a registered patient aged 16 or over who has not previously received a completed course of MMR vaccination’. Two doses may be administered if the GP considers that this is clinically necessary, or the patient’s vaccination status is unknown, provided that there is an interval of at least four weeks between the administration of each dose.
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. The link to the Department of Health portal for this only works in Chrome and Internet Explorer browsers.
This service is covered under the additional services section of the GMS contract. To deliver this, 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.
Payment requires the correct clinical code; relevant SNOMED codes are:
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 CQRS and GPES errors can be pursued by NHS Digital.
This service allows for the vaccination of any previously unvaccinated patient over the age of 16. This can include teenagers, travellers (Eastern Europeans are particularly vulnerable), women planning pregnancy or those who may be at risk of exposure.
Healthcare workers are required to have evidence of vaccination. While GPs cannot be paid for providing Occupational Health services this group can be treated as any other unvaccinated adult would.
The green book suggests those born before 1970 were probably exposed to the three viruses in the MMR and can be considered immune. However, the contract allows practices to give the vaccination to patients in this age group who request vaccination, if they consider it clinically necessary. This means that the target cohort could potentially be the entire practice list of over 16s or, at the very least, those born after 1970 and over 16. Any catch-up doses for under-16s are covered by the normal childhood immunisations scheme.
There are plenty of ways to maximise coverage:
Dr John Allingham is Medical Secretary of Kent LMC
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