Maximising MMR catch-up uptake in the over-16s

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.

Key points

• Practices must be signed up as delivering or ‘accepting a quality service’ on CQRS (Calculating Quality Reporting System).
• The potential cohort could be the entire practice list of over-16 year olds.
• Make sure you order sufficient vaccine to avoid demand outstripping supply.

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.

The value 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. The link to the Department of Health portal for this only works in Chrome and Internet Explorer browsers.  

How to claim and ensure payment

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:

• MMR Vaccination 3859009
• MMR Catch up 505001000000109

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.

How to maximise coverage

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:

• Ensure a pop-up appears for every patient over 16 who does not have a vaccine status recorded, to remind clinicians.
• Opportunistically ask all recent school leavers if they had their ‘school leavers’ booster’ – the Tetanus/diptheria/polio combined jab – and MenACWY jab, at age 14, and ask about the MMR as well.
• Add the offer of an MMR to all travellers attending for advice or vaccination.
• Opportunistically offer the vaccination to anyone employed in health and social care on the practice list.
• Remember that any patient who has missed a dose or is uncertain needs two doses a month apart, both of which attract a fee.
• Make sure you order adequate quantities, as this is a vaccine that could be delivered in reasonably high volumes.
• Assume recent immigrants are not vaccinated and offer it automatically.
• Advertise the service on the website and in the waiting room.

Dr John Allingham is Medical Secretary of Kent LMC

Reference

1. UK Government. NHS The General Medical Services Statement of Financial Entitlements (Amendment) Directions 2014. Section 14A: MMR Vaccine for persons aged 16 and over