QOF expert Dr Gavin Jamie explains how the new vaccination and immunisation indicators work and offers tips on how to ensure maximum coverage and points
The new vaccination and immunisation domain contains four indicators.
Three are for childhood vaccinations and worth a total of 54 points. This is potentially a lot of points for a relatively small population and, as we will see, they are concentrated on quite a small number of children.
The other indicator rewards uptake of the shingles vaccination in the elderly, worth a total of 10 points.
The QOF payments related to target coverage are in addition to the item of service (IoS) payments which now apply to all vaccinations (except Covid) of £10.06.
The full UK routine immunisations schedule is available here. You can also read our analysis of the new childhood immunisations payment system and how this may impact practice finances here.
Practices will receive £10.06 for each dose administered. If fewer than 80% of children have the jab then they may face a clawback equivalent to half of the cohort, although this is at the discretion of the CCG. As a result, there is a potential big jump in payments when you get to that 80% threshold.
Importantly, the thresholds will now be measured at the end of the year, rather than quarterly as they were previously.
Each of the three QOF indicator payments will work as follows.
1. Completion of DTP vaccination at eight months (18 points)
This is a large number of points, but given over a very small range of uptake, from 90% to 95%. That could be only a handful of patients in a typical practice.
Three points are awarded at 90% achievement, with the remaining 15 points going up gradually until 95%. That is three QOF points for each 1% added, and a typical practice will have around 90 births a year. This will make immunisations for each additional patient in this small range very well paid – around £600 per course.
The timescales are tighter than in previous vaccination incentives, however – this indicator measures uptake in infants at eight months. Although the schedule for DTP should be completed at 16 weeks, there is a small allowance for delay due to febrile illness or other problems. Where the vaccine has to be delayed, it could be worth making an alternative future appointment in the same phone call. Confirmation with a SMS, or other written message, could also increase the chance of attendance.
After eight months, infants will no longer be eligible for the QOF indicator, but will still attract the IoS payments.
There is no exception reporting available for parental choice in the childhood vaccination indicators. Exception reporting is available where there are contraindications to the vaccine – but these will be rare and are likely to be mostly allergies.
Full indicator
VI001: The percentage of babies who reached 8 months old in the preceding 12 months, who have received at least 3 doses of a diphtheria, tetanus and pertussis containing vaccine before the age of 8 months. (18 points)
2. Receipt of at least one MMR vaccination at 18 months
This is a similar indicator, but for the single MMR vaccination. Again, there is little allowance for delay to the vaccination.
Seven points are awarded at 90% with the remaining 11 points gradually awarded as you get to 95%. That is quite an income jump at 90% and well worth aiming for.
Exception reporting for parental preference is not permitted, but contraindications may be a little more frequent as this is a live vaccination.
An appointment should be scheduled as soon as possible after the child’s first birthday. If it needs to be postponed due to a febrile illness then it there is still time to do so but it is important that happens promptly.
If patients have travelled away for more than three months, it would be sensible to make sure that they are removed from the practice list but can be re-registered on their return. So – be mindful to take note when parents inform you that they are travelling.
When patients do register it is essential that their previous vaccination details are recorded. This should be done as soon as possible and definitely before the end of the QOF year.
Because of the way that the timescales work a patient will be counted if they turn 18 months old at the start of the QOF year – meaning that they could be nearly two and a half years old when QOF data is collected. All of these patients will need accurate and up to date information.
Full indicator
VI002: The percentage of children who reached 18 months old in the preceding 12 months, who have received at least 1 dose of MMR between the ages of 12 and 18 months. (18 points)
3. Completion of both MMR doses and DTP booster at five years (18 points)
There are three vaccinations required for this indicator – both doses of MMR and the booster DTP. This is in addition to MMR in the previous indicator. The threshold is slightly more forgiving, with seven points at 87% increasing to the full 18 at 95%.
The timescale is more generous as well. The schedule suggests that these should be done at three years and four months – a full 20 months before the QOF measurement is taken. A child turning five years old in April of 2021 may have had the vaccinations in September 2019 with the payment not due until April 2022.
These long time periods make record keeping and transfer even more important. Where patients are coming from outside England the vaccination history will be on paper and often in patient held record. This should be obtained at the time of registration – a photograph from a phone is often sufficient and can be sent in using services such as MJOG or AccuRx. These details can then be coded in the practice.
Full indicator
VI003: The percentage of children who reached 5 years old in the preceding 12 months, who have received a reinforcing dose of DTaP/IPV and at least 2 doses of MMR between the ages of 1 and 5 years (18 points)
1. Uptake of shingles vaccination between 70 and 79 years in 80 year olds (10 points)
The indicator for shingles vaccination is a little different. Much of the work for this indicator is likely to have happened already. Currently it will be looking at patients who have been part of the catch-up vaccination programme for shingles. These patients may have had the vaccination up to seven years ago and, in future years, there could be up to 11 years between vaccination and payment.
The vaccinations themselves will continue to be paid at £10.06 by the IoS payment. QOF points will be in addition to this.
All of the QOF points are available where 60% of 80-year-old patients have had the vaccination at the end of the year, although any doses received after their 80th birthday will not count. National figures suggest that most practices are well on the way to achieving this already, but it would be worth looking at your 79 year olds and inviting them as soon as possible. If vaccine supply is limited then concentrate on those closest to their 80th birthday as after that day there will be no way to make them achieve this indicator.
Unlike the childhood vaccinations, exception reporting if patients do not want the vaccination will apply – although the timescale for this to be entered is still uncertain. As this is a live vaccination there are also a number of medical contraindications.
Full indicator
VI004:The percentage of patients who reached 80 years old in the preceding 12 months, who have received a shingles vaccine between the ages of 70 and 79 years. (10 points)
Dr Gavin Jamie is a GP partner in Swindon and runs the QOF Database website
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