A radical overhaul of the way practices in England are paid for vaccinations – the most significant change to the system in 30 years – is to begin from this April under the GP contract.
The changes are a result of a major review of immunisations, which took place last year. Under the plans, vaccinations and immunisations will become an essential service rather than additional service.
All practices will now be expected to offer all routine vaccinations and NHS travel vaccinations to their patients and each practice will be required to have a named vaccination lead.
Practices will be paid a standardised item of service fee of £10.06 for each dose of the routine vaccinations that they administer. For 2020/21 this payment will apply to all MMR vaccines and will be rolled out to other childhood immunisations in 2021/22. The fee will will be fixed until 2023/24.
From April 2021 there will also be incentive payments for achieving specified levels of vaccination coverage that will be paid via the QOF. A new vaccination domain will be added to the framework to ‘reward incremental improvements in performance’.
QOF vaccination domain
To enable this, indicators relating to the seasonal flu vaccinations will be removed from the QOF and incentive payments will instead be covered at primary care network level. They will be paid from the new Investment and Impact Fund, which will work in a similar way to the QOF and rewards networks for performance.
Until now practices have only received payment for childhood immunisations if they reach 70% coverage and earn an extra payment if they reach 90% coverage.
Under the new system, practices that fail to reach 80% coverage will have to pay back a proportion of the item of service fees that they have received on an annual basis. This will apply from April 2021 – NHS England and the BMA intend to publish details of exactly how repayments will be calculated later this year.
The contract documentation says: ‘We have balanced the payment reforms such that all practices, apart from a very small number of the lowest performers, will gain from the new arrangements.’
It adds that it would be a ‘huge success’ if no practice was required to repay money in 2021/22 because they had all hit at least 80% coverage.
Practices will also be expected to participate in catch-up campaigns. However, when these happen an item of service fee will be paid per vaccine delivered and payment will no longer be linked to call and re-call activity.
The contract also sets out a range of core standards relating to vaccinations that practices should meet, covering availability of appointments, call and recall procedures and record keeping.