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.
Under the agreement between the BMA and NHS England, 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.
New item of service fee
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.
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.'
Incentives to boost vaccination coverage
From April 2021, a new vaccinations domain will be added to the QOF. It will 'reward incremental improvements in performance' and be worth at least £40m in total.
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 (IIF), which is introduced from April 2020 and will work in a similar way to the QOF and reward networks for performance.
Some £6.5m will be included in the IIF from April 2020 aimed at helping networks to improve coverage of the seasonal flu vaccination in over 65s in collaboration with community pharmacies.
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. For 2020/21 there will be a continuation of the MMR catch-up in 10-11 year olds.
New core standards
The contract also sets out a range of core standards relating to vaccinations that practices will be required to meet. There are five core components, which are:
- All practices should have a neamed lead for vacciantion services, who is responsible for ensuring the core standards and contractual requirements are met and is responsible for liaising with others, including the PCN, public health teams, child health information systems and other public health colleagues.
- Practices must ensure the availability of properly-trained staff and convenient appointment times to cover 100% of their eligible population. Appointments should be available at a range of times, including using PCN extended hours services on evenings and weekends. Appointments should also be bookable online.
- Practices should ensure their call/recall systems and opportunistic offers and in line with national standards – these will be defined in supporting guidane for each vaccination programme. All practices must move to text-based reminders as soon as the infrasructure is available.
- Practices should participate in agreed national catch-up campaigns (see above).
- Practices should follow defined standards for record keeping and reporting of coverage data.