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Payments for Vaccines
Note: Important change of GPC legal opinion - re Hepatitis B immunisation fees for
occupational health purposes.
The GPC issued revised guidance in November 2005.
Please note that the previous LMC advice was that a practice was not able to charge an employer for giving Hepatitis B vaccination unless the
practice provided this to all in the organisation. This advice has now been changed and a practice can charge the employer for vaccination of an individual employee.
We are grateful to Kent LMC for allowing us to adapt their guidance.
Wessex LMCS wall chart based upon Kent LMC guidance
Index: 
Introduction
Childhood Vaccinations and Immunisations
Index of Vaccinations
Further Information
Introduction
The vaccinations and immunisations listed in this Guide are divided into 3 sections with respect to payments:
1. Global sum - vaccinations and immunisations that are now part of the Global sum and where NO
charges may be made to patients. The vaccine can be obtained either in bulk by the practice and charged to to the PPA on FP10 or FP34D(appendix) for Flu, typhoid, Hep A, Hep B,
Pneumococcal, Meningococcal or combination of these vaccines eg Twinrix. Some vaccines are free from Farillon mainly for children.
2. Enhanced service – vaccinations and immunisations where the item of
service has been transferred to the NES or where a LES is in place and has been agreed between the Kent PCTs and the LMC.
3. Private service – where the practice may charge the patient directly for the service. But Please Note:
- You CANNOT charge for advice
- You CANNOT charge if the service is available on the NHS
- You CANNOT mix NHS and non NHS
- The level of charges is for the practice to determine. It is advisable to develop a practice protocol available to patients in the form of a
leaflet or section of the practice leaflet
- You cannot provide occupational health services to your own patients and charge either the patient or the employer. You must
refer patients to another practice. This is particularly relevant to Hep B.
- Kent LMC last year decided to withdraw previous advice that medical, dental and other health care students should be provided
with Hep B and other vaccinations required by Universities and Colleges as a condition of entry to courses as part of GMS. The LMC were concerned that the number of students requiring vaccination
had outgrown the resources of practices and that in order not to discriminate practices should be advised not to provide vaccinations to any students. Students should be advised to attend the University
or College occupational health department or to another practice for a private service.
Practitioners should also refer to the Green Book and Yellow Book for advice on appropriate immunisation and the BNF for detailed advice for each preparation. Details of the “at risk groups” have been mainly taken from the headings in the Green Book and are not a full
explanation. If in doubt please consult the Green Book for full details.
Childhood Vaccinations and Immunisations
Vaccinations and Immunisations that are part of full childhood schedule are all part of the Global Sum and are not covered in detail in this Guide. The
outline of the schedule is as follows:
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Disease (vaccine)
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Age
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Comment
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diphtheria/tetanus/acellular pertussis/ inactivated polio vaccine/haemophilus influenzae type b (DTaP/IPV/Hib)
meningococcal type C (men C)
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2, 3 and 4 months
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primary course
(3 doses, a month between each dose)
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measles/mumps/rubella (MMR)
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12 to 15 months
(can be given at any age over 12 months)
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first dose
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diphtheria/tetanus/acellular pertussis/ inactivated polio vaccine (dTaP/IPV))
polio
measles/mumps/rubella (MMR)
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3 to 5 years (three years after completion of primary course)
3 to 5 years
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booster dose
second dose
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tuberculosis (BCG)
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10 to 14 years and neonates at high risk
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|
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diphtheria/tetanus/inactivated polio vaccine (Td/IPV)
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13 to 18 years
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booster dose
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Index of Vaccinations:
1) BCG vaccine
2) Cholera Vaccine
3) Diphtheria/Tetanus/Polio – IPV
4) Haemophilus Influenza type b (Hib) vaccine
5) Hepatitis A vaccination **
6) Hepatitis B Vaccination **
7) Hepatitis A and B combined vaccine **
8) Hepatitis A & Typhoid Combined Vaccine **
9) Influenza Vaccine
10) Japanese B encephalitis vaccine
11) Measles, Mumps & Rubella (MMR) Combined vaccine
12) Meningococcal A,C, W135 & Y vaccine
13) Pneumococcal vaccine
14) Polio Vaccine IPV
15) Rabies vaccine
16) Tetanus vaccine ( as part of D,T,P-IVP)
17) Tick-borne encephalitis vaccine
18) Typhoid polysaccharide vaccine
19) Varicella (Chickenpox)
20) Yellow fever vaccine
1) BCG vaccine
If the vaccination is requested in connection with travel abroad, and the patient has not been vaccinated as part of the childhood immunisation
schedule then refer the patient to your local Chest Physician.
2) Cholera Vaccine
Global Sum
a) Aid workers assisting in disaster relief or refugee camps
b) More adventurous backpackers travelling to remote regions with limited access to medical care
c) In addition the vaccine may be considered for at risk travellers with underlying gastrointestinal illness or immune suppression in whom cholera
would have serious adverse consequences
To cover the cost of the vaccine
FP10
Private Service
a) Travellers requesting vaccination as a personal preference
To cover the cost of the vaccine
Issue a private prescription or charge patients from stock and charge for the administration of vaccine
3) Diphtheria/Tetanus/Polio - IPV
Global sum
a) Children aged 10 and over who have not had the basic course of immunisation.
b) Staff in hospital considered being at risk of infection of Diphtheria.
c) Children aged 6 and over that have had the basic course of immunisation but not a reinforcing dose.
d) Unimmunised travellers requiring a full course of three doses at monthly intervals. **
e) Adults and children over 10 years requiring either a primary course or a booster should be given a low dose vaccine.
f) Previously immunised travellers requiring a booster dose if they are
to live or work with local residents and their primary immunisation was more then 10 years ago. **
To cover the cost of the vaccine
The vaccine is centrally purchased and distributed free by Farillon as part
of the childhood schedule; for others issue FP10.
** Polio vaccine for travellers is not now available from Farillon & patients should be issued with a prescription.
4) Haemophilus Influenza type b (Hib) vaccine
Global Sum
a) Asplenic children and adults, irrespective of age or the interval from splenectomy, should receive a single dose of Hib vaccine if not already
given.
To cover the cost of the vaccine
The vaccine is centrally purchased and distributed free by Farillon for
children or FP10.
5) Hepatitis A vaccination
Global Sum
a) Patients with chronic liver disease
b) Haemophiliacs
c) Homosexuals
d) Persons in institutions who are exposed to a high risk of infection and for whom vaccination is recommended by the Medical Officer of
Environmental Health.
e) persons (particularly those going to reside for 3 months or longer or who, if infected, might be less resistant because of pre-existing disease)
travelling outside northern Europe, Australia or New Zealand to areas e.g. of poor sanitation, where the degree of exposure to infections is likely to be high
To cover the cost of the vaccine
FP34D
Locally Enhanced Service
a) Vaccine administered as part of outbreak control on the advice of Consultant in Communicable Disease Control.
To cover the cost of the vaccine
FP34D
Private Service
a) Occupational Exposure (refer to employer to undertake or to another practice).
b) Travellers to areas that do not qualify for GMS
To cover the cost of the vaccine
Issue a private prescription or charge patients from your stock and charge
for the administration of vaccine.
6) Hepatitis B Vaccination
Global Sum
a) Babies born to mothers who are chronic carriers of hepatitis B virus or to mothers who have had acute hepatitis B during pregnancy.
b) Parenteral drug misusers
c) Individuals who change sexual partners frequently
d) Close family contacts of a case or carrier
e) Families adopting children from countries with a high prevalence of hepatitis B
f) Haemophiliacs
g) Patients with chronic renal failure.
h) Those travelling to areas of high prevalence who intend to seek employment as health care workers or those who plan to remain there for
lengthy periods and who may therefore be at increased risk of acquiring infection as the result of medical and dental procedures carried out in those countries
i) Children born outside the UK and who have received a primary dose in their country of origin and who are now domiciled in the UK should have
their course of the vaccine completed under GMS.
To cover the cost of the vaccine
FP34D
Local Enhanced Service
a) Post-exposure prophylaxis with hepatitis B immunoglobulin (HBIG)
To cover the cost of the vaccine
FP34D
Private Service
a) Occupational Health. Patient sent by employer to request Hepatitis B immunisation for occupational health where: -
a. Healthcare workers involved in invasive procedures or caring
for drug misusers or patients with severe learning difficulties;
b. The risk is no greater than the population as a whole and for
whose welfare they are responsible e.g. health care workers not involved in invasive procedures; prison, police, ambulance officers; morticians and embalmers.
Advise the employer to
carry out a COSSH assessment. If Hepatitis B is still required inform the employer that this service is not covered by GMS and the employer will have to make private arrangements with another
practice, or occupational health provider to administer the vaccine.
If requested by the employer to carry out this Private Service for a patient not on your NHS List, bill employer
for payment for administration and cost of drug (+ VAT) + on cost and dispensing and administration fee.
As part of the service blood tests for Hepatitis B antibodies are indicated. Bill
the employer for the cost of phlebotomy and the test.
Practices should determine an appropriate fee taking into account the cost of the drugs, blood tests and the work involved.
b) Travel. If the vaccination is requested in connection with travel abroad, and the patient does not fall into a risk group for a GMS service
then a private service is appropriate
To cover the cost of the vaccine
Issue a private prescription or charge patients from your stockand charge for the administration of vaccine.
MAKE THE PATIENT AWARE OF THE NEED FOR 3 INJECTIONS OF HEPATITIS B VACCINE, AND THE BLOOD TEST TO CONFIRM IMMUNITY.
7) Hepatitis A and B combined vaccine
Global Sum
a) There are few circumstances where the combined A & B will be required. Hepatitis A combined with Typhoid is a more useful combination
where the patient is travelling to a risk area. If Hepatitis B is also indicated it is preferable to administer this separately.
Private Service
a) Twinrix should only be used for the small group of travellers who are at risk of Hepatitis A and B, and who present for immunisation at least six
months before they travel. The potential benefit to these travellers is the reduction in the total number of injections from five to three. Those at
risk of both diseases who present with less time should be immunised with the separate vaccines using the accelerated Hepatitis B schedule.
The cost of the Twinrix primary course is the same as a primary course using the separate vaccines in pre-filled syringes. The primary course of
Twinrix should give protection against Hepatitis A for ten years and Hepatitis B for five years, the same as for the vaccines given separately.
This may lead to confusion, because after five years people at continuing
risk will need a Hepatitis B booster only and not a Twinrix booster. The cost of using Twinrix as a Hepatitis B booster is more than double the cost of Hepatitis B vaccine.
To cover the cost of the vaccine
FP34D or Issue a private prescription or charge patients from your stock and charge for the administration of vaccine.
Notes
Persons requiring only Hepatitis A in connection with travel abroad (see 5) Hepatitis A above for entitlement to NHS service)
should receive Hepatitis A vaccine (Havrix®, Avaxim®). No item of service fee is payable.
Persons requesting only Hepatitis B vaccination in connection with travel abroad should receive Hepatitis B vaccine. A charge may be made to the patient for administering the vaccine unless the patient falls into the risk group as set out under global sum - see 6) Hepatitis B above.
8) Hepatitis A & Typhoid Combined Vaccine
Global Sum
a) persons (particularly those going to reside for 3 months or longer or who, if infected, might be less resistant because of pre-existing disease)
travelling outside northern Europe, Australia or New Zealand to areas e.g. of poor sanitation, where the degree of exposure to infections is likely to be high.
The above requirement is the same for both Hepatitis A and Typhoid.
Hepatyrix is presented as a convenience to travellers, in that Hepatitis A and Typhoid vaccinations can be administered with one injection.
Primary course of Hepatyrix should give protection again Hepatitis A for up to 1 year, and Typhoid for 3 years. This is the same as for the vaccines
given separately.
This may lead to confusion because at 6 months to 1 year patients will need a booster dose of Hepatitis A.
Note re Hepatyrix booster. After boosting, patient’s protection for Hepatitis A is extended to 10 years, but the Typhoid component only gives
protection for 3 years.
To cover the cost of the vaccine
FP34D
Private Service
a) Where the patient requests vaccination but does not qualify for a GMS service.
To cover the cost of the vaccine
Issue a private prescription or charge patients from stock
9) Influenza Vaccine
Global Sum
a) Where the doctor considers the vaccine is indicated but the patient does not qualify for the enhanced service, no fee can be charged from the
patient
To cover the cost of the vaccine
FP34D
Enhanced Service
a) Where the patient qualifies under the terms of the DES
To cover the cost of the vaccine
FP34D
Private Service
a) Where the doctor does not consider the vaccine is clinically indicated it should not be given.
b) Where the doctor considers the vaccine is indicated but the patient does not qualify for the enhanced service the patient should be referred
to another practice for a private service
c) Patients who are not registered with the practice
To cover the cost of the vaccine
Issue a private prescription or charge patients from stock and charge for the administration of vaccine
10) Japanese B encephalitis vaccine
Private Service
a) In connection with travel abroad
To cover the cost of the vaccine
Issue a private prescription or charge patients from stock and charge for the administration of vaccine.
Notes
Vaccine not licensed in UK - available only on named patient basis.
11) Measles, Mumps & Rubella (MMR) Combined vaccine
Enhanced Service
a) Children over the age of 15 years if not previously been immunised with an MMR combined vaccine.
b) Opportunistically young adults who have not been vaccinated
To cover the cost of the vaccine
The vaccine is centrally purchased and distributed free by Farillon
12) Meningococcal A,C, W135 & Y vaccine
Global Sum
a) Asplenic children and adults irrespective of age or the interval from splenectomy should receive a single dose of vaccine before travelling to
areas where there is increased risk of Group A infection under GMS.
To cover the cost of the vaccine
The vaccine is centrally purchased and distributed free by Farillon for children or FP34D
Enhanced Service
a) Adults entering full-time education at university or college of higher education.(C only).
b) Meningococcal vaccination of contacts of cases
Where a case is confirmed as infected with a Group A or C strain, the Communicable Disease Control Team of the Health Authority will advise
the doctor to offer vaccination as additional protection to those who have already received prophylaxis with rifampicin/ciprofloxacin.
To cover the cost of the vaccine
FP34D
Private Service
a) If the vaccination is requested in connection with travel abroad, there is no item of service fee payable under the SFA.
To cover the cost of the vaccine
Issue a private prescription or charge patients from stock and charge for the administration of vaccine.
13) Pneumococcal vaccine
Global Sum
a) Pneumococcal vaccine is recommended for all those aged 2 years or older in whom pneumococcal infection is likely to be more common
and/or dangerous i.e. those with:
a. asplenia or severe dysfunction of the spleen including homogenous sickle cell disease and coeliac syndrome
b. chronic renal disease or nephritic syndrome
c. immunodeficiency or immunosuppression due to disease or treatment, including HIV at all stages
d. chronic heart disease
e. chronic lung disease
f. chronic liver disease including cirrhosis
g. Diabetes mellitus
To cover the cost of the vaccine
FP34D
Enhanced Service
a) Where the patient qualifies under the terms of the DES
To cover the cost of the vaccine
FP34D
14) Polio Vaccine IPV
Global Sum
a) persons aged 6 years and under 40 and parents/guardians of children may be given oral polio.
b) previously immunised but without receiving a reinforcing dose, persons aged 6 years and over, on leaving school, entering higher education or
starting work.
c) single dose vaccine is available where clinically appropriate.
To cover the cost of the vaccine
FP10
15) Rabies vaccine
Global Sum
These occupational groups are in the global sum because an item of service fee was payable under the SFA
a) Vaccination of “at risk” groups e.g.
a. at kennels and catteries approved by the Ministry of Agriculture, Fisheries and Food for the quarantine of imported dogs, cats, etc
b. at quarantine premises in zoological establishments
c. by carrying agents authorised to carry imported dogs, cats, etc.
d. at approved research and acclimatisation centres where primates and other imported mammals are housed
e. in laboratories handling rabies virus
f. at seaports and airports where they are likely to come into contact with imported animals or animals on ships or aircraft, e.g.
Customs and Excise and police officers
g. as veterinary and technical staff of MAFF
h. as inspectors appointed by local authorities under the Diseases of Animal Act or employed otherwise who, by reason of their
employment, encounter enhanced risk
i. licensed bat handlers
j. health care workers who are likely to come into close contact with rabies
b) persons directly involved in control measures carried out under the direction of the Medical Officer for Environmental Health, together with
veterinary surgeons engaged in private practice within the infected area and their ancillary staff.
To cover the cost of the vaccine
FP10
Enhanced Service
a) Post exposure treatment including travellers
To cover the cost of the vaccine
For post-exposure use, vaccine is supplied by centres listed in the PHLS Directory. See BNF for details.
Private Service
a) Travellers seeking vaccination
To cover the cost of the vaccine
Issue a private prescription or charge patients from stock and charge for the administration of vaccine.
16) Tetanus vaccine ( as part of D,T,P-IVP)
Global Sum
a) not previously immunised children at 15-19 years of age or on leaving school or persons after leaving school.
b) previously immunised persons on leaving school entering higher education or starting work or persons who have not had a reinforcing dose
in the previous 5 years and then afterwards the previous 5-15 years.
c) Travellers requiring vaccination or booster
To cover the cost of the vaccine
FP10
17) Tick-borne encephalitis vaccine
Private Service
a) Travellers requiring vaccination
To cover the cost of the vaccine
Issue a private prescription or charge patients from stock and charge for the administration of vaccine.
Note
Vaccine not licensed in UK - available only on named patient basis, see BNF for details
18) Typhoid polysaccharide vaccine
Global Sum
a) travel outside the UK except to Canada, USA, Australia, New Zealand and northern Europe (Belgium, Denmark, Iceland, the Netherlands,
Norway, Sweden)
b) travel to an infected area
c) travel to countries where it is a condition of entry that visitors should have been immunised.
To cover the cost of the vaccine
FP34D
Private Service
a) If the patient is travelling to an area that does not qualify for an item of service
To cover the cost of the vaccine
Issue a private prescription or charge patients from your stock and charge for the administration of vaccine.
19) Varicella (Chickenpox)
Global Sum
a) Front line Health Care Workers. No patients should be treated under the global sum as front line Health Care Workers should all be covered by
an appropriate Occupational Health Service. Refer staff to Occupational Health Service (in Kent Heales Medical Ltd)
Private Service
a) All front line Health Care Workers in the private sector
To cover the cost of the vaccine
For patients on your list, refer to another practice.
For patients not on your list, issue a private prescription or charge patients from your stock and charge for the administration of vaccine.
20) Yellow fever vaccine
Private Service
a) Persons aged nine months and over travelling through or living in infected areas and those travelling outside urban areas of countries in the
yellow fever endemic zone (see maps in ‘Health Information for Overseas Travel’), even if these countries have not officially reported the disease
and do not require evidence of immunisation on entry. Immunisation under nine months is not recommended but may be performed if exposure to the risk of infection cannot be avoided.
b) Travellers requiring an International Certificate of Vaccination for entry into a country
Yellow fever vaccine is only supplied to and administered by designated centres.
To cover the cost of the vaccine
Issue a private prescription or charge patients from your stock and charge for the administration of vaccine.
THOSE PRACTICES WISHING TO APPLY FOR DESIGNATION SHOULD WRITE TO HEF 2, DEPARTMENT OF HEALTH, SKIPTON HOUSE, 80 LONDON ROAD,
LONDONSE1 6LW. YELLOW FEVER VACCINE AND INTERNATIONAL CERTIFICATES ARE SUPPLIED ONLY TO SUCH CENTRES.
Further Information
NHS Immunisation Information (Mainly designed for patient information)
The National Travel Health Network and Centre (NaTHNaC) is funded by the Department of Health to promote clinical standards in travel medicine.
The
Green Book “Immunisation against Infectious Disease” on line
or alternatively, On line version with all current updates
Health Advice for travellers
Health Information for Overseas Travel (Yellow Book)
http://www.prodigy.nhs.uk/
Prescription Pricing Agency
For a copy of
FP34PD and FP34D Appendix
NB High volume drugs are: Influenza, Typhoid, Hepatitis A, Hepatitis B, Pneumococcal, Meningococcal or combinations of the vaccines listed e.g.
Twinrix and Hepatyrix
** Clarification of the position relating to Hepatitis
Q&A Hepatitis A
Q&A Hepatitis B
Important change of GPC legal opinion - re Hepatitis B immunisation fees for occupational health purposes.
The GPC issued revised guidance in November 2005.
Please note that the previous LMC advice was that a practice was not able to charge an employer for giving Hepatitis B vaccination unless the
practice provided this to all in the organisation. This advice has now been changed and a practice can charge the employer for vaccination of an individual employee.
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