This isn’t a new problem, but I think it’s time we launched a challenge relating to Vaccination and Immunisation payments, CQRS and the ‘business rules’…
We recently had to update a CQRS submission as the data extraction had picked up one fewer vaccination than we had on our records. It turns out that the patient in question had had a vaccine administered in July, but was deducted from our list on 31st July.
According to the Vacc/Imms team, the business rules state that Item of Service payments will always follow a patient to the practice they’re registered with, at the time of the data extraction. The theory is ‘win some, lose some’. The person responding to my email query said that they know it’s “not ideal” but the national team, LMCs and GPC have discussed it in the past – and the status quo remains.
Now, I work in a very small practice with a very small number of children, so our vaccination numbers don’t generate much income – but surely that’s not the point, is it? There are plenty of surgeries out there with much larger cohorts of kids, where the income is going to make a difference.
My personal view is that if you did the administering, using your practice nurse, your treatment room, your heating and lighting, etc., then the payment (pittance that it is) should be given to you. I know that the Vacc/Imms team are saying, “Oh, but you’ll benefit when there’s positive movement in your list with new patients”, but wouldn’t it just be simpler if we got paid for this particular activity in the same way that we get paid for all the other activities we undertake?
I just don’t understand why these procedures are paid for in a different way – perhaps someone out there can enlighten me?
Locally, I’m raising this again with my LMC – they’ll decide if it’s worth a challenge higher up the food chain. We at the IGPM will discuss it further – it’s easy for us to add our weight to the cause. But what do you think? Are we on a hiding to nothing? Is it time for a battle, and do we have the energy?
I’m ready if you’re behind me!
Nicola Davies
August 25, 2023 at 7:34 am
I’m with you, Nicola. This is 2023, things should be better, no excuses!
August 25, 2023 at 8:08 am
Really? I had no idea that this was the way that payments are calculated. (After 10 years in general practice there is still loads to learn!)
It does sound completely inequitable. Happy to rise to the challenge!
August 25, 2023 at 9:52 am
I strongly advocate if you do the work, you get the money….
August 25, 2023 at 11:28 am
I agree with you Nicola, as a small practice we already take a hit when parents don’t wish to have their child vaccinated which makes it impossible to reach Qof targets due to small numbers. We cannot afford to lose money for the ones that we have vaccinated that decided to change practices.
August 25, 2023 at 1:30 pm
i agree-with the above
Also parents who do not want their children vaccinated – we send countless messages and letters and there is no way to record that parents have refused. this affects our numbers plus the aggravation of complaints for keep contacting the parent who is adamant they are not having a child vaccinated freedom of choice
but a read code to register “no to the vaccination” would help the %
August 25, 2023 at 2:03 pm
I agree – I always double check and challenge vaccination payments on CQRS. I include deceased and deducted patients in my reports. I’ve never had this come back to me and would challenge it as strongly as possible. As you say, we’ve used our resources to deliver the service and should be paid accordingly. I seriously doubt that any practice has been paid in this way for a newly registered patient. It wouldn’t register on the extraction that the service had been delivered by them – would it?
Patient has a vaccination on 1st July, leaves practice on 31st July, would their new practice really have that vaccination included in their extraction when the delivery site is a different location??
September 11, 2023 at 11:43 am
Same here, Helen – I include transferred out patients in my claims searches too. I’ve never been challenged on this
August 25, 2023 at 3:44 pm
To be honest I have known about this since the inception of Vacc/Imms payment through CQRS, but… I always stuck to my thinking of ‘we have given the vaccine then therefore we are entitled to payment’. So I have always asked for amendments to CQRS submissions every month and was never refused as long as I have provided a screenshot from Reporting screen that these are our numbers (obviously anonymised). I have to say that CQRS submission numbers have never reflected our search numbers anyway (even if they were to exclude patients who left).
August 26, 2023 at 5:34 am
Totally agree – I make monthly amendments but this is all extra work.
Also if the previous practice has not coded correctly we do not get the payment for subsequent imms given.
August 29, 2023 at 11:46 am
This is just the tip of the iceberg!
The whole of the NHS payments systems is unjust and a total joke. I wholeheartedly agree with the earlier comment that, given the fact that it is 2023 this is simply not acceptable.
In my view this is a relatively minor problem. A far worse issue is with the central claims system / tradeshift where they just “roll up” several claims into one payment. This takes ages to unravel in order to assign for accounting purposes and, indeed, ensure that all claims have been settled – we have had many cases where claims have not been paid and it has taken months, and even years, to resolve the issue. The whole NHS claims process is over complex and bureaucratic and this is made worse by the fact that their central accounting system is woefully inadequate. Who else has spent many an hour trying to decipher their codes to work out what the payment relates to.
With regard to the CQRS discrepancies described I tend to let these go on the basis that my time/effort spent pursuing these would amount to more than the £10.60 (ish) payment itself!!
August 29, 2023 at 2:31 pm
What bothers me too the amount of effort we put into getting the child vaccinated and when we finally have got them to come then it is past the claiming date, sometimes by only a month and we don’t get paid. So we can chase them from being 4 and if mum decides she will do it the month after the 5th birthday then we do it but we do not get the payment. Same with 3 doses of DTaP before 8 months, the children are notorious for being sick so the imms are delayed and we are penalised for that. I would definitely go back to items of service payments rather then idiotic targets, Do it get paid for it, no other industry would work this way