With all the damage caused by the COVID-19 crisis, general practice has benefitted from some income protection. It’s all change for the year 2021/22. The gloves are off. We’re into new territory with additional indicators added to QOF. The Vaccination and Immunisations domain will make up a significant part of this. We’ll take a look at what you need to do to ensure good performance and to maintain your income.
The GP contract update gives us a complete overview of the rationale for the changes to vaccination and immunisation payments. Part of the motivation is that GP practices are fully aware of their QOF performance, but they don’t have the same oversight for vaccination and imms. Arguably, they are right.
For most practices, baby imms are something that happen, rather than something that we make happen. We spend hours scrutinising QOF populations and figures, but child imms rarely attract the same amount of attention. With the changes due to happen this year, NHSE is aiming to change that. The new contract changes will not apply to seasonal influenza or COVID-19 vaccinations, both of which will continue under separate Enhanced Service arrangements.
From 21/22, practices will be paid an Item of Service fee (IoS) of £10.06, and this has been agreed for the remainder of the current GP contract deal.
From 21/22, there will be a new Vaccination and Immunisations domain in QOF, which will reward both childhood imms (3 indicators, total 54 points maximum, average QOF value £10862.64, at £201.16 per point) and shingles vaccination (1 indicator, 10 points, average QOF value £2011.60).
NHSE have recognised the financial challenges faced by practices that struggle to vaccinate 70% of the cohort under existing arrangements. By changing to an IoS figure, practices should be paid for every immunisation regardless of how many they carry out altogether. It’s not all good news, though. Moving to an IoS method for payment means that lower-achieving practices gain at the expense of higher-achieving practices. To balance this, NHSE will trigger a deduction from the practice if they don’t achieve 80%* coverage on their routine childhood imms. It’s anticipated that payments will be made in a similar way to the current QOF arrangements. Practices will be paid a monthly aspiration payment, with a balancing calculation at the end of the year. The danger of this for low-performing practices will be that they will already have spent the money before the reconciliation happens and will be left with a balance to pay back.
For practices that do not meet the 80%* vaccination threshold, you should ensure that you are meeting the Core Standards set out in the Vaccines and Immunisations guidance (see references). You can check your uptake on the NHS Digital website (see references section).
|
IOS Fee |
Total cohort for vaccination |
Vaccinated % |
Total number vaccinated |
Total Payment |
Repayment |
Comments |
|
£10.06 |
500 |
90% |
450 |
£4,527.00 |
0 |
Full IOS fee received |
|
£10.06 |
500 |
80% |
400 |
£4,024.00 |
0 |
Full IOS fee received |
|
£10.06 |
500 |
50% |
250 |
£2,515.00 |
£2,515.00 |
Not entitled to receive IOS fee for 50% or below achievement |
|
The achievement between 51-79% the calculation becomes a little bit more complicated. For practices who achieve in this range, the first 50% of patients vaccinated you will not be entitled to receive the IOS fee. We have worked through an example below of how you calculate this, using an achievement of 67% |
||||||
|
£10.06 |
500 |
50% |
250 |
£0.00 |
No payment received for the first 50% vaccinated | |
|
£10.06 |
500 |
17% |
85 |
£855.10 |
This amount is what you will be entitled to keep at year end | |
Clarification in payments with thanks to the Wessex LMCs
The BMA has indicated that they do not expect practices will be able to ‘exception code’ their immunisation cohorts as immunisations have not previously been subject to exceptions.
Practices should be aware that the timed nature of the associated QOF domains will inevitably mean that income will be affected if children reaching the upper end of the timescales aren’t vaccinated consistently throughout the year. For QOF related to childhood imms, this is 8 months, 18 months and 5 years of age, so practices should start looking at these cohorts immediately and check who is unvaccinated and will breach these thresholds beginning in April.
Alongside the economic changes, there are significant changes to how practices will deliver this essential service. Practices must have a named accountable lead, call and recall in line with national standards, and adhere to national standards for data and record-keeping. Additionally, practices will need to participate in national catch-up campaigns.
Perhaps the most onerous challenge for practices will be the need to allocate enough appointments for 100% of the cohort to be vaccinated. These appointments will need to be offered at convenient times across the working week including PCN extended hours. This may mean that practices need to consider staffing competencies across a range of hours.
Where call/recall has previously been a letter or text-based endeavour, practices will now need to make sure that the third contact is made via telephone or face to face by a healthcare professional. PHE has made resources available to support those conversations. Patients remaining unvaccinated after the third contact should be flagged in the GP record to increase chances for opportunistic vaccination. Where local child health provision currently manages the call/recall, practices will need to ensure that the service meets the standard, and if not, will need to make alternative arrangements to ensure the criteria are met.
*The Contract guidance paragraph 5.15 refers to a minimum of 79% coverage. However, NHSE has confirmed that they expect that this will be a minimum of 80% coverage.
What are the relevant documents you need for the full detail?
Update to the GP contract v2 (February 2020)
Update on Vaccination and Immunisation changes 2021/22
Supporting General Practice in 2021/22
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