This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

CAMHS won't see you now

GPs asked to buy more expensive flu vaccine to save NHS money

A CCG in the Midlands has highlighted a conflict of interest facing GP practices with regards to ordering flu vaccine, concluding that practices should order a majority at a price that will disadvantage them financially.

Although the arguably more effective flu vaccine - quadrivalent (QIV) - is cheaper to practices due to a large, 50%, discount offered by one manufacturer, the cost to the NHS to reimburse practices is higher.

Meanwhile, a vaccine that provides protection to fewer strains of influenza - trivalent - is more expensive to practices, but cheaper for the NHS when it comes to reimbursing practices.

Manufacturer Sanofi offers GPs discounted QIV at £4 per dose, but the current NHS list price for its product is £8 per dose, NHS Dudley CCG has found.

The CCG said there are two clinically approved trivalent vaccines with NHS list prices of £5.22 and £5.25 per dose respectively. It has now decided to ask GPs to ensure that at least three quarters of the vaccines they order are at the lower cost.

It said in a board paper from last week: 'Following a review of the recommended flu vaccines for the 2017-2018 season we are recommending that GP practices in Dudley review their ordering/purchasing and make changes to ensure at least 75% of vaccines purchased are below an NHS list price of £6.'

The CCG acknowledged that Public Health England's Green Book 2016 for vaccinations states that 'all other things being equal, QIV are preferable', but added that there was 'no robust evidence to support this'.

The paper said: 'Public Health England is currently undertaking a cost effectiveness analysis for QIV compared to trivalent vaccines and until further guidance is forthcoming, [NHS] Dudley CCG does not consider the QIV vaccines to be cost effective for the adult immunisation programme.'

But GPC dispensing and pharmacy policy lead Dr David Bailey told Pulse that although GPs could make 'marginally' more profit by ordering QIV in this instance, they should make their judgement based on what is best for patients.

He said: ‘It is undeniable that the quadrivalent vaccine will prevent more cases in total and thus at an individual level is better for the patient in front of you

'GPs should always make the best decision for the individual patient – all things being equal having some regard to cost.

'Should there be an outbreak of the influenza B strain covered by one but not the other it would be the GP who might be criticised for providing the less effective of the two available products.’

NHS Business Services Authority, which reimburses GPs for vaccines in line with the NHS list price without asking how much they paid, said this was 'in accordance with the Drug Tariff and the GMS Statement of Financial Entitlements Directions 2013'.

A Sanofi spokesperson said: ‘QIVs offer a broad protection against influenza by helping to protect against four influenza strains (two A strains and two B strains).

‘Sanofi provides discounts to healthcare professionals in the UK on influenza vaccines similar to those offered by other influenza vaccine manufacturers.

They added that its QIV NHS list price 'is currently the lowest of all available QIVs' from any manufacturer 'aligned with Sanofi’s commitment to addressing affordability issues in the NHS', and that 'reimbursement criteria to practices are driven by the NHS as one of the tools to increase vaccination coverage rates'.

Readers' comments (7)

  • shame shame shame on the doctors who are board members of dudley CCG to allow sh1t like this

    Unsuitable or offensive? Report this comment

  • shouldnt we all just be ordering qivs pharma should stop making trivalents available anyway

    Unsuitable or offensive? Report this comment

  • Dudley CCG should stick to commisioning not interfering in practice business

    Unsuitable or offensive? Report this comment

  • if it's cheaper from a gp budget, and more likely to be effective and save costs of treating flu complications then surely there could be no possible defence for NOT using the quadrivalent...if the above could be proved there could even be an argument for the MDU etc to announce it would not cover practices for choosing the trivalent where quadrivalent was available!!

    Unsuitable or offensive? Report this comment

  • And arent they asking GPs to bail out CCG finances?

    Unsuitable or offensive? Report this comment

  • Oh dear. I used to be on the Dudley CCG Board. I retired 18 months ago. I was always the none "yes" man. I always stuck my neck out and sometimes got it chopped off. No way would I have voted for the less effective option. I fear they have not found another "unreasonable" man to replace me. All boards should have at least one if not two unreasonable men to ensure that sufficient scrutiny takes place. Knowing the GPs on the board as I do, many would have voted this down. It may well have been carried by the lay majority on the board. I wonder if an FOI request for the voting numbers and how people voted would get anywhere, but I think the minutes would note that it was agreed to and no more detail. Minutes are kept that way in all NHS institutions so an FOI has nothing to get its teeth into. Also this was probably in the private section of the board meeting, and an FOI request would probably be rejected on the grounds of confidentiality

    Unsuitable or offensive? Report this comment

  • I also had a gut feeling it would be Dudley when I read the headline, and it was

    Unsuitable or offensive? Report this comment

Have your say