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At the heart of general practice since 1960

Flexible response to woolly patients?

GPs are now

able to provide pneumococcal vaccination to senior citizens who are not in the standard chronic disease groups, and will be paid for doing so '

Dr John Couch discusses the implications

If you were to ask 100 GPs the significance of April 1,

the response would be a unanimous ' end of the first QOF year'. We will all be checking our QMAS points, prevalence and bottom-line cash totals before chasing up PCT payments. But there is another, less well-known, opportunity heralded by this date. Since the start of this month, we have been able to provide, and be paid for, pneumococcal vaccination to patients aged 65-74 who are not in the standard chronic disease groups.

The sums it is possible to earn may seem small beer compared with QOF but the gross payment for an average practice of four partners could exceed £6,500. Quite apart from the clinical benefits of this campaign, this clearly deserves some attention from a financial point of view.

The 2005/6 campaign, a continuation of the programme started in 2003 with the

over-80s and continued in 2004 with over-75s, is a directed enhance service (DES). As such, PCTS are obliged to provide it locally.

Interestingly, they are not obliged to get practices to provide the service. It can be offered to a suitable third party or even provided by the PCT itself. Therefore the first message to both GMS and PMS practices is most definitely 'use it or lose it'. If we do not provide this service ourselves someone else will and it will be very difficult to get it back.

The Department of Health has set down minimum criteria for this service. All practices should draw up a protocol to include:

-Indications and contraindications

-Adequate and ongoing staff training

-Database of patients (existing groups, those aged 65-74 and those reaching age 65 during April 1, 2005, and March 31, 2006)

-Concentration of invitations between August 1 and March 31

-Concentration of vaccinations between September 1 and March 31

-Adequate storage of vaccine

-Adequate recording of consent, batch number, expiry date, brand name, site of injection, contraindications and adverse reactions

-Read-coded entry

-Adequate call and recall system

-Mechanism for providing statistics to PCT

-Mechanism for regular review.

How much is the campaign worth?

There are two elements to payment. The PCT will pay a fee per injection given, in the same way as that for over-75s, over-80s and currently approved chronic diseases. This fee is presently set at £7.28 for England, Wales and Scotland with Northern Ireland getting £9.08 (this includes a data fee ' also note that

N. Ireland has been giving this vaccination to over-65s since 2002).

Although not yet officially confirmed, the fee should rise by 3.225 per cent for 2005/6, making it £7.51. I have based my subsequent calculations on this figure.

The second fee is via the personally administered fees scheme. Practices buy their own vaccine and can therefore claim reimbursement via the Prescription Pricing Authority along with a dispensing fee. The precise profit made in this way will largely depend on the discount your practice has

been able to negotiate on the vaccine. The elements of the personally administered

fee are:

-Reimbursement at basic drug tariff price (plus 10.5 per cent) and VAT refund

-3.8p container allowance

-Dispensing fee around £1.20 but varies a little (higher for dispensing practices and lower for high-volume practices).

Overall an average £4.50 per item can be earned in this way and adding in the £7.51 injection fee gives a gross profit of around £12 per injection.

Costs

It should be remembered that there will be costs involved. These will largely be staff costs (nursing and clerical) but will also include stationery, postage and telephone expenses. The table gives an idea of how to arrive at your own net profit.

While the Department of Health is encouraging both recall and vaccination to coincide with the annual influenza campaign, practices are not bound by this and a year-round campaign has some advantages such as spreading the load to quieter times of the year.

Many practices will have a combination of approaches remembering that, unlike influenza, boosters are not encouraged for 10 years in most patients.

It is worth setting up a system of inviting patients as they reach their 65th birthday, run on a monthly basis. This can also be continued into subsequent years to keep figures up.

Next, opportunistic vaccinations can be offered throughout the year to any patients in the relevant age group. All staff need to be aware of this and you must ensure regular checks of vaccine stocks.

Finally the vaccination can be offered at the same time as the 2005/6 influenza campaign. This will save on recall costs but does increase the pressure on staff time.

Claiming payment

DES pneumococcal payments are claimed along with the other enhanced services at the end of each quarter on the enhanced services claim form. Make sure you have an efficient system for this to occur on time.

PPA payments must be claimed monthly using the relevant forms. These payments are usually made two months in arrears. As always, check that payments actually arrive ' we all know this cannot always be relied on!

Notes

-Assumes 1,000 patients aged

65-74 of whom 200 have already been immunised via chronic disease indicators. Also assumes 70 per cent uptake in remainder.

-Assumes nurse vaccinates eight patients per hour.

-It is important to note the bottom line potential net profit per partner is £1,242 in this example. Figures will obviously vary depending on each practise's age spread so each practice must look at their individual position.

-The bottom-line figure can also be affected by the amount of discount negotiated on vaccine purchase, the higher the better.

It is worth finding out if your PCT or other local practices run bulk-buy schemes where larger discounts can be obtained. The type of recall system will also have an effect, with a direct mailshot being the most expensive.

John Couch is a GP in Ashford, Middlesex

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