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getting YOur Audit Criteria right

By Emma Wilkinson

Dr Redmond Walsh gives a weary sigh. After almost a decade of constant battle over vaccine uptake, he thought he had finally hit the target for top vaccine pay.

But his practice, in gentrified Clapham, south London, with its mix of middle-class objectors and the acutely deprived, has now received another dispiriting blow.

A change in the rules ­ with uptake now calculated from just MMR and the new five-in-one ­ has sent the 90 per cent target drifting out of reach once again.

'Our MMR uptake is low,

although not bad for Lambeth, but for the first time ever

we hit the 90 per cent,' he

said, his voice betraying his frustration.

'The new rule change is bound to affect us. We won't be able to hit the target. There's no incentive to bother.

'We're pretty good in our practice in how efficient we are but immunisation is too much work for the amount of support we are given.'

Dr Walsh admitted his practice had tried to opt out of vaccine services ­ only to be dissuaded by the PCT.

'We have been advised that if we did we wouldn't get any enhanced services,' he said.

He is clear who he blames for the change in rules. 'I think the GPC agreed it without realising what they were doing.

'It's typical of the GPC really,' he said

While the rule change has left Dr Walsh frustrated and demoralised, other GPs have been sparked to anger.

Dr Susan Toothill, a GP in Kent, was furious when she

realised her practice was on course to lose £9,000 this


'In Sevenoaks there is a big wodge of very educated parents who can afford to get vaccines privately and all the persuasion in the world wouldn't convince them,' she said.

'MMR dropped to about 80 per cent but we could juggle that with the uptake of the


'If you can only get 80 per cent MMR you haven't got a hope in hell [now] and it only takes one patient to miss out.'

She said many practices in Kent had been adversely affected by the change which could result in a big opt-out of childhood immunisation.

'It would be a sad day if practices chose to opt out.

'We like to maintain close contact with our mums and

babies in the practice and see these clinics as important to

the relationship we build as family GPs. But it is becoming harder to hang on to these


'We feel very let down, we offer a good service and our patients appreciate it. We feel we are doing the same work so why should we settle for less payment?'

LMCs contacted by Pulse have been bracing themselves for a flurry of angry phone calls from practices, but say many GPs have yet to notice the reduced payments.

But as practice managers begin to decipher the latest quarterly figures on vaccine targets, they are becoming increasingly aware of a shortfall.

Marion Ackroyd, practice manager at a 10,000-patient practice in Keighley, West Yorkshire, was dismayed to find it had missed the 90 per cent target for the first time.

'Last quarter we should have got 92.5 per cent uptake but because they worked it out based on two vaccines we only got 89 per cent,' she said.

'We got paid £755 as opposed to £4,607. The impact is ridiculous. It will affect general practice massively and if it carries on quarter after quarter the doctors may consider opting out.'

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