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Performance indicators for PCT ratings should include uptake of all childhood vaccinations, Government immunisation advisers have recommended.

The move could intensify the pressure on GPs to hit uptake targets in the face of parental reluctance and may fuel the current debate over informed dissent.

The Joint Committee on Vaccination and Immunisation expressed concern after being presented with Health Protection Agency data suggesting a gradual fall in coverage for a range of vaccines.

Currently, MMR is the only vaccination included as a PCT performance indicator, but the JCVI has advised the Government that wider performance management could arrest declining uptake.

The Department of Health said it 'believed very strongly' that performance indicators were 'very important when it comes to immunisation'.

It has not yet taken a decision on the JCVI's recommendation but is holding talks with PCTs over how to performance manage their immunisation rates.

Figures remain above 90 per cent for all vaccines apart from MMR but the committee was concerned about 'low vaccination rates in some areas' and noted 'central performance management may help ensure immunisation receives the priority it merits'.

Dr George Kassianos, RCGP immunisation spokes-person, said: 'I am sure GPs would welcome performance management by the PCTs as regards to immunisations as long as exception recording will apply.' He said GPs could not 'force' patients to have a vaccine.

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