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GPs to lose flu vaccine discounts

GPs may have to hit a series of targets for flu vaccination just to keep their current income under Government proposals.

A Department of Health

review recommends GPs lose their role in negotiating prices for flu vaccines, with a discounted price instead arranged with manufacturers centrally.

The money saved would be ploughed into a new 'graduated incentive scheme' for vaccination uptake to recompense GPs for loss of income from locally negotiated discounts.

Incentives could also be paid to private providers to provide flu vaccination. The review committee warned there was 'limited capacity' for GPs to take on vaccination of at-risk groups and carers, and advised ministers 'assess the role of alternative providers in supporting flu immunisation'.

The proposal is the committee's preferred option of three set out to overhaul the system for procuring flu vaccines, probably from 2008. It would retain GP responsibility for ordering vaccine supplies, unlike the two alternatives.

Under one, GPs would place orders with local pharmacies as in Scotland. In the other, the department would run England's system centrally, negotiating prices, buying supplies and distributing them to PCTs or strategic health authorities.

Each option was assessed on feasibility, quality improvement and acceptability, with the system of central negotiation and devolved procurement scoring highest (see box below).

The review, published last week, stressed: 'There is no desire to erode GP income and it is proposed the money saved be used to fund a graduated incentive scheme to reward performance.'

Dr David Salisbury, the department's director of immunisation, said all three proposals were likely to be controversial. 'They've clearly got to be consulted on now and negotiated, and we need to make sure the solution is better than what we've already got.'

Dr Doug Fleming, a member of the flu subgroup of the Joint Committee on Vaccination and Immunisation, said the present arrangements could be improved. 'Central distribution is worth a serious look, providing the department keeps a range of manufacturers, a fee and appropriately targeted payments.'

Dr John Canning, Cleveland LMC secretary and a GP in

Middlesbrough, warned: 'GPs shouldn't be expected to provide the same service for less. The Government has enough ways of reducing our profits without creating another one.'

Options and how they rated

Option one

• Scottish system – pharmacies receive orders from local GPs

• 'Would significantly alter financing of flu vaccination. GP income would be threatened'

Option two

• Central procurement and distribution – department purchases all vaccines

• 'Would be an erosion of GP income and independence'

Option three (preferred)

• Central negotiation of price with savings used for incentives

• 'Practices and providers carry most of the financial risk. Non-GP providers compete with GPs'

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