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GPs are facing a postcode lottery over immunisation pay

after the Government refused national funding for the addition of two at-risk groups to this winter's flu campaign.

In a letter to GPs this week, Sir Liam Donaldson, Chief Medical Officer for England, said people with chronic liver disease and carers of elderly and disabled people should be given the flu vaccine.

But he said no amendment to the directed enhanced service would be made and PCTs would have to decide whether to set up locally enhanced services to pay practices instead.

GPC negotiators told Pulse they had not been informed of the change prior to the announcement and said it could mean some GPs would get paid under a LES and others would not. They pledged to push for a national agreement.

GPC chair Dr Hamish Meldrum said: 'We heard about this for the first time this week which I find very surprising. It seems an odd way to go about it because if we rely on a LES it may not happen.

'It would be far easier to amend the DES and they could have come to us and that would have been done.'

Dr David Love, GPC Scotland co-chair, said the failure to negotiate payment in advance was highly regrettable.

'There seems to be no intention in Scotland to change the DES and it's not clear where the money is coming from. If it is left to local health boards it will be patchy.

'In our view, having a LES is a very unsatisfactory way of going about it. We are trying to stop the CMO letter going out in Scotland until we can get answers,' he added.

In Northern Ireland, GPs will have to rely on payment under a LES and GPC (NI) chair Dr Brian Dunn was confident health boards would co-operate, adding: 'Otherwise those groups will not be immunised.'

GPC Wales chair Dr Andrew Dearden said the Welsh Assembly had told GPs to immunise the new at-risk groups and claim back just as they would under a DES.

Dr Nigel Watson, chief executive of Wessex LMCs, said: 'Carers of elderly and disabled are a significant number.'

By Emma Wilkinson

Flu vaccine pay

As well as the row over payment for the two new at-risk groups, GP negotiators have failed again to equalise item-of-service fees across the UK

England

·GPs to get £7.51 IoS for immunising over-65s and at-risk under-65s

·New at-risk groups to be paid under a LES

Wales

·Welsh Assembly will pay GPs £7.51 IoS for new and existing at-risk groups as well as

over-65s

Scotland

·GPs get £7.51 for at-risk under-65s; new at-risk groups still under negotiation; pay likely to be a LES

·Pay for the over-65s based on last year's sliding scale ranging from £7.05 to £8.70

Northern Ireland

·As for Scotland but new at-risk group payments confirmed as a LES

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