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I'd rather listen to experts, thanks

Since vaccine targets first appeared about 15 years ago a pleasant part of a GP's job has turned administrative nightmare.

With the change in uptake calculation hitting practice profits (see box, above) some GPs will be seriously considering whether to opt out of vaccination.

Childhood imms and vacs is an additional service and a

designated enhanced service, with 1 per cent of your global sum reflecting its provision. Target payments are paid through the DES.

Under the DES we have to maintain a register, inform all parents of the immunisation programme, with written information where appropriate, and carry out an annual audit of immunisation rates.

I do not see any obligation to chase up errant patients beyond normal liaison.

There is nothing to stop you forming a local co-operative with other practices and subcontracting immunisations. You would not lose control over the contract but could lose the grief it brings.

If you wish to opt out you may do so temporarily (for

example during a practice manpower crisis) or permanently.

You may seek to opt out because of workload pressures, historical non-provision of service, lack of skills in the practice, on conscientious grounds or because the practice is not fulfilling its obligations for the additional service.

You need to give the PCO three to six months' notice then decide whether it is permanent.

At two months the PCA can instruct the practice to continue providing immunisation for six months and can apply for a further three-month transitional period. After nine months it is responsible for provision of the service unless it appeals to the strategic health authority.

You cannot seek to regain the service until the PCO's contract with the alternate provider ends and then only by open competition.

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