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PCTs are 'actively considering' commissioning alternative pro- viders to take over immunisation from practices with poor uptake, Pulse can reveal.

The warning follows a Department of Health report in March urging trusts to explore the use of alternative pro-viders, including private firms, to improve uptake.

Dr Tony Snell, medical director of Birmingham and the Black Country strategic health authority, told Pulse PCTs in his area were 'actively considering it'. He added: 'I think all PCTs who have problems with uptake are considering it.'

Dr David Jenner, GP contract lead at the NHS Alliance and a GP in Cullompton, Devon, said: 'It was always one of the options where practices aren't performing and the new contract allows PCTs to find alternative providers. Practices have first refusal but the service isn't guaranteed.'

Pulse has learned Newham PCT in London has recommended practices with consistently low uptake of cervical cytology should be 'encouraged to opt out'. The trust is currently investigating options for improving vaccine uptake.

Dr Robert Morley, joint executive secretary of Birmingham LMC, said it was a 'typical heavy-handed' approach. 'If a trust has any sense it will realise GPs have delivered on vaccination for years.'

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