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Planning your pneumococcal campaign

t is not before time that the Department of Health has finally decided to pay GPs for immunising older patients with pneumococcal vaccine. In England a £6.80 fee will be paid to GMS practices (PMS practices will get a 'reward commensurate with achievement') for every vaccination given to a patient aged 80 and over. From April 2004 patients aged 75-79 and from April 2005 aged 65-74 will also attract a fee. Subsequently all patients reaching 65 will be offered the vaccination.

Scotland and Wales are likely to endorse payment for all the above groups from this year. Note that no payment has been offered for younger patients in at-risk disease groups.

As usual practices can purchase vaccine under the self-administration rules. This allows an extra profit that should boost the total payment per patient to more than £10. My practice has 78 patients over 80 per partner.

Around 20 per cent of these have already had the vaccine, making a maximum potential gross profit of £700-£750. Practices that have never given the vaccine and those with more elderly patients would earn more.

Potential profits for 2004/5 and 2005/6 are much higher, up to £1500 per partner for each of these years, given the larger numbers of patients involved. Practices in seaside resorts, much loved for retirement, will do particularly well!

Get your order in now

Your computer search should be easy. Remember to exclude patients who have already been immunised. Re-immunisation with polysaccharide vaccine is not currently recommended except for people whose antibody levels are likely to have declined more rapidly, for example those with no spleen, with splenic dysfunction or with nephrotic syndrome. In these circumstances, another dose should be given five years later.

The suggestion for this year is to give the vaccine opportunistically at the same time as the influenza campaign and this makes some administrative sense, but you must get your order in now. You will need to make some extra nursing provision to follow this route. Any patients who do not attend can be sent a letter and/or dealt with opportunistically as they are seen in future.

Some practices are swamped during the influenza vaccine season so it is perfectly reasonable to separate your pneumococcal campaign. You can use batched mailshots to spread the load over several months, dealing with defaulters opportunistically. You can also start to vaccinate the 75-79 age group from April 1 next year in the same way. Vaccine stock control will be vital.

Although no announcement has been made about how payments will be structured from when the new GMS contract begins, it is likely they will be made via the national enhanced service element, like influenza vaccinations. There are no prizes for guessing that payments are then likely to be linked to the percentage of patients vaccinated. This makes it even more important to have an action plan ensuring high coverage.

Ensuring payment

To ensure payment, double-check your recording methods. Use a short template that includes the 'pneumococcal vaccine given' Read code, batch numbers, expiry date and consent. Ensure your item-of-service claims for 2003/4 are made and that your PPA reimbursement system is robust.

From April 1 make sure you are clear how to claim payment under new GMS or PMS and you have the 75-79 patient group identified. Finally do not forget to include unimmunised patients who reach the 80, 75 and 65 age groups over the next few years.

Potentially we will reduce mortality and morbidity from pneumococcal disease and earn around £4,000 per GP over the next two-three years of this campaign. This seems a satisfactory result.

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