What should you do with patients wanting last minute vaccinations before going on holiday? A medical defence expert advises.
The problem
As the summer holidays approach, practices will increasingly be consulted for travel health advice and vaccinations. Patients who book last-minute deals may also request immunisations at short notice. For busy practices, already working at full capacity is it reasonable not to provide this? Should you charge for them?
Expert advice
When setting up a travel clinic, have an agreed protocol, signed by the GP and practice nurse. This could include providing information to patients about accessing the service.
Consider any request for urgent travel immunisations on its own merits and be sure you can justify a decision not to offer an urgent appointment. Seek specialist advice if you are uncertain whether giving vaccinations close to the date of travel provides sufficient protection.
Establish which travel vaccines are available on the NHS, as charging for these may be in breach of your contract. Vaccinations for which GPs are paid include typhoid, cholera, polio and infectious hepatitis. GPs would be expected to prescribe and administer these unless they have opted out of the vaccination and immunisation additional service. Under the GMS contract, practices can charge patients for treatment connected with travel where there is no remuneration by the PCT.
Patient Group Directions cannot be used for the provision of medications not normally available on NHS prescriptions - these require a patient-specific direction or individual prescription. GPs delegating immunisation to a nurse will still be responsible for the patient's overall care and should ensure the nurse is suitably qualified and experienced . Anyone providing treatment in a travel clinic should be familiar with the relevant guidance on appropriate travel vaccines for different holiday destinations.
Ensure you know the details of the patient's current medication and any previous vaccinations and that this is recorded in the notes, along with the patient's consent and which vaccine they have received. When obtaining consent, check the patient understands the need for the vaccination, the risks associated with the disease the patient is being immunised against, the risks and side effects of the vaccine and alternative options.
Those administering the immunisation should also record the product licence and document details of the drug, mode and site of injection as well as the batch number and expiry date.
Dr Jacqui Phillips is a medicolegal adviser at the Medical Defence Union
Practice calendar: June
