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Swine flu deal is another classic of complexity

If you thought you understood the link between vaccine uptake and the patient survey, then you probably didn't

By Richard Hoey

If you thought you understood the link between vaccine uptake and the patient survey, then you probably didn't

What is it with the passion of the BMA and Department of Health for striking deals so complicated that even the negotiators themselves seem nervously unsure about what they've signed up for?

First we had the fantastically mind-befuddling stage one of the MPIG phase-out, which uplifted the proportional rises in the various components of the contract in a 7:5:5:2 ratio.

Then there was the patient survey deal, which may or may not have built in securities for the confidence intervals of practice results, and definitely did raise the lower payment thresholds of the two key questions, although by differing amounts.

Now, there's the swine flu deal. On the face of it, it looks simple enough - but like all great puzzles, you only really start to understand it when you realise how much you don't understand.

Sure, the numbers look pretty clear on the face of it - £5.25 a pop for giving the vaccines, plus a relaxing of the rules on the patient survey if practices achieve 3% higher uptake than the average for seasonal flu last year.

But while 3% higher might sound pretty precise, it turns out it's not, because no one's quite sure what it's 3% higher than.

Initially, the DH claimed it was 3% more than the average uptake in over-65s last year (74%), which would have left GPs with an almost impossible target of 77% in the younger age groups prioritised for the swine flu vaccine.

Pretty soon, the DH press office slunk back, tail behind its legs, and admitted it didn't mean that at all, but an average of all the target groups for last year.

That could still have meant a target of perhaps 65% or more, but fortunately, it was another explanation that turned out to be wrong.

What's actually happening is that the DH and GPC are wrangling over which risk groups from the seasonal flu campaign most closely match those to be targeted for swine flu.

Over-65s won't be included, so the average figure should be somewhere around last year's 47% for younger clinical at-risk groups, and GPs in turn will be expected to get 3% more than that.

At least, I think that's right. But then the deal's only been out a week or two. There's probably a whole new layer of complexity I've completely missed.

By Richard Hoey, Pulse editor

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