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Under a rule change slipped into April's Statement of Financial Entitlement, uptake is

now calculated on just two vaccines: MMR and the new five-

in-one. Under the old system, uptake was based on four vaccines: MMR, DTP, pertussis and Hib. The increase in weighting for MMR makes it much more difficult to hit the 90 per cent target for higher vaccine payment.

An average, three-partner practice, with national average uptake, was previously just hitting the 90 per cent target and

earning £8,488. That same

practice, with the same up-

take, will now miss out on the 90 per cent target and earn just £2,829.

In theory. In practice, PMS practices are paid upfront for vaccination and PCTs do not always choose to claw money back if targets are missed.

Uptake in two-year-olds on which payment is based has since April been calculated on a 50:50 split between MMR and either the five-in-one or the previous trio of vaccines. For the purposes of the new calculation, giving DTP, pertussis and Hib ­ whether together or separately ­ counts as a single vaccine.

It says introduction of the five-in-one vaccine will reduce workload and that the change was signed off by the GPC. But it also claims it offered to include meningitis C in the uptake calculation ­ reducing MMR's weighting to one in three ­ only to be turned down by the GPC.

The GPC could press the department to restore the previous one-in-four weighting for MMR. Or it could argue that the target percentages should be adjusted downwards to take into account MMR's higher weighting.

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