GP-based vaccination programmes have historically been a huge public health success in preventing disease. But cracks are beginning to show.
After a year in which vaccine shortages, infectious disease outbreaks, and major changes to the oversight of public health have all put pressure on the system, GPs could be forgiven for hoping for a few months of stability.
But they would be disappointed. There will be two new immmunisations introduced this year – rotavirus in the infant schedule and herpes zoster for the elderly – while the vaccination of children against flu will begin possibly as early as next year.
Beyond that, there are a number of major vaccination programmes on the horizon that could see GP practices involved.
They all offer more opportunities to prevent important diseases – but with an already crowded vaccination programme, will practices be able to cope?
Last year saw GPs battling on several fronts, with flu vaccines being recalled, a surge in whooping cough cases and a measles outbreak in north-west England.
The emergency whooping cough campaign – introduced in October to combat a fourfold increase in pertussis infection rates compared with the previous year – had an immediate impact.
GPs helped achieve uptake rates of 40%, even though practices in some areas were hampered by their removal from antenatal care and a lack of support from midwives, who said they didn’t have the capacity or training to provide the vaccine.
There were problems with the flu vaccination campaign, with the recall of batches of flu vaccine from manufacturer Crucell in the autumn leaving practices short of supplies at the beginning of the flu season. This led to criticism that the DH had not stockpiled any emergency supplies.
This year sees the continuation of the whooping cough programme in pregnant women, and some major changes to the immunisation programme delivered by GPs.
Rotavirus vaccination will be added to the infant schedule from September 2013 for babies aged under four months, to reduce cases of gastroenteritis. Immunisation against herpes zoster in patients aged 70–79 years will also be introduced this year, although exactly when has yet to be finalised because of uncertainty about vaccine stocks.
The immunisation schedule for meningococcal disease is also likely to change substantially in the near future, with the first vaccine for the B strain licensed by European authorities last month and changes to the timing of the vaccine that protects against meningitis C.
Infants currently receive two doses of meningitis C vaccine at three and four months, and a booster at 12 months, but this booster is now to be moved to the teenage years, in a schools-based programme that will lighten the load for GPs.
Influenza is another area where GPs will see major changes. The DH plans to roll out annual flu vaccination for all children from the age of two to 17 years in 2014 at the earliest.
The nasal vaccine is likely to be delivered through a school nurse-based programme for those aged five upwards, while GPs would be expected to vaccinate the pre-school-age groups.
However, a shortage of school nurses could see GPs mopping up work in the older age group too.
A crowded schedule
The raft of changes has led the GPC to warn that any future changes will need to be worked out very carefully with the profession in advance.
Dr Bill Beeby, who chairs the GPC’s clinical and prescribing subcommittee, believes GPs will be able to manage the imminent changes, but warns the current schedule is already ‘about as crowded as it’s possible to be’.
He says: ‘It has been changed several times. So any new changes need to be talked over with the GPC, to discuss
how we are going to introduce new vaccines.
‘There are always going to be complex [immunisation] routines and if they do introduce new vaccines, such as rotavirus, then it is going to be helpful if they introduce them at points when we are already doing something.
‘It’s not too difficult to design a schedule that doesn’t involve multiple visits.’
Dr Beeby also warns that while parents with young children usually follow GPs’ vaccination advice, they may struggle if repeated visits are required.
He says: ‘If the schedule becomes too complicated, there’s a risk that parents just won’t be able to keep up with it. The immunisation schedule needs to be kept sensible so that it is easy for parents to make sure their children become fully immunised.’
The great unknown over the next few years is how national immunisation programmes are going to fare after the reorganisation of the NHS, with responsibility for overseeing vaccinations transferring from the Department of Health and PCTs to Public Health England and CCGs.
Dr John Middleton, vice-president of the UK Faculty of Public Health, warns the changes will make the immunisation system much more fragmented.
‘This is going to make it extremely hard to bring in new programmes,’ he says. ‘In fact, it’s going to be difficult enough to keep up levels with the existing immunisations that we have already got.’
But Dr Beeby is more optimistic, saying: ‘There shouldn’t be any difficulty with any of the things as we transfer over.
‘PCTs don’t have any direct role in the day-to-day running of the vaccination programme, and I don’t think [the transition] will interfere at all with vaccine giving by GPs.’