Childhood immunisation scheme to include exception reporting and lower targets

Target thresholds for childhood immunisations have been revised, NHS England has announced, following warnings that deprived practices are missing out on funding.

The contract imposed by NHS England will also include some form of exception reporting for children who register late in the financial year, or at the upper end of age limits.

The 2023/24 contract revealed that the controversial ‘claw back’ of item of service fees when practices fail to meet certain targets will be removed from April.

The changes have been made in in response to ‘feedback’ from PCNs and the BMA’s GP Committee, NHS England added.

Currently, practices that fall short of 80% coverage for routine childhood immunisations have to make a repayment of IoS fees, equivalent to what they would earn for half the cohort.

This system, introduced in 2021/22, along with stricter targets, have led to serious concerns about it widening health inequalities and leading to some practices having to take a substantial financial hit.

The repayment mechanism has now been scrapped for 2023/24, so practices performing at lower levels less will no longer be penalised.

The thresholds for QOF childhood vaccination and immunisation indicators will also be reduced to 89% for VI001; 86% for VI002; and 81% for VI003.  However, the upper threshold for all three will be raised from 95% to 96%.

NHS England said: ‘All the points for each indicator will be put into a sliding scale of reward between the lower and upper threshold. Reducing the lower thresholds will decrease the number of practices receiving no payment across the three indicators.’

In addition, a new personalised care adjustment – exception reporting – will be introduced for children who register at a GP practice too late either in age, or too late in the financial year to be vaccinated in accordance with the UK national schedule or the requirements of the relevant QOF indicator.

QOF expert GP Dr Gavin Jamie welcomed the removal of the clawback system and said the changes to targets ‘are probably sensible and avoid the cliff edges’.

However, he added, that, as ever there will be ‘winners and losers’.

‘I think that practices, overall, might have fewer points due to the removal of the lump of points at the lower threshold and the higher top threshold but that is likely to vary quite a bit between practices.

‘To balance that, children that register late in the year or outside their immunisation window will be exception reported which may have a bigger, positive effect on practices.’

Dr Jamie added: ‘If this had all come in two years ago, we would likely have had a more positive reaction.’

NHS England recently said in its annual report that it will not claw back £4.2 million ‘overpayment’ from GP practices that did not meet childhood vaccination targets last year.

It noted that the main reasons for low performance were ‘issues outside of a practice’s control such as increased vaccine hesitancy, people either not coming forward when invited or declining, less ability to opportunistically offer vaccination when children are present in practice for another reason.’