NHS England’s new vaccination strategy is likely to see the end of the current GP practice enhanced services and QOF targets, with ICBs set to take over population-level management.
Under the new strategy, infants and pre-school children vaccinations will ‘likely’ continue to be delivered within general practice, while adult vaccinations will be at ‘a range of locations depending on circumstances’, NHS England has said.
However, the plan proposes for PCN-level teams to take over the responsibility of vaccinations and while NHS England will maintain overall accountability for vaccination services, it will delegate commissioning responsibility to ICBs, with the intention that all ICBs take this on by April 2025.
The plan also set out that routine and seasonal vaccinations delivered to school-aged children ‘are likely’ to be at primary and secondary schools, while adult seasonal and routine vaccinations are ‘likely’ to be delivered at a range of locations depending on local circumstances, including general practice and community pharmacy.
Where vaccinations are likely to take place
- Vaccinations delivered to infants and pre-school children are likely to be within general practice.
- Routine and seasonal vaccinations delivered to school-aged children are likely to be at primary and secondary schools.
- Adult seasonal vaccinations are likely at a range of locations depending on local circumstances, and likely to include general practice and/or community pharmacy.
- Adult routine vaccinations are likely to be at a range of locations depending on local circumstances, aligned with seasonal vaccinations where possible.
- Routine vaccinations delivered to pregnant women and newborn babies (eg pertussis) and likely to be at maternity services or primary care settings. Selective vaccinations (eg babies born to hepatitis B infected mothers) are likely to be at maternity services.
Source: NHS England vaccination strategy
The plan says: ‘We heard that the way current primary care incentive schemes for vaccination are structured may not maximise our opportunities to address disparity in uptake.
‘We heard that funding for outreach was used during the COVID-19 pandemic to support underserved groups and address disparity in uptake, but that it is more expensive per dose administered than high throughput approaches, which can miss underserved communities. We heard support for the extension of similar approaches to other vaccinations.
‘During 2023/24 we are therefore considering how we can maintain a consistent national financial framework and national item of service fee, while giving systems greater flexibility over how they direct their resources. This is in line with the Fuller Stocktake recommendation to amalgamate existing primary care funding where possible and maximise system decision-making on discretionary investment. The aim is to rebalance funding to increase uptake in underserved populations and tackle wider health inequalities.’
One of the ways they said they would address this was through reducing running costs by ‘simplifying and streamlining payment processes to free up provider and commissioner capacity and enable maximum automation,’ it added.
It also said that it will work with the royal colleges, GMC, other relevant bodies and local authorities to explore how vaccination ‘can be a more prominent part of training’ for all staff.
A vaccination workforce ‘with a skill mix that makes best use of trained, unregistered staff’ where ‘clinically appropriate’ and subject to the appropriate legislation, will also be developed, according to the plan.
Some of the actions included in the strategy will begin to be implemented in 2023/24, with ‘as many changes as possible’ to be brought in from 2024/25 and most of the proposals set to be delivered by 2026.
Implementation timescale
In 2023/24 we are beginning to implement some of the actions in this strategy. These include:
- developing the roadmap to delegation of commissioning responsibility, including a pre-delegation assessment framework
- drafting new service specifications and developing commissioning, contracting and procurement options
- building digital services capability.
In 2024/25 we will implement as many changes as possible, which may include:
- moving towards shadow population-based ICS-level budgets for vaccination, using 2023/24 to explore the benefits and risks of this approach with systems
- some commissioning and contracting changes
- more formal joint working between regional commissioning teams and ICBs as a step towards full delegation
- delivering some changes to digital services.
We expect that most of the proposals in this strategy will be delivered by 2025/26.
Source: NHS England vaccination strategy
Will that be an end to the ‘incentive’ where we lose thousands of pounds because a few young children have joined the list having missed vaccination window elsewhere? Or will that bit of incentive continue? Running large vaccination centres is expensive, you need premises, staff, management, parking and infrastructure. No one can do it cheaper than a GP practice. Good luck with this one NHSE. Spoiler; remember what happened with OOH!
So, ICBs will either have to rent space in GP surgeries from the GPs, to provide the vaccination clinics, or they will have to pay for childcare and transport for Mums to take children long distances to distant Mass Vaccination Centres, but the latter will not be popular amongst most parents, leading to a fall in vaccination uptake, and failure to meet criteria for ‘herd immunity’ in those instances where it is valuabkle (NOT covid, remember, there is no herd immunity to covid because vaccination does not prevent infection and transmission)
And there is absolutely no value in opportunistic contact opportunities to review mums while thay are having their kids jabbed, like to check for domestic abuse, postnatal depression or psychosis, post-partum problems, or offer contraception, or any chronic disease management matters that might be arising, but mother too busy to book a personal GP appointment to sort it out.
And there is no value to opportunistic offering of other reviews or procedures alongside flu jabs for the elderly? One flu jabe day in my previous surgery I gave 8 overdue B12 injections as well as flu jabs, several pneumonia boosters (or primaries), and did have a dozen medication reviews – and even reduced polypharmacy burden in 2 patients, but that must have been valueless. Oh dear.
I wonder how many pateints will be able to negotiate the MVC appointments system on the borderline of dementia and frailty too? Certainly many will opt out solely due to long travel distances and costs. They will miss out on the occasion and cameraderie of the day as well. More lonely depressed elderly without protection from flu coming up…….. but then, does government care if they die off sooner, relieving the tax burden?
I think you only need to look at COVID vaccine delivery to see who the experts in the country are in delivering mass vaccination. So to improve the system they are going to take the service of the experts, with allied continuity of care, and give it to some other service that currently only exists on the back of some one’s very old and tatty fag packet. What is there to go wrong? From a vaccination of the population this is heading for a massive public health disaster. I am confident it will in no way prove to be cheaper. Geography away from that London is certainly likely to be a barrier to vaccination. We are in Nottinghamshire ICB. We are in Nottingham but my patients rarely if ever go to Nottingham as all links between here and Nottingham be that road, rail or bus are diabolical. I can get to London quicker by train. When it goes wrong will they expect us to pick up the pieces after they have dismantled our well oiled service? This is a disaster coming down the line.
Hey guys , isn’t this all about increasing uptake where it is not so good?
Where GPs are getting good results the ICB will surely just contract from them as (the paper says) its more expensive doing other options but sometimes you need outreach clinics with hard to reach communities.
I think if you are getting good uptake rates no sensible commissioner is going to take that away from you
You may lose flu vaccine to central purchase though but margins on jabs getting less each year
Community pharmacy will compete for flu and covid but they can only do the easy ones !
Hopefully insane QOF targets with no exception coding may go and the ICB be penalised for low uptake not us
All the vaccine expertise in the country is with GP surgeries, covid showed that.
But if they think they can do it better, lets see them try.
But as already mentioned, remember OOH.
Am I missing something or is this another disinvestment away from GMS yet again?
more dis- integration of care ?
If children’s vaccine are to be done in primary care and adults like any where, like pharmacy . I thought this is how it is now. Obviously all practices will have financial interest to vaccinate children and adult. . Why all this?
They never learn from what went before. When I first went into practice mothers could take their children to community clinics run by community medical officers, or take their children to their GP. GP vaccination rates were far in excess of what the clinics achieved.
These proposals will result in fractured care with no one taking responsibility for vaccination. It will be a bureaucratic nightmare
Good. Less work. Less blame.